Question

A 42-year-old G4P4 presents with a history of progressively worsening severe menstrual pain. Menses are regular, but she complains of very heavy flow requiring both a menstrual pad and tampon with frequent bleeds through this protection on heavy days. She takes Oxycodone that her husband used for back pain to relieve her dysmenorrhea. She had a tubal ligation four years ago. Pelvic examination shows an enlarged, soft, boggy uterus. No masses are palpated. Pregnancy test is negative, hemoglobin 9.8 and hematocrit 28.3%. What is the most likely diagnosis?

A. Adenomyosis
B. Endometrial carcinoma
C. Endometriosis
D. Primary dysmenorrhea
E. Endometrial hyperplasia

Answer 1

The most likely diagnosis for the woman's symptoms is adenomyosis, a condition in which the endometrial tissue grows into the muscular wall of the uterus. Treatment options may include pain medication, hormonal therapy, or surgery.

Step-by-step explanation:

The most likely diagnosis for the 42-year-old woman with progressively worsening severe menstrual pain, heavy flow, and an enlarged, soft, boggy uterus is adenomyosis. Adenomyosis is a condition in which the endometrial tissue grows into the muscular wall of the uterus, causing pain and heavy bleeding. Other symptoms of adenomyosis may include blood clots during periods and prolonged periods.

Treatment options for adenomyosis may include pain medication, hormonal therapy, or surgery to remove or shrink the abnormal tissue.