Adenomyosis
Obstetrics & Gynecology
Illness script · Obstetrics & Gynecology
Adenomyosis
Ectopic endometrial glands/stroma within the myometrium, causing a diffusely enlarged, boggy, tender uterus.
This illness script for Adenomyosis covers predisposing factors, classic presentation, mechanism, workup, management, and the clinical pivots that separate it from look-alikes—written for USMLE Step 1 and clerkship reasoning.
01
Predisposing factors
- Multiparous women, typically age 40-50
- Prior uterine surgery (C-section, curettage)
- History of endometriosis or uterine fibroids
- Tamoxifen use, early menarche
- Often coexists with endometriosis/leiomyomas
02
Presentation
- Classic: heavy/prolonged menstrual bleeding (menorrhagia)
- Severe secondary dysmenorrhea
- Chronic pelvic pain, dyspareunia
- Exam: diffusely enlarged, symmetric, boggy, tender uterus
- Symptoms often improve after menopause
03
Pathophysiology
- Endometrial tissue invaginates into myometrium
- Ectopic glands respond to estrogen, causing hypertrophy/hyperplasia of surrounding muscle
- Cyclic bleeding within myometrium triggers inflammation and pain
- Results in globular, diffusely enlarged uterus
04
Diagnostics
- First-line: transvaginal ultrasound (heterogeneous myometrium, cysts)
- MRI most accurate: thickened junctional zone (>12 mm)
- Gold standard: histology after hysterectomy
- Pearl: clinical suspicion in multipara with boggy tender uterus + menorrhagia
05
Management
- Symptomatic: NSAIDs, hormonal therapy (OCPs, progestins)
- Levonorgestrel IUD very effective for bleeding/pain
- GnRH agonists for temporary suppression
- Definitive: hysterectomy (only cure)
- Uterine artery embolization as fertility-sparing option
06
Clinical pivots
How to separate this script from the look-alikes that show up on exams and on the wards.
Uterine leiomyoma (fibroids)
Fibroids cause an asymmetric, firm, nodular uterus; adenomyosis is symmetric, soft, and tender.
Endometriosis
Endometriosis is ectopic tissue OUTSIDE the uterus with normal-sized uterus and adnexal findings.
Endometrial carcinoma
Postmenopausal bleeding with thickened endometrial stripe on biopsy, not a boggy premenopausal uterus.
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Educational use only. This illness script is a study framework, not medical advice. Confirm decisions with current guidelines and your clinical supervisors.