Illness script
Adenomyosis
Multiparous woman in her 40s with heavy, painful periods and a diffusely enlarged, boggy, tender uterus.
This illness script for Adenomyosis covers the classic presentation, who it affects, how you work it up, the mechanism, and first-line treatment—written for USMLE Step 1 and clerkship clinical reasoning.
Updated Jul 18, 2026All scripts
01
Who it affects
- Reproductive-age women, classically 40s-50s
- Multiparous women
- History of prior uterine surgery/C-section
- Often coexists with fibroids or endometriosis
- Rare in nulliparous/postmenopausal
02
Diagnostics & workup
- Menorrhagia and dysmenorrhea (secondary, worsening)
- Exam: symmetrically enlarged, globular, boggy, tender uterus
- Transvaginal ultrasound: heterogeneous myometrium, subendometrial cysts
- MRI: thickened junctional zone (>12 mm) — best imaging
- Gold standard: histology after hysterectomy
03
Pathophysiology
- Endometrial glands/stroma invade the myometrium
- Ectopic tissue causes myometrial hypertrophy and hyperplasia
- Diffuse involvement gives globular uterine enlargement
- Estrogen-dependent; regresses after menopause
- Distorted myometrium causes bleeding and pain
04
Treatment
- NSAIDs and tranexamic acid for symptom relief
- Levonorgestrel IUD — first-line hormonal option
- OCPs, progestins, or GnRH agonists
- Uterine artery embolization for uterus preservation
- Hysterectomy — definitive cure
Keep reading
Full library- Abnormal Uterine Bleeding (AUB)Reproductive-age woman with heavy, prolonged, or irregular menstrual bleeding outside normal patterns.
- Bacterial VaginosisReproductive-age woman with thin, gray, malodorous ('fishy') vaginal discharge and no significant inflammation.
Educational use only. This illness script is a study framework, not medical advice. Confirm decisions with current guidelines and your clinical supervisors.