Clinical Evidence of Adenomyosis

Adenomyosis is characterized by uterine enlargement caused by ectopic rests of endometrium located deep within the myometrium. It has 2 types.

• Diffuse –ectopic rests scattered throughout the myometrium
• Focal – ectopic rests form circumscribed nodular focal collection with a pseudo capsule

Pathogenesis:

• Downward invagination of endometrial basalis layer deeply into myometrium due to myometrial weakness caused by decreased immunological activity at the endometrial – myometrial interface. –Frenczy & Levgur 2000
• Oestrogen – progesterone play role in development & maintenance of the condition. As evidenced in adenomyosis – develops during reproductive age & regresses after menopause.

Case – Mrs. J, aged 50yrs

Presenting Complaints:

Menses profuse, clotted since 2 years but regular 4/30 day cycle. But for the past 6 months – bleeding dark with large clots, painful and protracted flow for 8 days.

Pain lower abdomen, cramping, before & during menses

Pain left breast, drawing, <before menses since 6 months, > after menses.

Family History

• Father- Diabetes with Hypertension & died of uremia 15 years back.
• Mother- Alive, diabetic, and hysterectomy done for fibroid uterus
• Sisters – 2- healthy ; Brother – 1- Diabetic

Past History

• Measles at age of 6 years.
• 2 normal deliveries PS done.
• No H/O of abortion or contraceptive use.

Physical General

• Appetite – normal.
• Thirst, Stool, Urine – Normal.
• Sleep – refreshing.
• Desires – salt++, fanta++, sour food
• Aversion – milk++
• Perspiration – profuse on least exertion

Mental General

• She cannot tolerate contradiction. She gets angry when contradicted.
• She suppresses her anger by keeping quiet and rarely lets out by shouting.
• Broods over the problems and doesn’t share.Desire for company.
• Suppressed sexual feelings. – husband is working in foreign country and visited her once in 3 years.

Evaluation of symptoms

Mental – Company desire for

Contradiction intolerant of

Suppressed sexual feeling

Brooding

Physical – Desire sour drinks, food, salt

– Aversion milk

– Menses protracted, dark, clotted, painful

– Perspiration profuse on least exertion

Particulars – Pain lt mammae, drawing,

<menses before

> after menses

– Uterus induration

1	1234	1	MIND – BROODING	80
2	1234	1	MIND – COMPANY – desire for	190
3	1234	1	MIND – CONTRADICTION – intolerant of contradiction	129
4	1234	1	FEMALE GENITALIA/SEX – INDURATION – Uterus	41
5	1234	1	FEMALE GENITALIA/SEX – MENSES – clotted – dark clots	45
6	1234	1	FEMALE GENITALIA/SEX – MENSES – protracted	166
7	1234	1	FEMALE GENITALIA/SEX – SEXUAL DESIRE – suppressed	13
8	1234	1	CHEST – PAIN – Mammae – menses – before – agg.	68
9	1234	1	PERSPIRATION – EXERTION – agg. – slight exertion	151
10	1234	1	GENERALS – FOOD and DRINKS – milk – aversion	130
11	1234	1	GENERALS – FOOD and DRINKS – salt – desire	160
12	1234	1	GENERALS – FOOD and DRINKS – sour drinks – desire	45
13	1234	1	GENERALS – FOOD and DRINKS – sour food, acids – desire	185

 

	con.	sep.	bell.	phos.	calc.	nat-m.	puls.	ign.	chin.	sulph.
	12/22	11/20	11/14	9/23	9/20	9/20	9/19	9/17	9/15	9/15
1	1	1	1	–	1	1	–	3	–	1
2	2	2	1	4	2	1	2	2	–	1
3	1	4	1	1	–	2	1	3	1	1
4	2	1	2	–	–	–	–	–	2	–
5	–	–	3	–	–	–	2	1	2	–
6	2	2	1	2	3	3	3	2	2	2
7	3	–	–	3	–	–	–	–	–	–
8	4	1	1	2	4	3	2	1	1	–
9	1	3	1	3	3	2	3	1	3	3
10	1	2	1	2	2	2	2	2	1	2
11	2	1	–	4	2	4	–	–	2	1
12	1	1	1	–	1	–	2	–	–	2
13	2	2	1	2	2	2	2	2	1	2

Follow up

• 28/06/08 – LMP – 16/06/08.

Rx. Conium 0/1 –BD for 1 month

• 24/07/08 – LMP – 12/07/08. Bleeding reduced on 2^nd day. No pain in breast before and during menses.

Rx. Conium 0/1- BD for 1 month

• 09/09/08 – Menses on 8/8/08, 5/09/08. Flow reduced to 5 days. No pain in breast.

Rx. Conium 0/1 – OD for 1 month.

15/10/08 – Feeling better. Menses on 5/10/08. Normal flow for 5 days. No other c/o. USG reveals normal study. Rx. SL for 1 month.

(See ultrasound tests below)