A 45-year-old multipara presents with dysmenorrhoea and menorrhagia. Uterus is symmetrically enlarged upto 14 weeks. What is the probable diagnosis? (E. REPEAT 2008)

Ref: Shaw's Textbook of Gynaecology, 15th edition. Page 474 Explanation: ADENOMYOSIS * Common in women above 40 years. * Often co-exists with fibroid, endometriosis and endometrial cancer. * Uterus is symmetrically enlarged to not more than 14 weeks size. * Histology - Islands of endometrial glands surrounded by stroma seen in the myometrial tissue beyond the endomyometrial junction. * The distance between basal endometrium and the endometrial gland should be > 2.5 mm. * Common complaint--Menorrhagia and Progressive dysmenorrhoea. * Clinical examination reveals symmetrical enlargement of the uterus and tender uterus. * Treatment is localized excision, hysterectomy. * Medical treatment includes Danazol. GnRH, Mirena IUCD.