Snapshot A 43-year-old woman who is Gravida 3, Para 2 and Aborta 1, presents with increasing, worsening pain with menses, along with progressively heavier menstrual bleeding. Pelvic examination reveals a diffusely enlarged, tender, and boggy uterus. Serum β-hCG is negative. Transvaginal sonogram showed an enlarged uterus with a thickened posterior myometrium (arrows). Summary Invasion of endometrial glands into uterine myometrium EPIDEMIOLOGY women ages 35-50 Etiology Pathogenesis login to view 1 more bullet Associated conditions login to view 3 more bullets Presentation Symptoms login to view 3 more bullets Physical exam login to view 7 more bullets Imaging Sonogram login to view 1 more bullet MRI (T2-weighted) login to view 3 more bullets Studies Initial test to order in patient with enlarged uterus login to view 1 more bullet Differential Diagnosis Leiomyoma Pregnancy Endometrial polyp Diagnosis Diagnosis is based on clinical history and exam Definitive diagnosis login to view 1 more bullet Treatment Symptomatic treatment for dysmenorrhea login to view 2 more bullets When fertility is no longer needed or failure of medical therapy login to view 1 more bullet Complications Controversial evidence linking adenomyosis with infertility