Salient Features:

26 yo

Nulligravid

Severe dysmenorrhea

TVS posterior uterine wall mass 4.7cm x 3.7cm x 3.5cm

OCP (Lizelle for 6 mos) 24 active pink tablets and 4 white placebo tablets

GnRH Agonist for 6 mos IM gluteal

Dieonigest (Visanne) 2mg tablet OD 28 tablets

Non smoker non alcoholic drinker

Smooth vaginal walls, cervix pink and smooth

Minimal amount of malodorous white cervicovaginal discharge

Closed cervix, retroverted uterus, corpus enlarged to 12 weeks size

No adnexal mass or tenderness

1. Endometriosis

Rule In Rule Out

Pelvic Pain
Infertility – due to use of oral contraceptives
Dysmenorrhea
Retroverted uterus findings on pelvic exam
History of use of GnRH agonist for 6 months
Weight gain

2. Uterine Leiomyoma

Rule In Rule Out

Early Menarche
Obesity
High fat diet
Enlarged corpus at 12 weeks
Non-smoker, which increases the incidence of
myoma
Pelvic pain
History of medications of GnRH agonist, and
OCPs
 3. Adenomyosis

Rule In Rule Out

Involvement of the posterior uterine wall Presents in women between ages 35 and 50
Dysmenorrhea
History of medication consisting of GnRH agonists
and OCPs.

4. Leiomyosarcoma

Rule In Rule Out

Obesity Prior history of leiomyoma
Use of oral contraceptives
Pelvic mass

References:

Lobo and Lentz. Comprehensive Gynecology 3rd Edition.