Presentation
Pelvic pain. History of oral contraceptive pills use. Ultrasound revealed diffusely enlarged uterus and suspected adenomyosis. MRI is needed for better characterization.
Patient Data
Diffusely-enlarged uterus showing swollen globular myometrium with high signal intensity and thinned atrophic endometrium. Preserved zonal anatomy excludes neoplastic lesion and narrow junctional zone excludes adenomyosis.
Prominent follicles in both ovaries.
Case Discussion
Estrogen-progesterone combination (oral contraceptive pill) administration can result in uterine changes in the form of swollen and globular myometrium with high signal intensity and atrophic endometrium. Those changes are more pronounced in women taking higher concentrations of hormones.
Differential diagnosis of an enlarged uterus
Uterine enlargement can occur in a number of situations.These include:
- gestation-related events
- normal intrauterine pregnancy
- molar pregnancy - gestational trophoblastic disease
- postpartum uterus - still larger than usual
- hormonal causes
- exogenous hormones
- estrogen-progesterone combination (oral contraceptive pills)
- tamoxifen
- endogenous hormones secondary to hormone-secreting tumors
- exogenous hormones
- adenomyosis : common cause
- myometrial tumourous lesions
- benign
-
uterine leiomyomas : common cause
- multiple leiomyomata
- uterine leiomyomatosis
-
uterine leiomyomas : common cause
- malignant
- benign
- vascular causes
Special thanks to Professor Soha Talaat and Dr. Mohamed Talaat ali, Kasr Al Ainy school of medicine, Egypt.