A 38-year-old female presents with a two-year history of heavy menstrual bleeding and dysmenorrhea. Examination reveals obesity, mild pallor, and an enlarged uterus with thickened endometrium suggestive of adenomyosis. The patient has no significant comorbidities or relevant family history.

1. Rashmi
Jr-3,
Department of obstetrics and gynaecology
IMS BHU
Prof Uma Pandey
Professor
Department of obstetrics and gynaecology
Case Presentation.

2. Patient particulars
Case details.
• Mrs. XYZ
• 38 years Female
• Home maker
• Hindu
• Date of admission = 27’th July 2024

3. • Residence =Gazipur
• Education of husband = Intermediate (5)
• Monthly income = 10,000₹ (3)
• Work profile of husband = Semi skilled worker (3)
• Environmental sanitation and portable water = Good
• According to modified Kuppuswamy scale = Class II Lower middle
Socioeconomic history

4. Chief complaints
History
• Heavy menstrual bleeding since 2 years

5. History of present illness
• Patient was apparently normal 2 years back after which she developed heavy menstrual
bleeding, her cycles regular every - 28-30 days , bleeding for 8-9 days,with passage of
clots
• She changes 5-6 fully soaked pads per days , history of night time change of pads,history
of difficulty to attend work during 1 or 2 days of cycles
• She also developed pain during first 2 days of menstruation which is relieved on
medication

6. • No h/o intermenstrual bleeding, post coital bleeding
• No h/o abdominal distension
• No h/o vaginal discharge,fever
• No h/o burning micturition, increased urinary frequency,retention,or involuntary passage of urine
• No h/ o constipation
• No history of sudden weight loss and loss of appetite
• No h/ o of any hormonal pills and other medications
• No h/o hot / cold intolerance, nipple discharge
• No h/ o fatigue,breathlessness, palpitations,leg swelling

7. Menstrual history
• Age of menarche- 13 years
• LMP- 15/07/2024
• Duration of menstruation- 8-9 days
• Interval - 28-30 days
• Regular cycle
• Dysmenorrhea present
• Amount of bleeding- 5-6 pads / day fully soaked
• Clots-present

8. Obstetric history
• P4L4
• All were normal vaginal deliveries
• There weren’t any antepartum, intrapartum or postpartum complications

9. Past history
• Medical history- no h/ o any medications
• No h/ o thyroid disorders, diabetes mellitus , hypertension,tuberculosis,bleeding
disorders
• Surgical history- open ligation 10 years

10. Personal history
• Married for 20 years in a non consanguineous marriage
• Bladder bowel functions were normal
• Dietary intake of the patient was adequate
• She had adequate and regular sleep cycle
• No history of addiction
• No history of allergies

11. Family history
• No h/ o similar complaints in family
• No h/ o any gynaecological,breast, or colon cancers in family
• No h/o bleeding in the family

12. Sexual history
• No h/ o dyspareunia
• No complain of loss of libido
• 1-2 coitus per week

13. General
Physical examination
• Patient was alert, conscious, well oriented to time, place and person
• There was generalised pallor
• There was no icterus, clubbing or edema
• There was no lymphadenopathy
• Body mass index = 30 kg/ m2

14. Vitals
• Afebrile
• Pulse rate = 82 beats per minute
• Blood pressure = 130/78 mm of Hg
• SpO2 99% on room air
• Respiratory rate = 16 breaths per
minute

15. Systemic examination
• Central nervous system = higher mental functions were normal
• Cardiovascular system = S1 and S2 were auscultated, no added sounds were present
• Respiratory system = bilateral air entry present with normal vesicular breathe sounds, no
added sounds present
• Bilateral breasts were soft, non tender

16. Inspection
Abdominal examination
• Abdomen was uniformly obese
• Skin over the abdomen looked grossly normal
• Umbilicus was centrally placed, inverted
• There were horizontal scars, no rashes, no dilated veins

17. Palpation
Abdominal examination
• No significant findings noted

18. Percussion
Abdominal examination
• Dull note was felt in the central part of abdomen and resonant note in the flanks.

19. Per speculum examination
• External genitalia appeared normal
• Vaginal walls looked healthy
• Cervix bulky and erosions present
• No local lesions present

20. Per vaginal examination
Uterus- 8-12 weeks
B/l fornices free
Non tender

21. 38 years, Female, married for 20 years, P4 L4 ,class 1 obese with
AUB
Provisional diagnosis

22. Summary
• 38 years old Parous female with all SVD , presented with complaints of heavy menstrual
bleeding for past 2 years and spasmodic dysmenorrhea . She has regular cycles with no
known co-morbidities,no positive family history
• On examination she is obese BMI 30kg/m2 ,mild pallor, no mass palpable , uterus 8-10
weeks
• Her he is 7 gm , sonography of pelvis shows enlarged uterus with thickened
endometrium with adenomyosis

23. Thankyou