Approach to dysmenorrhea Quiz: Ace Your Exams
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A 34-year-old woman, gravida 1, para 1, presents for evaluation of painful menstruation that has progressively worsened over the past 2 years. Her periods are regular with heavy flow. The pain typically begins with the onset of menstruation and lasts 3 to 4 days, although she occasionally experiences similar pain when she is not bleeding. Review of systems is notable for frequent constipation, increased urinary urgency, and occasional deep dyspareunia. She is otherwise healthy and has a history of one spontaneous preterm vaginal birth. The patient’s mother had a hysterectomy in her 40s due to heavy menstrual bleeding and pelvic pain. Vital signs are within normal limits. Abdominal palpation is significant for mild tenderness and an irregular pelvic mass extending from the suprapubic region to the left lower quadrant. The pelvic exam shows a typical parous cervix and normal physiologic discharge. The uterus is mobile, grossly enlarged, mildly tender to palpation, and has a bulky, irregular contour. The adnexa are not confidently palpated. Urine pregnancy test is negative. Which of the following will most likely be seen on pelvic ultrasound?
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