Pain lower abdomen

A 40 year old female homemaker by profession and a BMI of 25 Chief Complaints She has been complaining of pain abdomen and it occurs severe at the time of menstruation and it will remain continue Only pain killer meftal spas or calpol t is given by gynecologist Investigations In Blood tests, only thyroid function test has been done in the last and it's normal Kindly find attached two USG reports attached, the recent one is of Novemeber 2020 Diagnosis In my opinion, she is probably quite overconcerned seeing her reports, which is leading to her symptoms. Management Kindly give ur valuable opinion on this case, along with apprppriate line of management?

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USG findings, 1.Adenomyosis - do not require any treatment- but a diagnostic curretage should be done to rule out any early malignancy Just give symptomatic treatment for pain relief .Addition of certain herbal preparations like liq Menohelp or Amycordial may help 2.For cholesterosis of Gall bladder- no treatment is required- a follow up scan every 6 months should be done and any of the G.B - polyp increases to more than 1 cms - cholecystectomy is indicated 3.She should take plenty of water as there is history of renal concretions and avoid food rich in oxalates and phytates

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Contradictory usg reports She is a c/o Dysmenorrhea But confusion about heterogeneity of myometrium which points to adenomiosis which is serious proposition should be r/o by biopsy and ct abdomen and pelvis D&c should also be considered

Thanx dr Kute Ankush
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Surgeon's opinion for cholesterosis. Adenomyosis is known to cause dysmenorrhea. Meftal spas is enough if pain is getting controlled with it. But if pain is present throughout the cycle and is not getting relieved then progesterones for 3 months can be considered. But before that a thorough clinical examination is required. Do per speculum and per vaginal examination and rule out local infections. Take pap smear. Ask her to lose some weight and maintain healthy diet and perform exercise.

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Adenomyosis of uterus Opinion of gynaec Harmonal or hysterectomy is solution Nebolith gland in cervix

Obviously Total Abdominal hysterectomy is indicated in such cases .

Thanks Dr. Ajeet Singh, Dr.Shivraj Agrawal
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? UTERINE PATHOLOGY.. ? UTERINE ADENOMYOSIS.. NEED'S.. GYNECOLOGIST OPINION FOR FURTHER MANAGEMENT..

Dysmenorrhea With these symptoms and reports, to be treated with analgesics, dietary and lifestyle modifications plus reassurance. If not responded go for contrast CT. Renal concretions also to be attented

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Adenomyosis- Treat medically. If not responding to medical therapy, Hysterectomy. Regarding cholesterosis, Surgeon's opinion to be taken.

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At present nothing needs to be done... cholesterosis-wait and watch..repeat usg after 3 months.. For adenomyosis medical treatment should be given if not resolved go for hysterectomy

I am agree with@Dr. Parveen Yograj Sir, And@Dr. Shivraj Agarwal Sir.

Thanx dr
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