Mrs Fatima had been told twice by other clinics that she had no fibroids. But her periods were getting worse every year — flooding, incapacitating, and destroying two days of every month. Mascot Healthcare's pelvic ultrasound found adenomyosis — a condition the previous scans had missed. Treatment was started and her periods transformed.
Housewife, Surulere. Presented with 3-year history of heavy, severely painful periods — passing large clots, soaking 10+ pads per day on Days 1–2, with incapacitating cramps requiring bed rest. Pain beginning 3 days before period and persisting for 5 days. Haemoglobin 9.8 g/dL. Two fibroid scans at other facilities: fibroids not identified. Referral for specialist pelvic ultrasound.
Pelvic Ultrasound (Adenomyosis)Mrs Fatima had been told twice that her scan was "normal — no fibroids." Each time, she had left the scan clinic with a report that said nothing to explain her flooding, painful periods. She had been given mefenamic acid and iron tablets at each visit. Each year, the periods worsened.
She came to Mascot Healthcare specifically asking for a scan that looked beyond fibroids. "I know my scan keeps coming back negative," she said, "but something is wrong. My mother had the same problem and eventually had a hysterectomy. I want to know what is happening to my uterus."
The Mascot Healthcare sonographer performed the pelvic scan systematically — assessing not just for discrete fibroid masses but specifically evaluating the myometrial echo-texture: the appearance and consistency of the uterine muscle itself. The image showed a heterogeneous, asymmetric uterine wall — thicker posteriorly, with fan-shaped shadowing and bright myometrial cysts within the muscle. "This is adenomyosis," the doctor said. "The previous scans looked for fibroids. This is different."
Adenomyosis — the presence of endometrial tissue within the uterine muscle (myometrium) — causes heavy, painful periods and an enlarged, tender uterus. It is frequently missed on ultrasound when the sonographer is only looking for fibroids. A systematic pelvic scan with attention to the myometrial echo-texture is required to detect it.
Flooding periods — saturating ultra-thick pads within 1–2 hours on the heaviest days. Clinically severe menorrhagia.
Cramps so severe that Mrs Fatima spent Days 1–2 in bed with a hot water bottle — unable to care for her children or perform household tasks.
Pre-menstrual pelvic pain — a characteristic feature of adenomyosis, where the ectopic endometrial tissue responds to hormonal changes before the period begins.
Iron-deficiency anaemia from 3 years of monthly heavy blood loss — causing fatigue, palpitations, and breathlessness on climbing stairs.
Two pelvic scans at other facilities reported no fibroids — but adenomyosis was not specifically assessed or reported.
Mrs Fatima's greatest frustration — more than the pain itself — was being repeatedly told that her scan was normal. "If the scan is normal, why are my periods getting worse every year?" she had asked. The answer she received was always the same: "Some women just have heavy periods."
The Mascot Healthcare doctor validated her experience directly: "Your symptoms are not normal. Heavy, incapacitating periods that are worsening over years are not something to be accepted. The fact that previous scans did not identify fibroids does not mean your uterus is normal — it means a different condition was present that was not assessed for."
Uterus: enlarged — 11.2 × 7.8 × 6.4 cm (normal: 8 × 5 × 4 cm). Myometrium: heterogeneous echo-texture with asymmetric posterior wall thickening (posterior wall 2.8 cm vs anterior wall 1.4 cm). Multiple myometrial cysts (1–4 mm) scattered throughout the posterior myometrium — pathognomonic of adenomyosis. Fan-shaped shadowing from the posterior wall. No discrete fibroid masses identified.
Endometrium: 12 mm (Day 5 of cycle — thick for early cycle, suggesting endometrial involvement). Junctional zone: irregular and indistinct. Cervix and ovaries: normal bilaterally.
Conclusion: diffuse adenomyosis — posterior predominant, with myometrial cysts and asymmetric thickening. Management options counselled: hormonal suppression (a hormonal IUD — first-line for adenomyosis); hormone-suppressing medication (temporary suppression pending definitive treatment); surgical options for severe/refractory disease (endometrial ablation or hysterectomy if family complete).
Diffuse adenomyosis — enlarged heterogeneous uterus (11.2 cm), posterior myometrial thickening, multiple myometrial cysts. No fibroids. Ovaries normal.
A hormonal IUD — primary treatment for adenomyosis (reduces endometrial shedding and pain); iron supplementation; a painkiller for breakthrough pain; gynaecology referral for specialist management.
At 3 months post-IUD: periods lighter, less painful. At 6 months: periods significantly reduced (spotting only); pain from 8/10 to 2/10; haemoglobin 11.4 g/dL (rising). At 12 months: haemoglobin 12.9 g/dL; quality of life dramatically improved.
Mrs Fatima's periods became manageable within 6 months of IUD insertion. Haemoglobin normalised at 12 months. She describes the adenomyosis diagnosis as "the answer I spent 3 years looking for."
Adenomyosis is a common cause of heavy, painful periods that is frequently missed when scans look only for fibroids. A scan reported as "no fibroids" is not the same as a normal uterus — it requires specific assessment of the myometrium by an experienced sonographer.
Heavy, worsening, incapacitating periods are not inevitable or untreatable. Adenomyosis has effective treatments — particularly the hormonal IUD — that dramatically reduce symptoms without surgery. Early diagnosis enables early treatment.
A scan that says "no fibroids" does not rule out adenomyosis. If your periods are flooding and incapacitating, ask specifically for a scan that assesses the uterine muscle — not just the surface.
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