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What is your Diagnosis of this Female Patient with Polymenorrhea?

What is your Diagnosis of this Female Patient with Polymenorrhea?

In this case we will discuss a 27 year old female patient with a history of polymenorrhea. She has been treated with medication.

History and Symptoms: This young woman came in for a routine ultrasound examination after 6 months of medication with an estrogen agonist after prolonged polymenorrhea. She had normal menstrual cycles before this episode and did not have any history of major illness. She had a history of lower segment caesarean section (LSCS) during the first pregnancy.

Family History: She has 1 healthy child, who was delivered at full term by LSCS. This mother (the patient) was one of 2 children.

Present History: The patient had prolonged and sometimes painful menses for which she underwent medical treatment. She had a history of occasional bleeding per vagina (P/V). The medication was stopped a few days before the ultrasound study.

Clinical Examination: Her blood pressure was normal (BP: 116/ 80 mm. of Hg); her other vital signs were also normal. On abdominal examination, she had no tenderness or palpable lesions in the pelvis.

Imaging Studies: This patient underwent routine transabdominal and transvaginal ultrasound imaging to study the pelvic organs.

Image 1: Sagittal section of uterus (transabdominal image)

sagittal section uterus

Image 2: Transvaginal sonographic image of the left ovary

transvaginal ultrasound ovary

The transabdominal image of the uterus in sagittal section shows a remarkable finding, but let's look at the myometrium first. It shows normal echogenicity and echotexture. The cervix appears grossly normal.  The thickness of the endometrium measures 18 mm. Is this normal?

The transvaginal image of the left ovary shows a simple cyst of 3.6 cms. Is this related to the findings of the uterus?

Let's look at an additional image.

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