Adenomyosis — DRCOG MCQ
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Correct answer: C — Adenomyosis
The best answer is “Adenomyosis”. Heavy menstrual bleeding with secondary dysmenorrhoea and a bulky tender uterus is typical of adenomyosis. Fibroids may enlarge the uterus but are often irregular; transvaginal ultrasound is preferred when adenomyosis is suspected and can also assess alternative structural causes. Endometrial hyperplasia can cause heavy bleeding but does not typically produce a uniformly bulky tender uterus, while PID is more often associated with discharge and cervical excitation.
Reference: NICE NG88: Heavy menstrual bleeding: https://www.nice.org.uk/guidance/ng88/chapter/recommendations