Adenomyosis with abnormal uterine bleeding complicated by venous thrombosis: a case series and literature review

Hong Zhang, Yaoying Chen, Y. Chen, Huixi Li
Annals of medicine and surgery (2012) · 2025 · vol. 88(1) , pp. 73–80 · doi:10.1097/ms9.0000000000004448 · PMID:41496988 · PMC12768039 · W4416951640
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Abstract

BACKGROUND: Adenomyosis is a benign disease characterized by the invasion of endometrial glands and stroma into the uterine myometrium, commonly presenting with abnormal uterine bleeding. METHODS: This paper retrospectively analyzes three cases of adenomyosis complicated by venous thromboembolism (VTE) in patients hospitalized at our hospital from 2023 to 2025, and discusses its high-risk factors and treatment strategies in combination with the literature review. Inclusion criteria: patients diagnosed with adenomyosis and having a history of menorrhagia complicated by venous thromboembolism. Exclusion criteria: VTE caused by other diseases; patients in menopause. RESULT: Case 1 involved a 47-year-old female who developed thrombosis in the right basilic vein after laparoscopic total hysterectomy. Case 2 was a 47-year-old female who experienced lower extremity venous thrombosis following treatment with gonadotropin-releasing hormone agonists (GnRH-a) combined with a levonorgestrel-releasing intrauterine system. Case 3 was a 49-year-old female who developed portal vein, splenic vein, and superior mesenteric vein thrombosis after long-term norethisterone therapy. Clinical experience indicates that GnRH-a combined with dienogest (DNG) can effectively control symptoms and preserve the uterus, but thrombotic risks require vigilance. Through case analysis and literature review, this article emphasizes the importance of individualized treatment plans. CONCLUSION: Patients with adenomyosis presenting with an enlarged uterus and menorrhagia are prone to developing VTE. When VTE occurs, total hysterectomy is often selected as the treatment. We attempted a combined regimen of GnRH-a, DNG, and anticoagulant therapy, which was effective in one case.

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