The majority of women are asymptomatic. The most common symptoms are
secondary dysmenorrhea and menorrhagia.
Examination reveals a uterus that is globular and diffusely up to 2–3 times the
normal size. Tenderness is most common immediately before and during
menses.
U/S study or MRI imaging shows a diffusely symmetrically enlarged uterus with
cystic areas found within the myometrial wall.
Management. Medical treatment includes the levonorgestrel (LNG) intrauterine
system (IUS), which may decrease heavy menstrual bleeding. Surgery in the
form of hysterectomy is the definitive treatment.