Venous Thromboembolism in a Woman with Diffuse Adenomyosis and Heavy Menstrual Bleeding: Case Report

This is a case of 41-year-old Filipina, nulligravid with no known comorbidities, admitted due to 1 month history of easy fatigability. Work up revealed acute pulmonary embolism with underlying Protein C deficiency and with concomitant diffuse adenomyosis presenting as abnormal uterine bleeding. The patient was treated with anticoagulation therapy for pulmonary embolism and with GnRH analog for adenomyosis. She was discharged stable and was advised close follow up for monitoring. Pulmonary embolism with concomitant diffuse adenomyosis is uncommon. Few case reports have described the interesting combination of adenomyosis and venous thromboembolism which poses a challenging management dilemma. In this patient with underlying protein C deficiency who presented with pulmonary embolism and deep vein thrombosis, the appropriate management is the use of anticoagulation. However, considering that the patient was also diagnosed of diffuse adenomyosis and concomitant abnormal uterine bleeding, anticoagulation may worsen the patient’s bleeding and anemia. Treatment of adenomyosis using combined oral contraceptive pills would aggravate thromboembolism and vice versa. This patient was managed successfully using a multidisciplinary approach with anticoagulation and GnRH analog injection with no adverse event noted. In conclusion, occurrence of venous thromboembolism in patients with adenomyosis is uncommon, however can be managed successfully with a multidisciplinary approach and careful planning. Management of these patients present with great challenges and requires timely intervention, including meticulous follow-up strategies after pulmonary embolism to prevent recurrence and untoward side effects of treatment regimen.