Right iliofemoral deep venous thrombosis associated with adenomyosis: A case report

Introduction: Adenomyosis is typically considered a benign gynecological disorder; however, accumulating evidence suggests an association with thromboembolic complications. This case report highlights the potential development of deep-vein thrombosis (DVT) in patients with adenomyosis, particularly when concurrent estrogen therapy is used, and emphasizes the diagnostic and therapeutic challenges posed by this scenario. Case Presentation: A 53-year-old woman with histologically proven adenomyosis and chronic menorrhagia presented with right lower-limb pain after prolonged travel. She had recently started estrogen-progestin therapy. On examination, oedema and tenderness were noted in the right calf and groin. Doppler ultrasound confirmed iliofemoral DVT; laboratory findings showed an elevated D-dimer (6.36 µg/mL) and markedly elevated CA-125 (2539.1 U/mL; normal < 35 U/mL). Rivaroxaban was initiated but precipitated heavy vaginal bleeding, necessitating hospital admission, blood transfusion, and temporary discontinuation of anticoagulation. An inferior vena cava (IVC) filter was placed, and she subsequently underwent total hysterectomy with bilateral salpingo-oophorectomy. Post-operative recovery was uneventful, and rivaroxaban was re-introduced. Conclusions: Adenomyosis is a benign uterine condition that predominantly affects middle-aged, multiparous women. Nevertheless, lower-limb DVT represents a serious complication, especially in patients with adenomyosis and menorrhagia receiving estrogen therapy. Management may require individualized anticoagulation strategies in conjunction with surgical intervention. A multidisciplinary approach is essential for accurate diagnosis, risk stratification, and effective management.