Case Report of Uterine Myoma in A Perimenopausal Woman with Anemia Managed by Hysterectomy

Abstract

Abnormal uterine bleeding (AUB) and pelvic pain in perimenopausal women are frequently driven by overlapping multiorgan etiologies, requiring appropriate definitive management. This case report evaluates a 46-year-old perimenopausal woman (completed family) who presented with recurrent menorrhagia (lasting 8–12 days), severe dysmenorrhea, lower abdominal fullness, and increased urinary frequency over the past six months. Physical and laboratory examinations confirmed a pelvic mass and moderate microcytic hypochromic anemia (Hb 8.3 g/dL, MCV 78 fL, MCH 25 pg), while ultrasonography revealed uterine enlargement (). The patient underwent preoperative anemia correction via Packed Red Blood Cell (PRC) transfusion to achieve Hb , followed by Total Abdominal Hysterectomy (TAH) with bilateral opportunistic salpingectomy and ovarian preservation. Histopathological examination confirmed a combination of uterine leiomyoma, adenomyosis, non-atypical endometrial hyperplasia, and Nabothian cysts. Synergism among FIGO classifications (AUB-L, AUB-A, and AUB-M) exacerbated clinical manifestations; adenomyosis disrupted junctional zone integrity and triggered local inflammation, which combined with uterine cavity expansion from leiomyoma and tissue friability from endometrial hyperplasia, resulting in persistent heavy bleeding. Hysterectomy with opportunistic salpingectomy aligns with ACOG and NICE guidelines to permanently eliminate bleeding and reduce future ovarian carcinoma risk without inducing surgical menopause. Management of AUB in perimenopausal women must account for multifactorial etiologies, where hysterectomy remains an effective and safe definitive therapy to eliminate symptoms and improve quality of life.