Brief Answer: SURGICAL MANAGEMENT IS BEST CHOICE. Detailed Answer: Hello Thanks for writing to us with your health concern. I have gone through your MRI report. You have basically three issues - 1. Adenomyosis - this implies thickening of the muscular wall of the uterus 2. Endometrial polyp - this is a thickening of the inner endometrial mucosa of the lining of the uterus leading to formation of a polyp 3. Thickening of the pelvic lymph nodes. Firstly, for such a combination, medical therapy is not likely to work. You would be suffering from severe bleeding during cycles, as well as pain in abdomen. For a patient with such findings on MRI, who comes to me, I would advice surgical management of the issues. This is because the endometrial polyp certainly requires removal, its size is too big, to respond to medical therapy. The adenomyosis also has not responded since the past one year or more to Primolut N. THe lymph nodes are also suspicious and raise the risk of having a malignant condition. Hence, for you, I would advice a total hysterectomy with bilateral salpingo - oophrectomy with pelvic lymph node sampling and pelvic lymphadenectomy. This means - surgical removal of the uterus, cervix, vaginal cuff, both tubes and both ovaries, and removal of the enlarged nodes, and sampling of the ones that cannot be removed. This tissue should be sent for biopsy to rule out any malignant changes. In trained hands, this surgery can be performed laparoscopically. I would ask you to strongly consider this option for long term cure and relief, and discuss it with your gynaecologist. All the best. Please feel free to discuss further. Take care.

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