Abstract
Cystic adenomyosis, a rare variant of adenomyosis, poses diagnostic challenges due to its resemblance to other uterine pathologies. We present the case of a 37-year-old multiparous woman with a history of cesarean sections, who presented with heavy menstrual bleeding and progressive pelvic pain. Despite initial medical management, symptoms persisted, prompting further investigation. Ultrasonography initially suggested fibroid degeneration or a neoplastic change, later confirmed by magnetic resonance imaging which showed degenerative changes in fibroid. However, worsening symptoms and failed medical management led to surgical intervention. The patient underwent a total abdominal hysterectomy, revealing cystic spaces filled with altered blood within the myometrium. Histopathological analysis postsurgery confirmed the diagnosis of cystic adenomyosis. This case highlights the diagnostic challenges and therapeutic considerations in managing cystic adenomyosis in multiparous women.