12th May 2024

A 36-year-old woman presents with a history of heavy and prolonged menstrual bleeding, pelvic pressure, and frequent urination.

A 36-year-old woman presents with a history of heavy and prolonged menstrual bleeding, pelvic pressure, and frequent urination. She reports that these symptoms have been gradually worsening over the past year. On pelvic examination, an enlarged, irregularly shaped uterus is palpated. Ultrasound imaging confirms the presence of multiple well-defined, solid masses within the uterine wall.

Which underlying mechanism is most likely responsible for her clinical presentation?