The paper describes two women with a uterine condition called adenomyosis who kept having strokes that seemed linked to heavy menstrual bleeding. Treatments that lowered hormone levels (like GnRH agonists) or stopped bleeding temporarily helped, but the strokes kept coming back unless the uterus was removed.

Benign gynecological disorders causing abnormal uterine bleeding (AUB), such as adenomyosis, may trigger recurrent thrombosis similar to Trousseau syndrome. Trousseau syndrome is characterized by recurrent thrombotic events in patients with malignant tumors. We report 2 patients with adenomyosis who experienced recurrent cerebral infarction (CI) associated with AUB, exploring the mechanistic insights and highlighting a multidisciplinary approach to treatment. One patient suffered 2 episodes of AUB and CI, following repeated failure of conservative therapies. The other patient experienced 3 CI events on the second day of menstruation. Both patients were diagnosed with adenomyosis complicated by CI. The first patient underwent conservative treatments, including gonadotropin-releasing hormone agonist, uterine curettage, and levonorgestrel-releasing intrauterine system insertion. The second patient received uterine artery embolization to suppress menstruation, followed by continuous gonadotropin-releasing hormone agonist therapy. Both patients received neuroprotective therapy to stabilize neurological symptoms. Both patients experienced temporary relief of AUB and neurological symptoms after each episode with conservative treatment. As of now, Patient 1 has experienced multiple episodes of symptom recurrence despite conservative treatment failures and has declined hysterectomy, while Patient 2 has not had any further recurrence. This report highlights the multifactorial pathogenesis of adenomyosis complicated by CI, emphasizing the shared pathway of hypercoagulability, endothelial injury, thrombus formation, and embolic migration. A multidisciplinary, staged management approach is crucial, with acute-phase focus on reperfusion therapy and AUB control, followed by conservative treatments or hysterectomy for long-term management. Neuroprotection and the management of comorbidities are integral throughout. Hysterectomy remains the most effective strategy to prevent recurrence. The proposed framework provides evidence-based guidance for managing these complex cases, with implications for clinical practice and future research.