Common GYN Conditions Flashcards
CPPD
Cyclic Premenstrual Pain and Discomforts - Cluster of physical and psychological sxs
- PMDD/PMS - Pre Menstrual, psychologic sxs (luteal phase)
- Dysmenorrhea-Pain during menses
Hallmark Sx of PMDD/PMS
- Depression
- Irritability
- Anxiety/Tension
- Labile Moods
- Tx with SSRI in Luteal Phase if not an exacerbation of current problem and interfere with ADLs
PMS/PMDD Tx mild, moderate, severe
- Mild: Exercise, relaxation, B6, E, Calcium, Mg
- Moderate to severe: SSRI (Zoloft, Paxil, Celexa, Prozac) daily or luteal phase. OCPs containing Drosperione (Yaz)
- Severe/Unresponsive: GnRh Agonist (Lupron), Surgery (oophorectomy/hysterectomy)
Primary Dysmenorrhea Pathophysiology
Increased prostaglandins in secretory endometrium –> increased uterine contraction and reduced blood flow –> pain
Dysmenorrhea tx
- Prostaglandin Inhibition: NSAIDs (Ibuprofen 400-800 q4-6)
- Endometrial Suppression - HC, Depo, Mirena
- Other: Analgesics, Calcium/Mg/E, Vitamin B1 (100mg qday), Acupuncture
First line for Dysmenorrhea?
Prostaglandin Inhibition: NSAIDs (Ibuprofen 400-800 q4-6)
Endometriosis - define
Presence of endometrial glands and stroma outside the uterus
Endometriosis - Etiologies
Genetic predisposition, retrograde menstruation, Direct transplant of endometrial tissues
- Common sites: Ovaries, anterior and posterior fornix, bowel, bladder
- Pain caused by higher concentration of nerves in endometrial implants
Endometriosis Prevalence
-10%
-60-80% w/ infertility or chronic pelvic pain
Most common reason for dysmenorrhea and menorrhagia in younger patient
Endometriosis Clinical Presentation
- AUB (Menorrhagia, intermenstrual bleeding)
- Asymptomatic to severe (aka cyclic or chronic) abdominopelvic pain, dysmenorrhea
- Pain on deep sex (worse during menses)
- Menstrual/sacral backache
- Cyclic bowel/bladder sx
- Infertility
- Degree of implants do not correlate with degree of sx
Endometriosis PE
- FHx, Hx of infertility?
- Best during menses when pain/discomfort happening
- Pain during palpitation of posterior fornix
- Tenderness if implants in uterosacral ligaments
- Fixed retroverted uterus from posterior fornix implants
- TVUS useful
- Laparoscopy w/biopsy
Appearance of Endometriosis?
“Chocolate cysts”
Endometriosis first line management
- COCs: Continuous
- Progesterone: 20-100 mg po qd (Depo, Mirena)
- NSAIDs
- Danazol - Creates hypoestrogenic/hypoandrogenic state w/BC
- Aromatase inhibitors - inhibit specific protein
- GnRH agonist –> pseudomenopause (limited to 3-6 months) w/Ca++ (Inhibits cascade)
Endometriosis Surgical Management
- For severe sxs that cannot be controlled
- Anatomic distortion
- Infertility
- Laprascopic or TAH with BSO
Adenomyosis - define
Endometrial glands and stroma invade Myometrium causing hypertrophy via invagination
Adenomyosis Prevalence
20-65% affected
More common >35
Increased risk: higher parity, prior uterine surgery, fibroids
Adenomyosis Clinical Presentation
-Dysmenorrhea
-Dyspareunia
Menorrhagia (with absence of endometriosis or fibroids)
Adenomyosis Medical Tx
Decreasing pain cascade - NSAIDs
Mirena - Progesterone key (implants may have higher sensitivity to estrogen, progesterone will decrease)
-Danazol - Creates hypoestrogenic/hypoandrogenic state w/BC
-Aromatase inhibitors
-OCs - Continuous
-Pain meds: NSAIDs
Adenomyosis PE
- Enlarged uterus that is globular or boggy and tender (due to hypertrophy)
- Pain within uterus itself NOT ovaries/fornix/ect.
- Histopathology from hysterectomy specimen (definitive)
- Imaging - MRI (More sensitive and specific)
Adenomyosis MRI
- Cystic appearance
- Heterogeneity of myometrium
- Asymmetric myometrial thickness
Adenomymosis Surgical Tx
- Hysterectomy
- Excision of implants (Difficult)
- Uterine Artery Embolism
Leiomymoma (Fibroids, myoma, leiomyomata, fibromyoma) Define
- Benign growth/tumor
- Etiology unknown (single cell cloned, genetic, over expression of growth factors, hormone receptors)
- Malignant = sarcoma (
Classification of fibroids (Leiomymoma)
- Submucosal - Protruding into uterine cavity
- Intramural - Within myometrium
- Subserosal - On serous surface of uterus
- Pedunculated - On stalk
fibroids (Leiomymoma) Prevalence
- 20-50% reproductive age have symptomatic
- Increased risk with obesity and Fx, African American, nullips, early menarche and infertility
fibroids (Leiomymoma) Clinical Presenation
- Asymptomatic (incidental)
- Menorrhagia - cyclic due to larger surface area
- Menometrorrhagia
- Dysmenorrhea, cyclic
- Dyspareunia
- Non cyclic pelvic pain
- Urinary frequency/bladder pressure
- Constipation
- Anemia, infertility, SAB
- Common to have more than one
- Range from
Endometriosis vs Adenomyosis vs fibroids (Leiomymoma)
- Bogginess of adenomyosis
- Pain during menses of endometriosis
- Fibroids are firm