Adenomyosis

Uterine leiomyomas are benign monoclonal smooth-muscle tumors of the myometrium that cause heavy menstrual bleeding, bulk symptoms, and reproductive dysfunction; management ranges from expectant care to hormonal bleeding control to fertility-sparing or definitive surgery.

Endometrial-like glands and stroma implanted outside the uterus drive cyclic pelvic pain, dyspareunia, dyschezia, and infertility. Diagnosis is presumed clinically and confirmed by laparoscopic visualization with biopsy; treatment is staged from NSAIDs and hormonal suppression through conservative or definitive surgery.

Endometrial polyps are focal, usually benign, estrogen-sensitive overgrowths of endometrial glands and stroma projecting into the uterine cavity that present with abnormal or intermenstrual bleeding; diagnosis is by saline-infusion sonohysterography or hysteroscopy, and treatment is hysteroscopic polypectomy with pathology, which is both diagnostic and curative.

Endometrial cancer is the most common gynecologic malignancy, most often a type I endometrioid adenocarcinoma driven by unopposed estrogen and heralded by postmenopausal bleeding. Any postmenopausal bleeding or thickened endometrial stripe prompts endometrial biopsy, and early-stage disease is treated with total hysterectomy and bilateral salpingo-oophorectomy, giving a favorable overall prognosis.

Abnormal uterine bleeding is any deviation from normal menstrual volume, duration, frequency, or regularity, classified by the PALM-COEIN system into structural and nonstructural causes. Pregnancy is excluded first with beta-hCG, postmenopausal bleeding gets an endometrial biopsy, and acute heavy bleeding is treated first-line with high-dose IV conjugated estrogen.

Primary dysmenorrhea is cyclic, crampy lower abdominal pain with menses driven by excess endometrial prostaglandin F2-alpha, occurring in the absence of any pelvic pathology. It is a diagnosis of exclusion made on history and a normal pelvic exam, and it responds to scheduled NSAIDs, combined hormonal contraception, or both.

Pelvic inflammatory disease is an ascending polymicrobial infection of the upper female genital tract, most often caused by Neisseria gonorrhoeae, Chlamydia trachomatis, or Mycoplasma genitalium, diagnosed clinically on uterine, adnexal, or cervical motion tenderness. Most women are treated as outpatients with a single dose of ceftriaxone plus 14 days of doxycycline, while parenteral cefotetan or cefoxitin plus doxycycline, or clindamycin plus gentamicin, is reserved for hospitalized patients, with tubo-ovarian abscess and infertility among the major complications of delayed treatment.

A fertilized ovum implants outside the endometrial cavity, almost always in the fallopian tube, and is the leading cause of maternal death in the first trimester. Diagnosis rests on quantitative beta-hCG paired with transvaginal ultrasound, and management branches immediately on hemodynamic stability.

Von Willebrand disease is the most common inherited bleeding disorder, caused by deficient or dysfunctional von Willebrand factor, producing mucocutaneous bleeding from impaired platelet adhesion plus a mild secondary factor VIII deficiency. Diagnosis rests on the vWF antigen, ristocetin cofactor activity, and factor VIII activity panel, and management centers on desmopressin for type 1, vWF concentrate for severe or desmopressin-unresponsive disease, and antifibrinolytics for mucosal bleeding.

Hypothyroidism is thyroid hormone deficiency, most commonly caused by autoimmune (Hashimoto) thyroid failure in iodine-sufficient countries, diagnosed by an elevated thyroid-stimulating hormone with a low or normal free thyroxine. First-line treatment is levothyroxine dosed at 1.6 mcg/kg lean body weight orally once daily, titrated using thyroid-stimulating hormone rechecked no sooner than 6 weeks after any dose change.

Menopause is the permanent cessation of menses from ovarian follicular depletion, confirmed retrospectively after 12 months of amenorrhea around a mean age of 51 years. Management centers on treating moderate to severe vasomotor symptoms with the lowest effective dose of hormone therapy in appropriately selected candidates, alongside bone and cardiovascular risk assessment.

Infertility is failure to conceive after 12 months of regular, unprotected intercourse (6 months if the woman is 35 or older), most often from ovulatory dysfunction, male factor, or tubal or pelvic disease. Diagnosis rests on midluteal progesterone, semen analysis, and hysterosalpingography in both partners concurrently. First-line treatment for anovulatory infertility is ovulation induction with letrozole or clomiphene citrate, escalating to intrauterine insemination or in vitro fertilization when indicated.