Endometriosis

Adenomyosis is the presence of endometrial glands and stroma within the myometrium, producing a diffusely enlarged, boggy, symmetric uterus with heavy menstrual bleeding and severe dysmenorrhea; it is a pathologic diagnosis, supported clinically by exam and ultrasound or MRI, and definitively treated with hysterectomy.

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.

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.

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.

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.

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.

Follicular and corpus luteum cysts are the most common ovarian mass in reproductive-age women, arising from a normal ovulatory cycle that fails to complete, and most resolve spontaneously within one to two cycles with observation alone. Management is a size- and age-stratified triage between watchful waiting, repeat ultrasound, and surgical evaluation, reserved for masses that are large, complex, persistent, or symptomatic.

Epithelial ovarian cancer is the most lethal gynecologic malignancy because nonspecific symptoms and the absence of an effective screening test mean most women present with stage III or IV disease. Diagnosis rests on pelvic examination, cancer antigen 125 (CA-125), and transvaginal ultrasonography followed by surgical staging; treatment is cytoreductive surgery plus platinum-taxane chemotherapy, with olaparib maintenance in breast cancer susceptibility gene (BRCA)-mutated disease.

Irritable bowel syndrome is a functional disorder of gut-brain interaction diagnosed clinically by Rome IV criteria, recurrent abdominal pain related to defecation, stool frequency, or stool form, without alarm features. Management is subtyped by stool pattern, with fiber and dietary change first, then IBS-C secretagogues or IBS-D antidiarrheals and antibiotics, and low-dose tricyclics or antispasmodics for pain.