Primary dysmenorrhea

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.

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.

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.

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.

Premenstrual dysphoric disorder is a severe, cyclic mood disorder in which at least five of eleven affective and somatic symptoms recur during the luteal week of most menstrual cycles over 12 months and remit within about a week of menses onset. Diagnosis is clinical. First-line treatment is a selective serotonin reuptake inhibitor such as sertraline 50 mg or fluoxetine 20 mg daily, dosed continuously or only during the luteal phase.

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.

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.

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.

Acute appendicitis is luminal obstruction and infection of the vermiform appendix presenting as migratory periumbilical-to-right-lower-quadrant pain, diagnosed by the classic history and exam plus confirmatory imaging (CT in adults, ultrasound or MRI in children and pregnancy), and treated with prompt appendectomy or, in selected uncomplicated cases, antibiotics alone.