A endometriosis chronic condition in which the

a. Endometriosis: chronic condition in which the endometrial
lining is implanted outside the uterus.
b. Most common cause of secondary dysmenorrhea.
c. All endometrial tissue breaks down and bleeds.
d. Uterine fibroids also cause secondary dysmenorrhea.
e. Pain that increases over time is associated with secondary
dysmenorrhea.
c. Management

i. Heat
ii. Lifestyle changes: vigorous exercise (more than 3 times per week);
breakfast every day
iii. Vitamin and herbal treatments: vitamin E; herbal medicine Shirzai
Thymus Vulgaris; ibuprofen
iv. Acupuncture
v. Nonsteroidal anti-inflammatory drugs (NSAIDs): most common and
effective
vi. Oral contraceptives
vii. Progestin implants
viii. Levonorgestrel (progestin) intrauterine device (IUD)
ix. Depot medroxyprogesterone acetate (DMPA) injections
x. Surgical interventions: not recommended
7. Abnormal Uterine Bleeding
a. Etiology
i. any uterine bleeding that is irregular in amount, frequency, duration, or
timing.
ii. May or may not be related to menstrual cycle.
iii. Can signal pathologic, life-threatening conditions (ectopic pregnancy or
endometrial cancer).
iv. Clinicians should always rule out pregnancy and pregnancy complications
first.
1. AUB-P (polyps): endocervical polyps and endometrial polyps are
growths on the cervix or endometrium.
2. AUB-A (adenomyosis): small areas of endometrial tissue within
the myometrium.
3. AUB-L (leiomyoma): fibroids; fibromuscular benign tumors in the
myometrium.
4. AUB-M (malignancy and hyperplasia): AUB is common symptom of
endometrial cancer
5. AUB-C (coagulopathy): clotting disorders.
6. AUB-O (ovulatory dysfunction): many cases stem from
endocrinopathies.
7. Anovulatory uterine bleeding
8. Amenorrhea
9. Ovulatory abnormal uterine bleeding
10. AUB-E (endometrial).
11. AUB-I (iatrogenic).
12. AUB-N (not yet classified).
b. Amenorrhea
i. Causes of primary and secondary amenorrhea: See Table 24-7.
ii. Anovulation: if left untreated, endometrial cancer can occur.
iii. Ovarian failure: low estrogen production while serum FSH is high.

iv. Hypogonadism or hyperprolactinemia: MRI.
v. Functional amenorrhea: underweight, over-exercised, stressed
adolescent.
c. Management
i. Non-Life threateneing
1. Estrogen therapy.
2. Combined oral contraceptives.
3. Progestogen therapy.
4. Gonadotropin-releasing hormone agonists (GnRHas).
ii. Acute bleed
1. Nonsteroidal anti-inflammatory drugs (NSAIDs). See Box 24-3.
2. Tranexamic acid (Lysteda): antifibrinolytic agent that reduces
menstrual bleeding
iii. Surgical Management
1. Endometrial ablation: destruction of endometrium using heat,
tissue freezing, microwave, or radiofrequency electricity.
2. Uterine artery embolization: addresses fibroids and may help
HMB.
3. Hysterectomy
8. Polycystic Ovarian Syndrome
a. Etiology
i. Androgen production occurs in the ovaries and adrenal glands, as well as
by peripheral conversion in adipose tissue, skin, and the liver.