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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.Heatii.Lifestyle changes: vigorous exercise (more than 3 times per week); breakfast every dayiii.Vitamin and herbal treatments: vitamin E; herbal medicine Shirzai Thymus Vulgaris; ibuprofeniv.Acupuncturev.Nonsteroidal anti-inflammatory drugs (NSAIDs): most common and effectivevi.Oral contraceptivesvii.Progestin implantsviii.Levonorgestrel (progestin) intrauterine device (IUD)ix.Depot medroxyprogesterone acetate (DMPA) injectionsx.Surgical interventions: not recommended7.Abnormal Uterine Bleedinga.Etiologyi.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 ofendometrial cancer5.AUB-C (coagulopathy): clotting disorders.6.AUB-O (ovulatory dysfunction): many cases stem from endocrinopathies.7.Anovulatory uterine bleeding8.Amenorrhea 9.Ovulatory abnormal uterine bleeding10. AUB-E (endometrial).11. AUB-I (iatrogenic).12. AUB-N (not yet classified).b.Amenorrheai.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.Managementi.Non-Life threateneing1.Estrogen therapy.2.Combined oral contraceptives.3.Progestogen therapy.4.Gonadotropin-releasing hormone agonists (GnRHas).ii.Acute bleed1.Nonsteroidal anti-inflammatory drugs (NSAIDs). See Box 24-3.2.Tranexamic acid (Lysteda): antifibrinolytic agent that reduces menstrual bleedingiii.Surgical Management1.Endometrial ablation: destruction of endometrium using heat, tissue freezing, microwave, or radiofrequency electricity.2.Uterine artery embolization: addresses fibroids and may help HMB.3.Hysterectomy8.Polycystic Ovarian Syndromea.Etiologyi.Androgen production occurs in the ovaries and adrenal glands, as well as by peripheral conversion in adipose tissue, skin, and the liver.