used for heavy bleeding Gonadotropin releasing hormone agonist used to shrink

Used for heavy bleeding gonadotropin releasing

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– used for heavy bleeding Gonadotropin-releasing hormone agonist – used to shrink fibroids prior to fertility treatment or surgery (may also control heavy bleeding) Selective estrogen reuptake modulators – shrink fibroid volume Selective progesterone receptor modulators – shrink fibroid volume Aromatase – shrink fibroid volume
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Combined oral contraceptives – may improve periodic bleeding control and/or dysmenorrhea Nonsteroidal antiinflammatory drugs – May improve periodic bleeding control and/or dysmenorrhea surgery – minimally invasive procedures or hysterectomy uterine artery embolization magnetic resource imaging – guided focused ultrasound Pregnancy Complications: Monitor pregnant women more closely as it may cause complications during a pregnancy such as: infertility failed implantation spontaneous abortion preterm labor placental abruption malpresentation cesarean birth peripartum hysterectomy postpartum hemorrhage Pre-pregnancy, fibroidectomy may be considered if there are concerns about impaired fertility. # 72 Lichen sclerosis Pathophysiology o Idiopathic chronic inflammatory condition of the peri-mucosal skin Signs and Symptoms o Asymptomatic in 1/3 of patients o Pruritic genital lesions involving the vulva or foreskin o Dysuria o Painful Intercourse o Painful Defecation o Initially vulva skin is thick and white o Later will be wrinkled and hypopigmented Diagnostics o Biopsy Indicating squamous cell hyperplasia is present Treatment o Topical Corticosteroid Initially High Dose Temovate Later Taper Down Potency to Valisone o Cryotherapy # 73 Adenomyosis Pathophysiology o Endometrial glands and stroma embed within the myometrium of the uterus – known as endometriosis of the uterus Signs and Symptoms o Dysmenorrhea o Menorrhagia o Metrorrhagia o Enlarged uterus that is tender and boggy;
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Diagnostics o Transvaginal Ultrasound o MRI of pelvis if ultrasound is not diagnostic #74 Physiologic menopause Signs and Symptoms o Disturbance of Menstrual Pattern o Hot Flashes o Atrophic Vaginal Mucosa o Depression o Insomnia Diagnostics o Follicle Stimulating hormone (FSH) – not necessary to confirm diagnosis, may be indiciated if patient is < 45 years old o TSH – consider if atypical age or vasomotor symptoms o Vaginal PH <4.5 Management o Estrogen replacement therapy – consider in women under 60 years old o Preventive Management Osteoporosis Cardiovascular Breast Cancer Cervical Cancer prevention #75 Endometriosis Peak diagnosis age 20-40 years old Risk factors o Early or late menarche o Nulliparity o Menstrual flow >6 days o Menstrual cycle <28 days Signs and Symptoms o Chronic pelvic pain o Dysmenorrhea o Infertility o Ovarian cyst o Heavy periods o Tender nodular ligaments o Fixed uterine retroversion Diagnostics o Histological diagnosis hemosiderin-laden macrophages o Laparoscopy o Endometrial tissue o Imaging Transvaginal ultrasound Management o 1 st line GnRH therapy o NSAID o Oral contraceptives Use at least 3-4 months
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