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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
▪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 ultrasoundPregnancy Complications:Monitor pregnant women more closely as it may cause complications during a pregnancy such as:infertilityfailed implantationspontaneous abortionpreterm laborplacental abruptionmalpresentationcesarean birthperipartum hysterectomypostpartum hemorrhagePre-pregnancy, fibroidectomy may be considered if there are concerns about impaired fertility.# 72 Lichen sclerosisPathophysiology oIdiopathic chronic inflammatory condition of the peri-mucosal skinSigns and SymptomsoAsymptomatic in 1/3 of patients oPruritic genital lesions involving the vulva or foreskinoDysuriaoPainful IntercourseoPainful DefecationoInitially vulva skin is thick and whiteoLater will be wrinkled and hypopigmentedDiagnosticsoBiopsyIndicating squamous cell hyperplasia is presentTreatmentoTopical Corticosteroid Initially High Dose TemovateLater Taper Down Potency to ValisoneoCryotherapy # 73 AdenomyosisPathophysiology oEndometrial glands and stroma embed within the myometrium of the uterus – known as endometriosis of the uterusSigns and SymptomsoDysmenorrheaoMenorrhagiaoMetrorrhagiaoEnlarged uterus that is tender and boggy;
Diagnostics oTransvaginal UltrasoundoMRI of pelvis if ultrasound is not diagnostic#74 Physiologic menopauseSigns and Symptoms oDisturbance of Menstrual PatternoHot FlashesoAtrophic Vaginal MucosaoDepressionoInsomniaDiagnostics oFollicle Stimulating hormone (FSH) – not necessary to confirm diagnosis, may be indiciated if patient is < 45 years oldoTSH – consider if atypical age or vasomotor symptomsoVaginal PH <4.5Management oEstrogen replacement therapy – consider in women under 60 years oldoPreventive ManagementOsteoporosisCardiovascular Breast CancerCervical Cancer prevention#75 EndometriosisPeak diagnosis age 20-40 years oldRisk factors oEarly or late menarcheoNulliparityoMenstrual flow >6 daysoMenstrual cycle <28 daysSigns and SymptomsoChronic pelvic painoDysmenorrheaoInfertilityoOvarian cystoHeavy periodsoTender nodular ligamentsoFixed uterine retroversionDiagnosticsoHistological diagnosis hemosiderin-laden macrophagesoLaparoscopyoEndometrial tissueoImaging Transvaginal ultrasoundManagemento1stline GnRH therapyoNSAIDoOral contraceptives Use at least 3-4 months