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Fibrocystic breast changes
Paget disease of the breast
Intrauterine growth restriction
Pelvic inflammatory disease
Gestational trophoblastic disease
Germ cell ovarian tumor
Polycystic ovary syndrome
Premature ovarian failure
Sex cord-gonadal stromal tumor
Surface epithelial-stromal tumor
Congenital cytomegalovirus (NORD)
Congenital rubella syndrome
Neonatal herpes simplex
Preeclampsia & eclampsia
Female sexual interest and arousal disorder
Genito-pelvic pain and penetration disorder
Fetal alcohol syndrome
Fetal hydantoin syndrome
Androgen insensitivity syndrome
Hypospadias and epispadias
Benign prostatic hyperplasia
Male hypoactive sexual desire disorder
Amenorrhea: Pathology review
Benign breast conditions: Pathology review
Breast cancer: Pathology review
Cervical cancer: Pathology review
Complications during pregnancy: Pathology review
Congenital TORCH infections: Pathology review
Disorders of sex chromosomes: Pathology review
Disorders of sexual development and sex hormones: Pathology review
HIV and AIDS: Pathology review
Ovarian cysts and tumors: Pathology review
Penile conditions: Pathology review
Prostate disorders and cancer: Pathology review
Sexually transmitted infections: Vaginitis and cervicitis: Pathology review
Sexually transmitted infections: Warts and ulcers: Pathology review
Testicular and scrotal conditions: Pathology review
Testicular tumors: Pathology review
Uterine disorders: Pathology review
Vaginal and vulvar disorders: Pathology review
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Uterine Leiomyoma (Fibroids) Characteristics and Presentation
29-year-old Carmen presents to the physician’s office complaining of severe lower abdominal pain during her menstrual periods as well as pain during intercourse.
She has been trying unsuccessfully to get pregnant for the first time for the past 2 years.
Pelvic examination shows a normal sized uterus.
Later that day, 44-year-old Susanna comes to her physician reporting heavy menstrual periods that last about 10 days.
This has been occurring for the past 6 months and is accompanied with a feeling of “fullness” in the lower abdomen as well as fatigue.
On further history, she has never been pregnant.
Physical examination shows an enlarged uterus with multiple round masses.
Laboratory studies reveal iron deficiency anemia.
Based on the initial presentation, Carmen and Susanna both have some form of uterine disorder.
Let’s first review physiology real quick.
The uterus consists of 3 layers, an outer layer called the perimetrium or the serosa, a middle smooth muscle layer called the myometrium, and the innermost layer, the endometrium.
The endometrium has two layers, an inner functional layer made up mainly of glands and supporting connective tissue, called stroma, and an outer thin basal layer which regenerates the overlying functional layer after each menstrual cycle.
Okay, now, the first uterine disorder is endometritis or inflammation of the endometrium.
This is usually caused by normal bacterial flora of the lower genital tract, meaning the cervix, vagina or external genital organs, that travel upwards into the endometrium.
Uterine disorders are conditions that affect the uterus, the female reproductive organ that is responsible for gestating a fertilized egg. Common uterine disorders endometritis, asherman syndrome, endometrial hyperplasia, endometrial polyps, endometriosis, and leiomyomas.
Endometritis refers to the acute or chronic inflammation of the endometrium due to invasion by bacteria normally found in the lower genital tract. Asherman syndrome involves intrauterine adhesions following procedures like dilation and curettage and can result in amenorrhea, infertility, or recurrent pregnancy loss. Endometrial hyperplasia is the excessive growth of the endometrial glands, most commonly caused by long-standing increased exposure to estrogen without the counteracting effect of progesterone.
There is also endometrial cancer, which is a type of cancer that begins in the lining of the uterus, called the endometrium. There can also be endometrial polyps, which are benign growths of the endometrial glands and stroma that protrude into the uterine cavity. Next, there is endometriosis in which there is the presence of endometrial tissue outside the endometrial cavity, usually on the ovaries, causing pelvic pain and bleeding that gets worse during menstruation. Finally, there are leiomyomas or uterine fibroids, which are extremely common benign smooth muscle tumors that usually develop in premenopausal women, in response to estrogen. Leiomyomas can present with abnormal uterine bleeding, pain, iron deficiency anemia, or fertility issues.
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