leiomyoma, amenorrhea, menopause

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uterine leiomyomas

fibroids ranging from microscopic to huge

location of leiomyomas

submucosal, subserosol, intramural or interstitial, pedunculated, cervical

s/s of leiomyomas

pelvic pressure, hypomenorrhea, metrorrhagia, dysmenorrhea, abdominal enlargement, irregularly shaped, firm, large uterus

hypomenorrhea

scant periods or spotting

metrorrhagia

uterine bleeding at irregular times

dysmenorrhea

severely painful periods

differential diagnosis of leiomyomas

pregnancy, ovarian neoplasm, endometriosis, tubal ovarian abscess

diagnosis of leiomyomas

examination, ultrasound, CT/MRI

management of leiomyomas

myomectomy, androgens, GnRH agonists, hysterectomy

Complications of leiomyomas

premature labor, spontaneous abortions, infertility, heavy bleeding, difficult delivery, increased postpartum bleeding, impedes ability to perform exam

amenorrhea

absence of menses

primary amenorrhea

failure to menstruate by age 16

secondary amenorrhea

absence of menses for 6 months after normal menstruation

causes of amenorrhea

genetic disorders, endocrine disorders, anatomic abnormalities, medications, marked weight loss, strenuous exercise, cervical scarring, hpo axis disorder

assessment of amenorrhea

pregnancy test, thyroid hormone, FSH, estrogen & progesterone, prolactin level, complete review of systems

climacteric

the 5-10 year period of gradual decrease in ovarian hormone production prior to menopause

perimenopause

the period of time including the climacteric up to menopause

menopause

permanent cessation of menses

postmenopause

cessation of menses for one year

changes of menopause

decreased estrogen & progesterone, unpredictable menses, heavier & longer cycles, fatigue, mood changes, disruption in sleep, vasomotor instability, bleeding and spotting in between cycles, FSH & LH increase

treatments for menopause

decrease caffeine, dress in layers, soy products, ginsing, SSRIs

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