OB/GYN
Benign Gynecologic Conditions
OB/GYN

Benign Gynecologic Conditions

Fibroids, endometriosis, adenomyosis, ovarian cysts, lichen sclerosus.

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◆Uterine leiomyomas (fibroids)

  • •Most common pelvic tumor in reproductive-age women
  • •Symptoms: heavy menstrual bleeding, bulk symptoms (urinary frequency, pelvic pressure)
  • •Enlarged irregular uterus on bimanual exam
  • •Confirm with TVUS
  • •Tx: NSAIDs, OCPs, LNG-IUD, GnRH agonists; UAE; myomectomy; hysterectomy

◆Adenomyosis

  • •Endometrial glands within myometrium
  • •Boggy, ENLARGED, tender uterus
  • •Menorrhagia + dysmenorrhea
  • •MRI confirms (vs fibroids: discrete masses)
  • •Tx: NSAIDs, hormonal therapy, hysterectomy

◆Endometriosis

  • •Endometrial tissue OUTSIDE uterus
  • •Classic triad: chronic pelvic pain + dysmenorrhea + deep dyspareunia
  • •Dyschezia (rectal), infertility
  • •Gold standard dx: laparoscopy with biopsy
  • •Tx: NSAIDs + COCs → progestins → GnRH agonists → laparoscopic excision
  • •Letrozole or IVF for fertility

◆Ovarian cysts

  • •Functional: follicular (most common), corpus luteum
  • •Dermoid (mature cystic teratoma): hair, teeth, sebum
  • •Endometrioma ('chocolate cyst'): endometriosis
  • •Management depends on size + characteristics + age
  • •Simple cyst <5 cm in premenopausal: observe
  • •Complex or postmenopausal: surgical evaluation

◆Ovarian torsion

  • •Sudden severe unilateral pain + N/V + adnexal mass
  • •RFs: ovarian mass >5 cm, pregnancy, fertility treatment
  • •Doppler may show ↓ flow (but normal flow doesn't rule out)
  • •Emergent laparoscopy with detorsion ± cystectomy
  • •Right > left (sigmoid protects)

◆PID (pelvic inflammatory disease)

  • •Lower abd pain + CMT + adnexal tenderness
  • •Treat empirically (don't wait for cultures)
  • •Outpatient: ceftriaxone IM + doxycycline ± metronidazole
  • •Inpatient: cefoxitin/cefotetan + doxycycline (if pregnant, severe, TOA, no response)
  • •Complications: infertility, ectopic, chronic pain, Fitz-Hugh-Curtis (perihepatitis)

◆Lichen sclerosus

  • •Postmenopausal vulvar pruritus + atrophic white patches in figure-of-eight
  • •Risk of vulvar SCC (biopsy if suspicious)
  • •Treat: high-potency topical corticosteroid (clobetasol)

◆Bartholin gland cyst/abscess

  • •Vulvar swelling, may be tender if abscess
  • •Cyst: observation if asymptomatic
  • •Abscess: I&D + Word catheter or marsupialization
  • •If recurrent or postmenopausal: biopsy (rule out cancer)

High-yield pearls

  • ◆Endometriosis triad: chronic pelvic pain + dysmenorrhea + deep dyspareunia
  • ◆Adenomyosis: ENLARGED boggy uterus + menorrhagia
  • ◆Fibroids: enlarged IRREGULAR uterus
  • ◆Ovarian torsion: emergent surgery to preserve fertility
  • ◆Lichen sclerosus: clobetasol + biopsy if suspicious
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