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NURO 733 - Dysmenorrhea And Pelvic Pain Exam Study Guide
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NURO 733 - Dysmenorrhea AndPelvic Pain Exam Study Guide
The most promising non-surgical management of adenomyosis is - Answer LNG-IUS. It
releases 20mcg per day of progestin Levonogesterel into the uterine cavity for 5-years.
It decreases menorrhagia and dysmenorrhea.
Candidates for the LNG-IUS include women free of the following contraindications: -
Answer known or suspected preg- nancy; current or recent pelvic inflammatory disease
or lower genital tract infection; genital tract bleeding of unknown eti- ology; breast,
uterine, or cervical malignancy; cervical dys- plasia; progestogen-dependent tumors;
uterine anomalies in- cluding fibroids if they distort the uterine cavity; acute hepatic
disease; and hypersensitivity to any components of the LNG- IUS.
The decision to use a sur- gical approach to treatment is based on factors such as -
Answer the woman's age; future fertility desires; the size, site, and extent of the
adenomyotic lesions; and the surgeon's preferences and skill.
Surgical options include: - Answer hysterectomy, uterine artery embolization, excision
of focal adenomyotic lesions, and endometrial ablation.
Hysterectomy has long been the only definitive and per- manent treatment for - Answer
adenomyosis. It is the only way in which a diagnosis can be confirmed. It remains the
approach of choice for women who do not desire future fertility. Hysterectomy also
might be the best choice for women in whom less invasive treatments have not been
successful and who have severe disease that involves more than one-third of the
myometrium.
Research of the uterine artery embolization treatment of adenomyosis shows that -
Answer it has limited long-term effectiveness, while others are encouraged by some
promising results and the low risk of complications that uterine artery embolization
involves.
Unlike the role of myomectomy in excision of fibroids - Answer adenomyosis cannot be
easily excised unless it is in the rarer form of localized, discrete lesions. Thus, excision
is rarely used to treat adenomyosis.
Endometrial ablation - Answer is effective in treating superficial lesions. If deeper
lesions are present, which is often unknown at the time of ablation, dysmenorrhea and
menorrhagia are likely to return, and women with deeper lesions may be best served by
more definitive surgical treatment.
However, a recent, small, nonrandomized trial suggested that - Answer ablation using
, high-intensity focused ultrasound is safe and effective in treating symptomatic ade-
nomyosis, with the majority of patients experiencing symptomatic relief through 2 years
of follow-up.
Adenomyosis is a - Answer prevalent, benign disorder in which the en- dometrial glands
and stroma invade the myometrium, either diffusely or focally.
It is most commonly diagnosed in women - Answer in their fourth and fifth decades of life
and in women who have been pregnant.
The cause of adenomyosis is still unclear, although most investigators agree that -
Answer it is related to a chronic disruption of the endometrial-myometrial interface.
Diagnosing adenomyosis is difficult because - Answer it shares symptomatol- ogy with
other disorders such as endometriosis and fibroids.
Symptomatic adenomyosis is associated with - Answer 1. menorrhagia
2. dysmenorrhea, and
3. an enlarged, tender uterus.
Potential medical treatments include symptomatic relief with - Answer combined oral
contraceptives, progestogens, gonadotropin-releasing hormone agonists, NSAIDs,
valproic acid, tranexamic acid, and LNG-IUS.
The most useful prehysterectomy diagnostic modalities are - Answer 1. Transvaginal
ultrasound and
2. MRI.
Prescribing a trial of nonsurgical therapy - Answer is within the midwives' scopes of
practice. The midwife can also provide patient education and has an important role in
comprehensive and col- laborative care of the woman with adenomyosis.
Adenomyosis occurs - Answer when endometrial glands and stroma, normally
sequestered in the endometrium, invade the myometrium. So the glandular endometrial
tissue invades the thick, muscular uterine myometrium.
The smooth muscle in the myometrium often - Answer hypertrophies in response to this
misplaced tissue, making the uterus enlarged and tender on examination.
This ectopically located endometrial tissue stimulates a local inflammatory response -
Answer that results in hypertrophy and hyperplasia of the surrounding muscle fibers.
Adenomyosis is a benign condition - Answer that may involve all or part of the uterus.
The most common type of adenomyosis, found in approximately two-thirds of cases is -
Answer diffuse adenomyosis in which the invading endometrium causes a generalized
expansion of the uterine walls, and the adenomyotic foci are distributed relatively evenly
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