American family physician

The etiology of chronic pelvic pain in women is poorly understood. Although a specific diagnosis is not found in the majority of cases, some common diagnoses include endometriosis, adhesions, irritable bowel syndrome, and interstitial cysti…

Infertility is defined as failure to achieve pregnancy during one year of frequent, unprotected intercourse. Evaluation generally begins after 12 months, but it can be initiated earlier if infertility is suspected based on history or if the…

Signs and symptoms of endometriosis are nonspecific, and an acceptably accurate noninvasive diagnostic test has yet to be reported. Serum markers do not provide adequate diagnostic accuracy. The preferred method for diagnosis of endometrios…

Dysmenorrhea is the leading cause of recurrent short-term school absence in adolescent girls and a common problem in women of reproductive age. Risk factors for dysmenorrhea include nulliparity, heavy menstrual flow, smoking, and depression…

Dyspareunia is genital pain associated with sexual intercourse. Although this condition has historically been defined by psychologic theories, the current treatment approach favors an integrated pain model. Identification of the initiating …

When abdominal pain is chronic and unremitting, with minimal or no relationship to eating or bowel function but often a relationship to posture (i.e., lying, sitting, standing), the abdominal wall should be suspected as the source of pain. …

Up to one half of pre-menopausal women will have endometriosis, in which endometrial-like glands and stroma grow in an extrauterine site. The American College of Obstetricians and Gynecologists (ACOG) has updated its guidelines on the treat…

Endometriosis is a progressive disease affecting 5 to 10 percent of women. It can cause dyspareunia, dysmenorrhea, low back pain and infertility. A definitive diagnosis can be made only by means of laparoscopy. Medical treatment designed to…

Primary dysmenorrhea is defined as cramping pain in the lower abdomen occurring just before or during menstruation, in the absence of other diseases such as endometriosis. Prevalence rates are as high as 90 percent. Initial presentation of …

Hysterectomy, the most common major nonobstetric operation, is performed in more than 570,000 women in the United States each year. Although the number of hysterectomies has decreased in recent years, many authorities believe that hysterect…

Hysterosalpingography is the only radiologic procedure routinely performed in the initial evaluation of the infertile woman. Hysterosalpingography is used to assess the anatomy of the uterus and the patency of the fallopian tubes, and is pe…

Chronic pelvic pain in women may involve more than the gynecologic organ systems. Urologic, gastrointestinal, musculoskeletal and psychiatric disease processes may be contributing factors, the majority of which can be treated medically. A t…

Compared with transabdominal pelvic ultrasonography, transvaginal ultrasonography provides improved resolution for visualization of female pelvic organs, with less artifact. Transvaginal ultrasonography has superseded the transabdominal app…

Menorrhagia due to dysfunctional uterine bleeding can be treated medically or surgically. Medical therapy is associated with less morbidity and less profound effects on body image and fertility. Nonsteroidal anti-inflammatory drugs are the …

Chronic endometritis is an inflammatory condition of the uterus and is characterized by the presence of plasma cells in the endometrium. This disorder may be discovered when an endometrial biopsy is performed to evaluate hormonal therapy, a…

Gonadotropin-releasing hormone (GnRH), a decapeptide synthesized and released by the hypothalamus, regulates production and release of the gonadotropins luteinizing hormone (LH) and follicle-stimulating hormone (FSH) by the adenohypophysis.…

Dysfunctional uterine bleeding is abnormal vaginal bleeding originating in the uterus and caused by a hormonal mechanism. Other sources and causes of vaginal bleeding should be considered before the diagnosis is established. Dysfunctional u…