This module covers common menstrual disorders and causes of pelvic pain, crucial topics for the USMLE. We'll explore the pathophysiology, diagnosis, and management strategies, integrating knowledge from various clinical areas.

Menstrual disorders encompass a range of conditions affecting the regularity, volume, or duration of menstrual bleeding. Understanding these is key to diagnosing and managing gynecological health issues.

AUB is a broad term for any deviation from normal menstruation. The PALM-COEIN classification system is essential for categorizing the causes:

Diagnosis involves a thorough history, physical examination (including pelvic exam), and often imaging (ultrasound) and laboratory tests (hormone levels, coagulation studies).

Dysmenorrhea is characterized by painful uterine cramps during menstruation. It can be primary (without underlying pathology) or secondary (due to an identifiable cause).

Secondary dysmenorrhea can be caused by conditions like endometriosis, adenomyosis, fibroids, or pelvic inflammatory disease. Diagnosis requires identifying and treating the underlying cause.

Pelvic pain is a common gynecological complaint with a broad differential diagnosis. It can be acute or chronic, and its management depends on identifying the underlying etiology.

Endometriosis is a condition where endometrial-like tissue grows outside the uterus. It is a common cause of chronic pelvic pain, dysmenorrhea, and infertility.

PID is an infection of the upper female reproductive tract, including the uterus, fallopian tubes, and ovaries. It is typically caused by ascending sexually transmitted infections (STIs) like Chlamydia trachomatis and Neisseria gonorrhoeae.

Diagnosis is often clinical, based on the presence of lower abdominal pain, cervical motion tenderness, uterine tenderness, or adnexal tenderness, along with laboratory evidence of infection. Treatment involves broad-spectrum antibiotics.

Ovarian cysts are fluid-filled sacs on the ovary. Most are functional (follicular or corpus luteum cysts) and resolve spontaneously. However, some can cause pain, especially if they rupture or undergo torsion.

Uterine fibroids are benign smooth muscle tumors of the uterus. They can cause heavy menstrual bleeding, pelvic pain, pressure symptoms, and infertility, depending on their size and location.

Management ranges from watchful waiting to medical therapy (hormonal suppression) or surgical intervention (myomectomy, hysterectomy).

For the USMLE, it's crucial to connect symptoms to underlying pathologies, understand diagnostic algorithms, and recall management principles. Consider the patient's age, reproductive history, and risk factors when formulating a differential diagnosis.