Glossary

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
  • Mirena
    • A progesterone-impregnated Intrauterine Device (IUD).
    • Typically placed for contraceptive purposes, it is a small T-shaped device placed into the uterus during a speculum exam.
    • The mechanism of action is unknown but likely is via inhibition of fertilization.
    • Highly effective with a 1-year pregnancy rate of 0.1 to 0.2. Completely reversible.
    • Effective for 5 years.
    • Patients experience a 40-50 percent reduction in bleeding and dysmenorrhea compared to preinsertion levels.
    • Has proven quite useful for treating heavy periods though, specific menorrhagia indication not given by FDA.
    • The most common reason given for discontinuation is lack of menstrual bleeding.
    • During the first 3 months, irregular bleeding and spotting is common. It decreases profoundly with time. After 5 years of use, 26 percent of users are amenorrheic.
    • Risks of Mirena are the same as any IUD. There is a risk of uterine perforation at insertion. There is a risk of infection after insertion especially if the patient is exposed to sexually transmitted infections. There is a risk of cramping and spotting after insertion.
    • Source: Dean G, Goldberg A. Intrauterine Device I. UpToDate. Boston. Version 13.2.
  • Miscarriage
    • Term used to describe a nonviable pregnancy. Medically, all miscarriages are called abortions.
    • Very common occurrence in reproductive medicine. Miscarriage affects 15-30 percent of clinically-recognized pregnancies.
    • Typically, the miscarriage presents in the first trimester with bleeding. Anytime there is bleeding, it is called a threatened abortion. Fifty percent of threatened abortions will end in miscarriage. Bleeding during the first trimester can be from a variety of causes. Some common sources include trauma from intercourse and vaginal or cervical inflammation. Sometimes, there will even be some bleeding from the placental implantation site.
    • Ectopic or tubal pregnancy can be a life-threatening condition and must be differentiated from threatened miscarriage. Ectopic pregnancy will commonly present with significant pelvic discomfort as well as vaginal bleeding.
    • The evaluation for threatened abortion involves an exam and labs such as the HCG or pregnancy hormone level and possibly an ultrasound.
    • If the pregnancy has advanced to 5 weeks, a small gestational sac should be visible in the uterus on ultrasound. Commonly, early in the sixth week, an embryo can be identified. If that embryo has a heartbeat, that is a very reassuring sign, and we can usually counsel the patient that we anticipate a routine course.
    • If the pregnancy has not progressed to the point where it is visible on ultrasound, we typically have to follow serial blood levels and ultrasounds. This can be a frustrating time because the question of viability is not immediately answered, and the bleeding may be ongoing or progressive.
  • Myomectomy
    • Procedure to remove the fibroid tumors from a uterus. It is usually done through an abdominal incision. May potentially be done through a laparoscope.
    • Ideal to treat symptomatic fibroids in a patient who desires preservation of fertility.
    • Typically requires cesarean delivery for subsequent pregnancies.
    • Considerable risks of postoperative bleeding with this procedure.
    • Seven percent risk or requiring reoperation.
    • Eighty percent cure rate for menorrhagia.
    • Source: Thompson JD, Rock JA. Leiomyomata Uteri and Myomectomy. Telinde’s Operative Gynecology. 8th ed Lippincott-Raven. 1997. pp554-564.
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