OBGYN Exam 2

What day in the menstrual cycle does Mittelschmerz occur? A. Day 14 B. Day 1 C. Day 28

14

What day dos fertilization occur? A. Day 0 after the LNMP B. 14-15 days after the first day of LNMP

14-15 days

What day does implantation occur? A. Day 0 after fertilization B. Day 4 after fertilization C. Day 6-8 after fertilization D. Day 14 after the first day of LNMP

6-8 days

Which of the following is a credible chief complaint in women with amenorrhea? A. Absence of menses B. Mittelscherz C. PMS D. Dysmenorrhea

Absence of menses

What is the term for dark pigmented areas with a velvety quality in her axillae and on posterior neck?

Acanthosis nigricans

What is the leading preventable cause f intellectual disability? A. Fetal exposure to nicotine B. Blood group in compatibility between mother and fetus C. Excessive exposure of the fetus to folic acid D. Alcohol consumption during pregnancy

Alcohol consumption during pregnancy

What does increased hCH levels mean in a woman of fertile age? A. Normalpregnancy B. Ectopic pregnancy C. Molar pregnancy or choriocarcinoma D. All of teh above

All of the above

What is the cause of increased amounts of pubic hair?

Androgens

What is the mechanism behind widespread acne's?

Androgens

What product is synthesized in the theca interna cells? ** A. HCG B. LH C. Androstenedions D. Cholesterol

Androstenedions

What is the term for irregular menstural periods due to failure of ovaries to ovulate?

Anovulatory bleeding

A 22- year old woman has consistently low progesterone levels. She is not taking contraceptive mediaction. Given this fact, predict the most significant character of the woman's menses? A. Regular luteal phase B. Irregular follicular phase length C. Cramping lasting for 48-72 hours D. Anovulatory menstrual cycles E. Premenstrual mood swings, breast tenderness, bloating

Anovulatory menstruatal cycle

Dilation and curettage (D&C) is a surgical procedure in which the cervix is opened (dilated) and a thin curette is inserted into the uterus via cervix. The curette is used to remove tissue from the inside of the uterus (curettage). The purpose is either diagnostic (e.g. detection of uterine cancer or endometriosis) or therapeutic (e.g. abnormal menstrual bleeding or medical abortion). The procedure may lead to adhesions within the uterus, which may cause irregular menses or infertility. What is the name of this iatrogenic condition? A. Sheehan's syndrome B. Cryptomenorrhea C. PCOS D. Ashermans Syndrome

Ashermans Syndrome

Dilation and curettage may lead to adhesions within the uterus, which may cause irregular menses and infertility. What is the name of this iatrogenic condition?

Ashermans syndrome

Which two regions of the nervous system are primarily at risk for injury in newborns with hemolytic jaundice? (Select 2) A. Brachial plexus B. Brainstem C.basal ganglia D. Temporal lobe cortex

Basal ganglia, temporal lobe cortex

Identify two clinical signs from physical examination that are consistent with endometriosis?

Bilateral lower quadrant tenderness and tender crvicalnoduls

What is the Embryonal development stage at the time of implantation? ** A. Morula B. Zygote C. Blastula D. Fetus

Blastula

What condition is characterized by a gestational sac that develops without embryo in early pregnancy/ the hCG levels are initially elevated but soon decline. ** A. Blighted ovum B. Molar pregnancy C. Choriocarcinoma D. Ectopic pregnancy

Brightened ovum

What is a cause of cryptomenorrhea?

Cervicalobstruction

What day does the menstration that precedes fertilization occur? A. Day 0 B. Day 14 after the beginning of the LNMP

Day 14

What is the major effect on blood pressure during pregnancy from appropriately high levels of progesterone? A. Decreased blood pressure due to relaxation of peripheral arterioles B. Increased blood pressure due to increased blood volume C. No effect on the blood pressure unless the women develops gestational hypertension

Decrease blood pressure due to relaxation of peripheral arterioles

What is a characteristic feature of chronic pelvic pain? A. Duration > 6 months B. Easy to diagnosis and treat C. Most common type if PMS D. Pelvic pain occurring only during menses

Duration > 6 months

Painful sexual inetrcouse is called... A. Dysuria B. Dysmenorrhea C. Dyschezia D. Dyspareunia

Dyspareunia

High levels of what hormones triggers a massive secretion of GnRH leading to the LH surge? A- hCG B- Progesterone C- estrogen D- FSH

ESTROGEN

A pregnant woman in week 32 presents with elevation in blood pressure, edema, and proteinuria followed by persistent headaches, abdominal pain, altered mental status, and seizures. What pregnancy-associated condition is most probable? A. Pre-eclampsia B. HELP syndrome C. Hyperemesis gravardium D. Gestational HTN E. Eclampsia

Eclampsia

A 22 year old female recently took a pregnancy test at home, which was positive. She presents at the chiropractic clinic with left lower quadrant pain sporadic scant vaginal bleeding, and dizziness for the past 24 hours. PMH reveals regular 28 day menstrual cycle. LNMP 30 days prior to the visit. Denies use of contraception. On deep palpation in the LLQ, you discover what appears to be a tender adenxal mass. Which of the following must be considered? A. Blighted ovum B. Appendicitis C. Premature labor D. Ectopic pregnancy

Ectopic pregnancy

Which of the following is the most common life threatening complication of early pregnancy?

Ectopic pregnancy

Explain why the three abnormal laboratory test results identified above are consistent with a diagnosis of endometriosis.

Elevated WBC and ERS are consisted with an occurring inflammation & elevated neutrophils suggest inflammation is acute

What is the consequence of decreased SHBG in regards to circulating androgens and estrogen?

Elevated androgens and estrogens

What causes the decline in GnRH pulsatility during the luteal phase A. Decrease levels of LH B. A positive feedback mechanism C. Elevated levels of progesterone and estrogen D. Massive secretion of endometrial mucus

Elevated levels of progesterone adn estrgen

What causes the decline in the GnRH pulsatility during the luteal phase? A. Elevated levels of progesterone and estrogen B. Positive feedback mechanism C. Decreased levels of FSH D. Decreased levels of LH

Elevated levels of progesterone and estrogen

Which individual of the following is the youngest? A. Neonate B. Fetus C. Mature infant D. Embryo E. Small to date infant

Embryo

Symptoms of PMS only occur... A. Day 14 of a 28 day cycle B. During mestruation C. End of luteal phase D. Mid-follicular phase

End of luteal phase

What is the most commmon gynecological cancer in the US? A- ovarian B- cervical C- endometrial

Endometrial

What condition is most probable cause of secondary amnehrrea?

Endometriosis

What 2 conditions are common causes of chronic/non-cyclic bladder pain? A. Chlamydia B. Gonorrhea C. Interstitial cystitis D. Endometriosis E. PMS

Endometriosis and interstitial cystitis

Aromatization of testosterone is induced by FSH. What is the end product? A. Inhibin B. Progesterone C. DHEA D. Estradiol

Estradiol

What product is synthesized by the granulosa cells under the influence of FSH during the follicular phase ? A. Mucus B. Lactic acid C. Estradiol D. Progesterone E. LH

Estradiol

Which of the following hormones has the highest efficacy and potency? *

Estradiol

The cervical mucus in anovulatory bleeding is dominated bed...

Estrogen

What are the 2 major females sex hormones?

Estrogen and progesterone

What type of menstrual bleeding is the most common cause of irregular menses in reproductive years, especially during adolescence and during the years preceding menopause?

Estrogen withdral

What type of menstrual bleeding is the most common cause of irregular menstrual periods in reproductive years, especially a few months or years after menarche and during the years preceding menopause? A. Progesterone breath through bleeding B. Progesterone withdrawal bleeding C. Estrogen- withdrawal bleeding

Estrogen withdrawl bleeding

What happens at the very end of the last stage of labor? A. The water breaks B. Cervical dilated 4-9 cm; no urge to push C. Fully dilated cervix; urge to push D. Expulsion of placenta E. Delivery of the baby

Expulsion of the placenta

What are the 2 gonadotrophins?

FSH and LH

T/F: The vast majority of womens with chronic pelvic pain have a definite diagnosis

False

Braxton hicks contractions are associated with... A. Cervical effacement B. Delivery C. Cervical dilation D. False labor

False labor

In what situation is anovulatory bleeding considered a physiological phenomenon? **

Fist few days after menarche

The duration of pregnancy is based on gestational age, which is calculated.... A. From the day of implantation of the fertilized egg B. From the first day of the last normal menstruation C. From the day of ovulation of the last normal menstruation D. From the last day of the last normal menstruation

From the first day of the last normal menstrual cycle

What is the most common maternal medical complication during pregnancy? ** A. Gestational HTN B. Gestational diabetes C. Isoimmunization D. Pre-eclampsia

GESTATIONAL DIABETES

A 35 year old female bus driver comes to your office for a prenatal visit. She is approximately 28 weeks pregnant and has had no complications. She is complaining only of heartburn and has nad no fatigue, headaches, leg swelling, contractions, leakage, fluid, or bleeding. On examination her blood pressure is 142/92 and her urine shows no glucose, protein or leukocytes. Her weight gain is appropriate with no large recent increases. Fetal tones are 140 and her uterus measure 32 cm from the pubic bone. Looking back through her char you see her prenatal BP was 120/70 a Nd her BP during the first 20 weeks were usually 120 to 130/70-80. What is the best assessment of the women's BP? A. Nomotensive for pregnancy B. Chronic HTN C. Gestational HTN

Gestational HTN

CASE A: A 30 year old previously healthy female currently pregnant, 10th gestational weeks. Recent onset of Eleanor=bated blood glucose, polyurethaning, and polydipsia. What is most likely diagnosis? A. Eclampsia B. Pre-clampsia C. HTN D. Gestational diabetes mellitus E. Isoimmunization

Gestational diabetes mellitus

Abnormal pulsatilla secretion of what substance causes many disorders such as amenorrhea, PCOS, and precocious puberty?

GnRh

What is the major site of sex hormones synthesis in sexually mature women? A. Theca interna of the ovarian follicle B. Granulosa cells of the ovarian follicle C. Posterior pituitary D. Adrenal coretex E. Anterior pititary F. Adrenal medulla G. Hypothalamus

Granulosa cells of varian follicles

What has to be ruled our for post menopausal women? *

Gynecologicalcancer

Absent heart tones ad. Interrupted fetal growth indicated fetal death. Which of the following test confirms? A. Pelvic plain film radiographs B. Pap smear test C. HCG testing D. RH factor test

HCG testing

A 27-year-old pregnant woman in week 28 presents with elevation in blood pressure, edema, and proteinuria followed by frequent headache, abdominal pain, nausea, vomiting, and mild dyspnea. Lab tests are significant for hemolytic anemia, elevated liver enzymes, and low platelet count. Based on the given presentation and lab data, what maternal pregnancy-associated condition is most probable? A. Pre-eclampsia B. HELP syndrome C. Hyperemesis gravardium D. Gestational HTN E. Eclampsia

HELP Syndrome

Which of the following is NOT a diagnostic criterion for the metabolic syndrome? A. History of cigarette smoking B. Elevated LDL C. Hypertension D. Hyperglycemia

History of cigarette smoking

A 27 year old monogamous married female presents with a 2 year history of amenorrhea with inability to conceive. Menarche at age 15. Eventually, quite regular menstrual periods every 26 days until the past two years. PMH is negative for contraceptive treatment, STD, and dypareunia. Physical exam reveals vitals WNL; BMI 29.5, mild acne, and acanthosis nigrans. Pelvic exam is unremarkable. What is most likely pathophysiological mechanism for this condition? A. Hyperinsulism- elevated levels of gonadotrophins and estrogens B. Fertilization and plantation of fertilized egg and secretion of HCG C. Increased sensitivity of fluctuation levels of estrogen and progesterone during menstrual cycles D. Social stress, eating disorder or mod disorder

Hyperinsulinism

Why is SHBG levels decreased?

Hyperinsulinism

In women with PCOS the levels of LH are usually elevated. What are the most likely causes of LH elevation? (2) A. Hyperinsulinism stimulates the anterior pituitary to secrete LH and FSH, without the need for hypothalamic GnRH stimulation B. The anterior pituitary dos not have insulin resistance in patients with PCOS C. Profound insulin resistance in anterior pituitary D. Elevated androgens

Hyperinsulinism stimulates the anterior pituitary to secrete LH and FSH, without the need for hypothalamic GnRH stimulation The anterior pituitary dos not have insulin resistance in patients with PCOS

Patients with PCOS usually present with elevated insulin level. In these patients, what is the endocrine consequence of high insulin levels? A. Increased anterior pituitary secretion of LH B low blood concentration C. Increased hypothalamic secretions D. Patino is pregnant

Increased anterior pituitary secretion of LH

What condition is associated with a high PUF (pelvic pain, urgency and frequency) score? A. Trichomonal vaginitis B. Interstitial cystitis C. Gonorrhea D. Chlamydia

Interstitial cystitis

For what condition is potassium sensitivity testing indicated? A. Secondary amenorrhea B. Interstitial cystitis C. PMS D. Endometriosis

Interstitial cystsis

What glycoproteins is responsible for the formation of the yellow body right after ovulation?

LH

Which hormone induces theca interna cells to synthesize androgens from cholesterol? A. HCG B. LH C. FSH D. Estrogen

LH

Which of the following is NOT associated with ovulatory menstrual cycles? Select one (1) answer A. Low progesterone levels B. Regular length cycle C. Mittelscmerz D. Dysmenorrhea

Low progesterone levels

What is the term for uterine bleedings at irregular intervals, particulary between the expected menstrual periods?

Meotrrhagia

What feature is specific for irregular anovulatory bleeding? A. Monophasic basal body temp B. Brest tenderness C. Dysmenorrhea D. Secretary endometrium

Monophasic basal body temp

Which of the following are labeled "conceptus"? Select all that apply. A. Morula B. Fetus C. Blastocysts before implantation D. Implanted blastula E. Zygote

Morula , blastocysts before implantation, zygote

What would a diagnostic ultrasonogram of the abdomen of a woman with PCOS most likely reveal? A. Non existing arctic ovaries B. Intrauterine adhesions C. Multiple BL ovarian cysts D. One chocolate cyst

Multiple b/l ovarian cysts

Pelvic bimaual palpation reveals multi-modular masses in the left and right lower quadrants, palpated non tender with no fever. What is most likely cause of there physical exam findings?

Multiple ovarian cyst indicated of PCOS

As discussed in class, pregnant women who have a blood pressure in the lower range may specifically experience one of the following. A. Nausea and or vomiting when getting out of bed in the morning B. Pre-eclampsia C. Eclampsia with seizure episodes. D. DVT

Nausea and vomiting when getting out of bed

With what is isoimmunization associated? A. Physiologic neonataljaundice B. Neonatal hemolytic anemia C. Genital herpes during labor D. Rh+ mother and Rh- fetus

Neonatalhemolytic anemia

Nurse Pain (see picture), who suffers from interstitial cystitis, proclaims a brilliant plan to consume enormous amounts of foods rich in potassium to ease the pain, like lots of bananas. You would tell Ms. Pain.... A. Go for it! Potassium surely fires up those bladder nociceptors until they burn out B. NO!! Avoid potassium and rich food

No

Where are the female sex hormones synthesized? A. Posterior lobe of pituitary B. Anterior lobe of pituitary C. Ovaries D. Adrenal medulla' E. Hypothalamus

Ovaries

What is most common site of endometriosis? A. Inside the myometrium B.ovary C. Fallopian tube D. Urinary bladder

Ovary

Spotting or light flow at times of mid cycle estrogen...

Ovulatory bleeding (pseudopolymenorrhea)

1 25 year old female presents to clinic with complaints of inability of becoming pregnancy. She and her husband have been having regular intercourses for 3 years without contraception. Her menses are irregular, occurring every 28-60 days. Physical exam reveals some facial and upper back hair as well as increased amount of pubic hair. Her waist line is 26 inches and there is pustular acne on her neck, forehead, and upper back. She also has dark pigmented area with a velvety quality in her axillae and on posterior neck. Pelvic palpation reveals multi-ocular masses in left and right lower quadrants, palpable and non tender. There is decreased levels of SHBG. BMI = 31 and hip.waist ratio is 0.86. **What is most likely cause of carousels inability to conceive?

PCOS

What condition is most likely associated with high BMI? A. Premenstrual dysphoric disorder B. PMS C. Endometriosis D. PCOS E. Interstitial cystitis

PCOS

A 25- year old sexually mature female with irregular menses presents at the Chiropractic Clinic with a 24 hour history of fever (1028F) and lower abdominal pain. The patient negates vaginal bleedings. The patient has a 6 year history of multiple sexual partners. Pelvic bimanual palpation reveals severely tender masses in both lower quadrants and intense pain on palpation of the cervix. What is the most probably differential diagnosis? A. PCOS B. Ovarian cancer C. PID D. Ectopic pregnancy

PID

Pelvic bimaual palpation reveals multi-modular masses in the left and right lower quadrants, palpated non tender with no fever. Suppose the examination revealed very tender/painful bilateral masses in both lower quadrants and high fever. What would be main differential in that case?

PID

What condition does NOT present with CPP? A. Endometriosis B. Interstitial cystitis C. PMS D. Pelvic adhesions E. Adenomyosis

PMS

What condition is managed with chiropractic adjustments, SSRI, magnesium supplementation, and tryptophan? A. PMS B. Endometriosis C. Interstitial cystitis D. PCOS

PMS

Which of the following are examples of xenoestrogens? A. Petrochemical pesticides and dioxins B. Estradiol and estrone C.goats and gymnena D. Metformin and danazol

Petrochemical [esticides and dioxins

What dos neonatal jaundice appearing day 1-2 after birth incidence? A. Cerebral palsy B. Hemolytic neonataljaundice C. Hepatic jaundice D. Physiologic neonataljaundice

Physiologic neonatal jaundice

What is an INCORRECT assessment of jaundice detected at the time of birth? A. Physiologic jaundice with only mild hyperbilirubinemia B. Hemolytic jaundice due to isoimmunization C. Life-threatening hyperbilitubinia possibly caused by rubles virus infection during pregnancy D. Hyperbilirubinemia possibly caused by maternal consumption of a tetraogenic during pregnancy E. Risk for kernicterus and cerebral palsy

Physiologic. Jaundice with only mild hyperbilirubemia

What are 2 serious pregnancy complications during the 3rd trimester? A. Miscarriage B. Extrauterine pregnancy C. Placenta Previta D. Premature rupture of membranes

Placenta prevai, premature rupture of membranes

HCG is produced by the _____ and is almost identical to ______. A. Placenta; LH B. Anterior pituitary gland; FSH C. Ovary; estrogen D. Corpus luteum; progesterone

Placenta; LH

Cycles less than 21 days is termed...

Polymenorrhea

Which sign of symptom is a positive sign of pregnancy? A. Morning sickness B. Positive HCG test C. Chadwicks sign D. Fatigue E. Abdominal enlargement

Positive HCG test

A pregnant woman in week 22 presents with elevation in blood pressure, edema, and proteinuria. What pregnancy-associated condition is most probable? A. Pre-eclampsia B. HELP syndrome C. Hyperemesis gravardium D. Gestational HTN E. Eclampsia

Pre-eclampsia

What is the most common cause of secondary amenorrhea?

Pregnancy

What is NOT a complication of ectopic pregnancy? A. Life threatening maternal hemorrhage B. Preterm delivery C. Chronic pelvic pain syndrome D. Risk for future ectopic pregnancy E. Infertility due to adhesion in the oviduct F. Spontaneous absorption

Preterm delivery

What is the leading cause of neonatal morbidity and mortality in the US? A. Hyperemesis gravidarum B. Preterm labor C. Isoimmunization D. Exrtrauterine pregnancy

Preterm labor

A women has primary amenorrhea due to failure of the granulosa cells to express LH receptors. Due to this malfunction what hormone cannot synthesize granulosa cells? *** A. FSH B. progesterone C. Estradiaol D. Nhibin

Progesterone

What withdrawal mechanism triggers a normal menstrual bleeding/endometrial shedding? A. Estrogen withdrawl B. Estrogen breakthrough C. Progesterone withdrawl D. Progesterone breakthrough

Progesterone withdrawl

In regulatory ovulatory cycles _____ produces and secreted by ____ converts estrogen-promised proliferative endometrium to secretory endometrium which sloughs predictably in a cyclic fashion if pregnancy does not occur. A. Progesterone; corpus luteum B. Estrogen; graffini follic;e C. FSH; anterior pituitary D. LH; anterior pituitary

Progesterone; corpus luteum

What feature of the female pubertal development requires androgens like DHEA and DHEA-S? *

Pubic hair growth

How does increased hCG and progesterone affect the uterus and the mother's blood pressure? A. Relaxation of the uterus; increased mother BP B. No effect on the uterus or the mothers bP C. Relaxation of the uterus; decreased BP D. Myometrial uterine contraptions; increases BP

Relaxation of uterus; decreased BP

A pregnant women experiences frequent, almost daily nausea and has two episodes of visiting for the past week. The onset of the symptoms occurred during the beginning of the 3rd week of gestation. What is the best clinical assessment? * A. Risk for ectopic pregnancy or blighted ovum B, insufficient increase in hCG C. Hyperemis gravidum D. Physiologic nause and vomiting of pregnancy

Risk of ectopic pregnancy and blistered ovum

What is/are risk factors for spontaneous abortion? A. SLE B. Uncontrolled diabetes mellitus C. Cigarette smoking D. Sexual activity during pregnancy E. Exercise during pregnancy F. Stress G.use of birth control prior to pregnancy H. Alcohol abuse I. Air travel J. Advanced maternal age K. HPV infection

SLE, uncontrolled Diabtes, cigarette smoking, alcohol abuse, advanced maternal age

Inflammation of the Fallopian tubes that can cause menorrhagia...

Salpingtitis

An obese 32 year old female with acne, facial hair, amenorrhea for 2 years wants to become pregnant. She does not use contraception. This is an example of... A. Secondary amenorrhea B. Oligomenorrhea C. Primary dysmenorrhea D. Preeclampsia E. Menorrhagia

Secondary amenorrhea

Jean, a 28year old woman has just given birth 6 months ago and is breast feeding her child. She has not had a period since giving birth. What does this most likely represent? A. Secondary amenorrhea B. Oligiomenorrhea C. Sheehans syndrome D. Severe stress postpartum

Secondary amenorrhea

Severe emotion stress is a cause of ...

Secondary amenorrhea

Which of the following is the best term for absence of 2 or more menstrual cycles in a womens during her reproductive years?

Secondary amenorrhea

Which of the following is the best term for absence of two or more menstrual cycles in a woman during her reproductive years? A. Primary dysmenorrhea B. Secondary amenorrhea C. Polymenorrhea D. Oligomenorrhea

Secondary amenorrhea

How is chronic pelvic pain (CPP)-related dysmenorrhea different from the most common form of dysmenorrhea, primary dysmenorrhea?

Secondary is manifestation of pelvic pathology

During or after labor and delivery, the mother may suffer ischemia necrosis of the pituitary gland due to blood loss and hypovolemia leading to permanent hypopituitarusm. What is the name os this obesity complication? **

Sheehans syndrome

What are 2 pregnancy complication during the first trimester? A. Spontaneous absorption B. Extrauterine pregnancy C. Premature labor D. Premature rupture of membranes

Spontaneous abortion and extrauterine pregnancy

Explain the pharmacologic mechanism for why oral contraceptives may relieve the pain of endometriosis.

Suppression of hypoathlamic pituitary system

What happens after fertilization of an egg?

The fertilized egg finished meiosis 2

In what situation is anovulatory menstrual bleeding considered a physiological phenomenon? A. The first few years after menarche B. A sexually immature 19-year old woman C. Polycystic ovary syndrome D. Prepubertal girls

The first few years after menarche

A woman, 10-weeks pregnant, experiences vaginal spotting bleedings without uterine contractions nor cervical dilatation. TVU shows intrauterine pregnancy and fetal heart activity. What is the best assessment? A. Ectopic pregnancy B. Threatened aborption C. Amnebryonic pregnancy D. Missed aborption

Threatened absorption

T/F: Women with chronic pelvic pain often suffer from endometriosis and interstitial cystitis.

True

To which organ do the Fallopian tube, endometrium, and cervix belong to?

Uterus

1 25 year old female presents to clinic with complaints of inability of becoming pregnancy. She and her husband have been having regular intercourses for 3 years without contraception. Her menses are irregular, occurring every 28-60 days. Physical exam reveals some facial and upper back hair as well as increased amount of pubic hair. Her waist line is 26 inches and there is pustular acne on her neck, forehead, and upper back. She also has dark pigmented area with a velvety quality in her axillae and on posterior neck. Pelvic palpation reveals multi-ocular masses in left and right lower quadrants, palpable and non tender. There is decreased levels of SHBG. BMI = 31 and hip.waist ratio is 0.86. * what is best plan for initial management? (2) A. Weight loss through dietary modifications and regular aerobic exercise B. Chiropractic adjustments C. Metformin

Weight loss and adjustments

In what condition does endometrial tissue exists within and grows into the uterine wall?

adenomyosis