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