a women’s guide to gynecologic health
TRANSCRIPT
Objectives:
• Discuss normal gynecologic changes through the years
• Introduce important gynecologic conditions that may occur at each age group
• Discuss medical and surgical treatments of common gynecologic conditions
• Present important aspects of pregnancy
• Answer questions about gynecologic health that woman are afraid to ask their doctor
Puberty
• When is it to early/late?
• Menarche
• Hypothalamus-Pituitary-Ovary Axis
https://search.yahoo.com/yhs/search?p=HPO+axis&ei=UTF-8&hspart=mozilla&hsimp=yhs-003
Puberty: The Menstrual Cycle• Notes: Normal menses – q 21-34 d,
regular intervals, lose less than80ml, 5 days
• allaboutmedicalscience.blogspot.com
Adolescence
• Sexually transmitted infection (STI)
• Testing recommendations
• Signs and symptoms
• Prevention
• Treatment
• Safe Sex
Contraception• Long acting reversible contraceptives
– Intrauterine device (IUD)
• Mirena, Skyla, Paraguard
– Subdermal implant
• Nexplanon
• Progestin only contraceptives
– “mini” pill, Depo provera, Mirena IUD, Skyla IUD
• Estrogen and progestin contraceptives
– pill, patch or vaginal ring
• Permanent contraception
20’s/30’s/40’s
• - AUB treatment• - Expectant management• - Hormonal therapy• -Oral contraceptive• - IUD• - Surgical management• -Endometrial ablation• -Hysterectomy
20’s/30’s/40’s
• Abnormal uterine bleeding (AUB)
– Irregular menses
– Heavy menstrual bleeding
– Amenorrhea
– PALM COEIN• Polyp, Adenomyosis, Leiomyoma, Malignancy,
• Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified
20’s/30’s/40’s
• AUB treatment
• Expectant management
• Hormonal therapy
• Oral contraceptive
• IUD
• Surgical management
• Endometrial ablation
• Hysterectomy
20’s/30’s/40’s
• Adnexal Masses/Ovarian cysts
– Symptoms: Pelvic pain, pelvic pressure
– Treatment: Expectant or surgical
• Ovarian torsion
– Gynecologic emergency
20’s/30’s/40’s
• Endometriosis
– Symptoms• pelvic pain, dysmenorrhea, infertility
– Treatment• contraceptive, Lupron, surgery
• Adenomyosis
20’s/30’s/40’s
• Vaginal infections
– Bacterial vaginosis
– Vaginal yeast infection
• Prevention of recurrent vaginal infections
– Identify trigger
20‘s/30‘s/40’s
• Pelvic Inflammatory Disease (PID)
– Infection of the female reproductive organs
– Symptoms• Pain, fever, vaginal discharge, painful urination,
nausea/vomiting
– Causes• Untreated STI, surgical procedure, childbirth, abortion
– PID can result in infertility
20‘s/30‘s/40’s
• Fertility
– Peaks in 20’s
– Drops considerably at age 35
• Infertility
– No pregnancy after 1 year of unprotected intercourse
– Assisted Reproductive Technology (ART)
– Male factor infertility
20’s/30’s/40’s• Pregnancy
– Pre Pregnancy visit
– First trimester bleeding
– Nausea/vomiting
– Constipation
– Screening for gestational diabetes
– Tdap vaccination
– Flu shot
– Group B Strep testing
20’s/30’s/40’s
• Miscarriage
– Loss of baby prior to 20 weeks gestation
– 50% of pregnancies end in miscarriage
– 15% of recognized pregnancy end in miscarriage
– Cause usually not identified
20’s/30’s/40’s• Ectopic pregnancy
– Embryo implants somewhere other than the uterus
– Risk factors
• IUD, tubal ligation, PID, ART, damage to the fallopian tubes
– Symptoms
• Pain and vaginal bleeding with positive pregnancy test
– Treatment
• Methotrexate
• Surgery
– This can be a life-threatening problem.
Menopause
• Cessation of menses for at least 1 year without any other pathologic/physiologic cause.
• Primary ovarian insufficiency
• Perimenopause
• Symptoms
– hot flushes, irregular menses, mood changes, sleep disturbance
Menopause Hot Flushes 75-80% of menopausal women
Risk factors:
• Obesity• Smoking• Reduced physical activity• African-American>Caucasian
Treatment:
• Behavioral• Medication• Alternative therapy• Hormone replacement
therapy
Postmenopausal Bleeding
• Causes
– polyp, atrophy, fibroid, hyperplasia, cancer, source other than uterus
• Ultrasound
• Endometrial biopsy
• Treatment
– Medical versus surgical
Osteoporosis• Low bone mineral density that results in increase fracture risk
• Screening
– Dual-energy x-ray absorptiometry (DEXA)
– Age 65 or earlier with risk factors
• T score -2.5 SD is diagnostic
• Fracture Risk Assessment Tool (FRAX)
• Treatment
– Calcium and vitamin D
– Exercise
– Medications
Female Sexual Dysfunction
• 40% of women experience but only 12% report the problem
• Risk factors:
– Depression, anxiety, stress, fatigue, history of physical or sexual abuse, pathologic problem that may cause pain
• Causes:
– Medications, pelvic floor dysfunction, endocrine disorders, relationship problems, body image problems
• Treatment:
– Counseling, physical therapy, lifestyle changes,lubricants, devices, hormone therapy
Uterovaginal prolapse• Herniation of the pelvic organs to or beyond the vaginal
walls• Risk factors
– parity, advancing age, obesity and repetitive increases in intraabdominal pressure
• Symptoms– pelvic pain, pelvic pressure/bulge in vagina, void and
defecation problems• Treatment
– Expectant, pessary, pelvic floor physicaltherapy, surgery
Urinary incontinence
• Stress urinary incontinence
• Urge urinary incontinence
• Treatment
– Physical therapy, medication, surgery