Treatments 6 Flashcards
(94 cards)
Central precocious puberty
Continuous GnRH
Pseudoprecocious puberty
Remove tumor, cortisol replacement for CAH
Pros of HRT for menopause
Control symptoms
Reduced risk of osteoporosis
Reduced risk of colorectal cancer
May decrease coronary calcification if taken age 50-59 (unknown correlation w/ cardiac disease)
Cons of HRT for menopause
Increases risk of invasive breast cancer, endometrial cancer (NO estrogen w/o progesterone if woman still has uterus)
Increases risk of stroke, heart disease, hypercoagulability, biliary disease
Non-HRT options for hot flashes
Desvenlafaxine, venlafaxine
Clonidine
Gabapentin
Time
Menopause treatment
Vaginal lubricants (dyspareunia)
Calcium, vitamin D, bisphosphonates, weight bearing exercise (osteoporosis risk)
SERMs (tamoxifen, raloxifene) (osteoporosis risk)
Emergency contraception
High dose OCPs (lots of AE) Levonorgestrel (Plan B, just progesterone) Copper IUD (insertion w/i 4-5 days of intercourse) Mifepristone (RU 486) (low dose, high dose for abortion)
Pros of OCPs
Reliable
Reduce risk of endometrial and ovarian cancer
Decreased incidence of ectopic pregnancy
Menses lighter, more regular, less painful
C/I for OCPs
Pregnancy
History of DVT/PE/hypercoagulability disorder
History of estrogen-dependent tumor
History of stroke or CAD
Poorly controlled HTN
Smokers >35 yo
Hepatic disease or neoplasm
Abnormal vaginal bleeding of unknown etiology
Migraine w/ aura, neuro sx or vascular involvement
Amenorrhea, behavioral
Behavior modification (eating, exercise)
Amenorrhea, anatomic
Surgical correction
Amenorrhea, HPO dysfunction
Leuprolide (GnRH agonist), pulsatile
Amenorrhea, prolactinoma
Dopamine agonists (bromocriptine, cabergoline)
Dysmenorrhea
NSAIDs, OCPs
PMS, PMDD
NSAIDs, OCPs
Vitamin B6, SSRI +/- alprazolam, exercise, progestins
Endometriosis
OCPs, progestins, GnRH, NSAIDs, (danazol)
Laparoscopy
Definitive = hysterectomy + b/l salpingo-oopherectomy
Abnormal uterine bleeding
Treat cause
NSAIDs, OCPs
Endometrial ablation / hysterectomy
When to get endometrial biopsy w/ abnormal uterine bleeding
Patient >45
Patient w/ multiple risk factors for endometrial cancer
Patient w/ persistent AUB >6 months
PCOS
Exercise, weight loss OCPs (or at least progesterone by itself) Spironolactone Metformin Consider statin, acne meds as needed
PCOS if patient wants to get pregnant
Clomiphene (antiestrogen, acts at hippocampus)
Pelvic prolapse
Mild - pelvic floor exercises
Moderate - pessary
Severe - surgery
Uterine fibroids (leiomyomas)
Asymptomatic - observation
GnRH agonists (temporary), OCP/IUD (for bleeding)
Myomectomy, hysterectomy, UAE
Endometrial cancer
TAH w/ bilateral salpingo-oopherectomy and LN sampling
Progestins to maintain fertility then surgery after finished
Add chemo/radiation for mets
Cervical cancer
Microscopic (<5 mm): TAH or conization
Visibly invasive: radical hysterectomy + lymphadenectomy
Major invasion/mets: radiation + chemo