women's health

Question 1

primary amenorrhea

Answer 1

no menarche by age 15
needs referral

Question 2

secondary amenorrhea

Answer 2

3-6 months of amenorrhea
pregnancy is the most common cause
management depends on underlying cause

Question 3

first thing to do if no menses

Answer 3

pregnancy test

Question 4

causes of no menses

Answer 4

menopause
stress
obesity
anorexia
thyroid disorder

Question 5

menopause ages

Answer 5

ages 45-55

Question 6

symptoms of menopause

Answer 6

amenorrhea x 12 months
hormone changes
atrophic vaginitis
lichen sclerosis
weight gain
hot flashes
mood changes
dry skin

Question 7

lichen sclerosis

Answer 7

Lichen sclerosus is a condition that causes patchy, discolored, thin skin. It usually affects the genital and anal areas. Anyone can get lichen sclerosus but postmenopausal women are at higher risk. It isn’t contagious and can’t be spread through sexual contact.

Question 8

atrophic vaginitis

Answer 8

A condition in which the tissues lining the inside of the vagina (birth canal) become thin, dry, and inflamed. This is caused by a decrease in the amount of estrogen (a female hormone) made by the body. Symptoms of atrophic vaginitis include vaginal dryness, itching, and burning, and pain during sexual intercourse.

Question 9

complications of menopause

Question 10

If a woman goes through menopause and then has bleeding

Answer 10

she needs to have a biopsy

Question 11

atrophic vaginitis treatment

Answer 11

vaginal lubrication or moisturizers
or cream with hormones

Question 12

potential complications of menopause

Answer 12

increased cardiovascular risk and increased risk of osteoporosis

Question 13

Management of menopause

Answer 13

herbal supplements- black cohosh
hormone replacement therapy

Question 14

Hormone replacement therapy

Answer 14

should never be initiated lightly- has it’s own risks and its own complications

Question 15

pap smears

Answer 15

starts at age 21
age 21: every 3 years no cotesting
age 30: every 5 years with cotesting
age 65 can discontinue

Question 16

abnormal results pap smear

Answer 16

AS-CUS atypical squamous cells of undetermined significance- this means that there aren’t cancerous cells present, but the cells aren’t totally normal either.

These patients would follow up with HPV testing. If it is positive- we would refer them to gynecology for a possible colposcopy.

If any thing higher than that is noted, especially the high grade lesions- even the low grade LSIL and HSIL- refer for a colposcopy.

Question 17

How often should you perform a pap and HPV test? With normal and abnormal results, how often will you perform tests?

Answer 17

*
* Begin pap screening at age 21
* Ages 21-29: Pap every 3 years
* Ages 30-65, there are 3 options:
* Pap every 3 years
* Pap/HPV co-test every 5 years
* HPV alone every 5 years

Question 18

• Post menopause hormone therapy, benefits, and contraindications

Answer 18

• Benefits
• For women with a uterus: Estrogen + Progestin = less risk of endometrial CA
   Only use for < 5 years as risk of breast CA increases
   Use younger than 60 y/o
• For women s/p hysterectomy: Estrogen can alleviate dyspareunia (painful sex) and vaginal/urethral atrophy
• contraindications
• Estrogen only: increases the risk of developing/exacerbating SLE (lupus?)
• Estrogen + Progestin: increase risk of breast CA, CVA, CAD and PE
• Other contraindications: pregnancy, untreated HTN, liver disease, DVT, AUB

Question 19

Post hysterectomy patients, cervix intact or removed, when should they be screen for cervical cancer

Answer 19

• Cervix intact: continue regular screenings (pap every 3 years, HPV or Cotest every 5 years)
• Total hysterectomy(benign): may stop screening
• Total hysterectomy d/t CIN3 or AIS (adenocarcinoma in situ): requires HPV based testing at 3-year intervals for 25 years

Question 20

• Symptoms of menopause
  *

Answer 20

Menopause occurs in 100% of women
* Not all women experience s/s with menopause
* Symptoms Same as above
* Hormone therapy is the most effective treatment for VMS and GSM and prevents bone loss/fractures
* Paroxetine (Brisdelle) is the only non-hormonal med FDA-approved for VMS

Question 21

What screening test will you perform for a sexually active female and how often? What screening test will you perform for a non-sexually active female and how often?

Answer 21

*
* What screening test will you perform for a sexually active female and how often? (CDC)
* < 25 y/o: test for Chlamydia and gonorrhea annually
* > 25 y/o with risk factors such as new or multiple sex partners, or positive partner, should test annually
* What screening test will you perform for a non-sexually active female and how often? (CDC)
* Pap smear for all women >21 y/o

Question 22

• Abnormal uterine bleeding, causes

*

Answer 22

Causes:
* PALM: polyps, adenomyosis, leiomyoma, malignancy
 Adenomyosis: when the tissue that normally lines the uterus grows into the muscular wall of the uterus
 Leiomyoma: “uterine fibroids”, growths that appear in the uterus (benign and common up to 75-80% of people will have)
* COEIN: coagulopathy, ovulatory disorders/hormone changes, endometrial, iatrogenic, not classified
* Acute: episodes requiring intervention; Chronic episodes lasting > 6 months

Question 23

AUB what test will you perform:

Answer 23

pregnancy test (r/o miscarriage)
* CBC (evaluate hemodynamic stability)
* Coags
* STD tests/Wet prep (r/o STIs and vaginitis)
* Pap smear
* hormone levels, prolactin/estrogen/testosterone levels
* hysteroscopic exam of uterine lining (r/o fibroid, polyps and CA)
* 1st line imaging: Pelvic/transvag US (r/o tumors, PID)
* Endometrial Biopsy (r/o CA)
* MRI

Question 24

• What is the usual age of menopause?

Answer 24

45-55, AVG=51

Question 25

Post hysterectomy patients, cervix intact or removed, when should they be screen for cervical cancer

Answer 25

• Cervix intact: continue regular screenings (pap every 3 years, HPV or Cotest every 5 years)
• Total hysterectomy(benign): may stop screening
• Total hysterectomy d/t CIN3 or AIS (adenocarcinoma in situ): requires HPV based testing at 3-year intervals for 25 years