Gyne

Question 1

COCP Risks/Benefits

Answer 1

risks:

• +3-4x VTE (1/10, 000)
• 3x MI & 2x CVA (when >50ug estrogen)
• GB dz
• breast ca (increase from 2/1,000 to 3/1,000)

benefits:

• cycle regulation, decreased flow,
• +BMD
• decrease dysmenorrhea/PMS/ance/hirsutism/endometrial/ovarian ca, decrease risk fibroids/ovarian cysts/benign breast dz/colorectal ca.

side effects: irreg bleeding, breast tenderness, nausea, wt gain, mood changes

Question 2

Starting COCP and continuous use schedule

Answer 2

starting: 1st Sunday of period, if started >5d from LMP, use backup for 7d.

Continuous Use: continue until breakthrough bleed or 4 packs (84 days). Breakthrough decreases over time.

Question 3

How long to use backup methods when starting contraceptives.

Answer 3

• ~7 days for most contraception devices (none needed for copper IUD)
• Backup only needed if starting >5 days after starting menses

Question 4

Progestin-only contraception risks/benefits/contraindications

Answer 4

contraindications:

• pregnant
• unexplained VB
• current breast Ca
• evere cirrhosis, active viral hep, hepatic adenoma

risks:

• delayed fertility (9 mo)
• decreased BMD
• irreg cycle
• wt gain, mood

benefits:

• 70% amenorrhea @ 24 months
• decreased endometrial ca
• decreased PMS, pelvic pain

Question 5

How to rx micronor

Answer 5

• rx 1st day of menstrual cycle
• take at same time daily (within 3h)
• if started >7d after LMP, use backup x 7d

Question 6

Managing irregular bleeding on micronor

Answer 6

• add NSAID
• change to COCP
• supplement estrogen

Question 7

IUD Contraindications

Answer 7

• pregnancy
• recent PID/STD (within 3 mo)
• puerperal sepsis
• distorted uterine cavity
• unexplained VB
• cervical/endometrial ca
• breast ca (Mirena)

Question 8

Side-effects of hormonal IUD’s

Answer 8

• headaches
• nausea
• hair loss
• breast tenderness
• depression
• decreased libido
• ovarian cysts
• 70% become amenorrheic at 2 years
• Greater chance PID during first 20 days, low afterwards
• Greater risk ectopic, but lower overall as fewer pregnancies

Question 9

Definitions of Ameorrhea

Answer 9

• Primary: absence of menarche by age 16 (investigate by age 14)
• Secondary: absence of menstruation for 3 or more months in women with past menses.

Question 10

Amenorrhea Workup

Answer 10

• FSH, Prolacin, TSH, pregnancy test, ultrasound.
• High Prolactin + Low FSH = CT/MRI brain
• High FSH = karyotype (if not peripmenopausal)

Question 11

Causes of Amenorrhea

Answer 11

Hypogonadotropic hypogonadism

• Hypothalamic:
  
  • constitutional delay
  • congenital: i.e. Kallman’s
  • Stress/weight loss/exercise
• Pituitary:
  
  • trauma
  • empty sella: Sheehan, apoplexy, radiation
  • craniopharyngioma
  • Hypothyroidism
  • adenoma: retro-orbital headache, bitemporal hemianopia, high prolactin
  • high prolactin
    
    • T4-T6 piercings, breast lesions, dopamine receptor antagonists

Hypergonadotropic hypogonadism

Ovarian:

• high FSH
• Primary: Turner’s, steroid enzyme deficiencies
• PCOS

Eugonadotropic causes

• Outflow tract: agenesis, 46, XY with peripheral androgen insensitivity, synechiae, transverse vaginal septum, imperforate hymen

Question 12

Menopause

Answer 12

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