OBGYN Flashcards
CIN types
CIN 1: mild, lower 1/3
CIN 2: moderate, lower 2/3
CIN 3: severe, over 2/3
Gardasil vaccine
Recommended at age 11-12 (from Hannah’s quizlet)
Age 9-14: 2-dose - 0 months and 6-12 months OR 3-dose - 0, 2, 6 months
Age 15-45: 3-dose (0, 2, 6 months)
(from Epperly’s slides)
Cervical cancer screening
Start at age 21
Pap every 3 years until 30
Pap & HPV every 5 years from 30-65 OR pap only every 3 years
When to stop screening for cervical cancer?
65+
No hx of moderate or severe dysplasia
3 negative paps in a row
Pap smear results
ASCUS (undetermined significance)
ASCH (cannot exclude high-grade lesion)
LGSIL (low-grade squamous intraepithelial, corresponds to CIN 1)
HGSIL (high-grade squamous intraepithelial, corresponds to CIN 2/3)
AGC (atypical glandular cells)
Treatment of ASCUS
Repeat paps every 6 months until normal
Next step for LGSIL and HGSIL
Colposcopy and biopsy
Treatment of CIN 1
Expectant management
2 paps every 6 months or pap & HPV test every 6 months
Treatment of CIN 2 or 3
Surgical procedure
HPV strains most correlated with cervical cancer
16, 18, 45
S/S of cervical cancer
Abnormal vaginal bleeding
*Postcoital bleeding
Treatment of cervical cancer
Radical hysterectomy and lymphadenectomy
Most common gyn malignancy
Endometrial cancer
Risk factors for endometrial cancer
Unopposed estrogen
Obesity
Risk reduction for endometrial cancer
Combo OCP use
Smoking
S/S of endometrial cancer
Abnormal uterine bleeding
MCC of endometrial cancer
Adenocarcinoma
Diagnosis of endometrial cancer
US first
Biopsy
Treatment of endometrial cancer
Total hysterectomy with bilateral salpingo-oopherectomy
Lactational amenorrhea
Exclusive breastfeeding leading to amenorrhea and contraception
MOA of OCP
Ovulation suppression
Benefits of combination OCP use
Reduced endometrial and ovarian cancer
Increase bone mass
Acne improvements
Dysmenorrhea improvement
SE of combo OCP use
VTE
Cervical dysplasia
Breast cancer
CI of combo OCP use
Migraines with aura
Smokers over 35
Hx of VTE
Hx of breast cancer
CI for progestin only OCP use
breast cancer
Paragard characteristics (Copper IUD)
Every 10 years
Non-hormonal
Nexplanon characteristics (implant)
Every 3 years
Progesterone only
Depo characteristics (injection)
Every 3 months
Progesterone only
IUD characteristics
Progesterone only
Cystocele
Protrusion of the bladder into anterior vagina
S/S of pelvic organ prolapse
Fullness and pressure (“falling out” sensation)
Pelvic pain
Urinary incontinence
Straining
worse with prolonged standing
better with lying down.
Uterine prolapse
Descent of uterus into the vagina
grading for uterine prolapse
grade 0: no descent
grade 1: descent into upper 2/3 of vagina
grade 2: cervix approaches introitus
grade 3: cervix outside introitus
grade 4: uterus outside vagina
Rectocele
Protrusion of rectum into posterior vagina
Enterocele
pouch of douglas small bowel herniating into upper vagina.
Treatment of pelvic organ prolapse
Pessary
Kegels
Surgical treatment (hysterectomy)
Estrogen for vaginal atrophy
Dysmenorrhea
Painful menstruation
Etiology of dysmenorrhea
- primary = increased prostaglandins
- secondary = pelvis/uterus pathology (endometriosis, PID, ect. )
Treatment of dysmenorrhea
NSAIDs
Hormonal contraceptives
if unresponsive to 3 cycles of initial therapy, consider laparoscopy.
When does PMS/PMDD tend to occur
1-2 weeks prior to menses lasting until 2nd/3rd day of menses
S/S of PMS and PMDD
HA
Fatigue
Breast tenderness
Bloating
Abdominal pain
Mood swings
Irritability
PMS vs PMDD
PMS: cluster of physical, behavioral and mood changes with cyclical occurrence during the luteal phase of menses
PMDD: Severe PMS presenting with clear functional impairment and predominant psych symptoms
Treatment of PMS/PMDD
Mild: behavioral modifications and symptomatic tx
Severe: SSRIs and OCPs
Menorrhagia
Heavy bleeding
Hypomenorrhea
Light bleeding
Metrorrhagia
Bleeding between normal menses
Polymenorrhea
Menses occurring too frequently
Menometrorrhagia
Bleeding with irregular intervals and amount
Oligomenorrhea
Menses occurring too infrequently
What is a common underlying cause of dysfunctional uterine bleedig
- anovulation: ovaries producing estrogen but not ovulation (corpus luteum)
- unopposed estrogen leads to endometrial growth and shedding.
what physical exam findings may be present in dysfunctional uterine bleeding
- abnormal bleeding with normal exam
- mass or enlarged irregular uterus (leiomyoma)
- symmetrically enlarged uterus (adenomysosis or endometrial cancer)
Evaluation of dysfunctional uterine bleeding (DUB)
Pelvic US
Endometrial biopsy
Hysteroscopy
when is endometrial biopsy warranted in dysfunctional uterine bleeding
to rule out cancer in all women >35 with obesity, HTN, or DM with postmenopausal bleeding.
Treatment of DUB 2/2 acute hemorrage
- IV estrogen (premarin)
- observation and COC’s
- refractory = IUD
- definitive = hysterectomy
Treatment of postmenopausal DUB
Hormones
US
Hysteroscopy
Menopause
No period for 12 months
What are the stages of menopause
- climacteric (phase transitioning from reproductive -> non-reproductive)
- menopausal transition (phase when menstrual cycle is irregular, lasts 1-3 years.)
- menopause (final menstrual cycle occurs)
- postmenopause (after menopause)
What is considered premature menopause
prior to age 40
Hormone levels in menopause, consider effects on:
LH, FSH, Inhibin, estrogen, progesterone, androstenedione, sex hormone binding globulin, and testosterone.
Low inhibin
Increased FSH and LH
Decreased estrogen (greatest decreased in estradiol!)
Decreased progesterone
decreased androstenedione
decreased testosterone
decreased sex hormone binding globulin
basically everything decreases except LH and FSH. (these rise because there is no negative feedback from estrogen and progesterone)
S/S of menopause
Hot flashes
Mood swings
Vaginal dryness
Hair loss
When does a female have the most oocytes
As a fetus at 20 weeks gestation. (7 million)
just fun fact:
7 million at 20 weeks
1-2 million @ birth
300,000-500,000 at puberty
Treatment of menopause
Vaginal moisturizer
Estrogens
Known risks of hormone replacement
Endometrial cancer
Breast cancer
Clots
1st line tx for vasomotor menopause sx (hot flashes)
Transdermal estrogen
what if the tx of hot flashes if trasndermal estrogen is CI
progestin alone
SSRI or SNRI
black cohosh
gabapentin
clonidine
Pros and cons of combination hormone therapy
for menopause
Pro: adding progesterone to estrogen decreases risk of endometrial cancer rather than just unopposed estrogen
Con: addition of progesterone to estrogen increases risk of breast cancer
If patient has intact uterus ___
(menopause treatment)
Must do combo estrogen and progesterone
what occurs as a result of atrophic vaginitis
loss of lactobacillus which converts glucose to lactic acid leading to an increase in vaginal pH of 5-7
what is the first line INITIAL treatment for atrophic vaginitis
vaginal moisturizer
what is the treatment of moderate/severe atrophic vaginitis if vaginal moisturizer fails.
topical vaginal estrogen
aside from vaginal moisturizer and vaginal estrogen, what are the other options for tx of atrophic vaginitis
- prasterone suppository (converts androtest and test -> estrone and estradiol. )
- ospemifene oral (mimics estrogen but causes hot flashes)
- testosterone 1-2% cream (if estrogen CI)
Actions of estrogen
Endometrial proliferation
Development of secondary sex characteristics
Increased vaginal lubrication
Actions of progesterone
Decrease uterine contractility
Promotes breast development
Falling levels trigger menses and lactation
Major hormone of pregnancy
Progesterone
Etiology of pelvic inflammatory disease
Polymicrobial
gonorrhea, chlamydia, mycoplasma genintalum
S/S of PID
Lower abdominal pain
Cervical motion tenderness (chandelier sign)
Fever
Treatment of PID
Rocephin + Doxy + Flagyl
