Reproductive Flashcards
What is the best procedural treatment for removal of uterine fibroids in women who wish to become pregnant?
Myomectomy.
Side note: uterine embolization is another treatment for fibroids, but it should not be considered in women who desire to become pregnant. The benefits over myomectomy are decreased bleeding and shorter hospital stays.
What are first line agents for induction of ovulation in women with PCOS who desire to become pregnant?
Metformin and clomiphene, alone or in combination, as well as rosiglitazone
Is pelvic ultrasonography required for a diagnosis of PCOS?
No, it is mostly a clinical diagnosis. “Pelvic ultrasonography can be performed to evaluate for ovarian neoplasm or polycystic ovaries, although PCOS is a clinical diagnosis and ultrasonography has a low sensitivity.”
What medication is indicated for management of PMS in patients who do not want to take estrogen or progesterone?
Randomized, controlled trials found that luteal-phase spironolactone improved psychological and physical symptoms of premenstrual syndrome over 2–6 months compared with placebo.
In a woman with a negative Pap but positive HPV test that is negative for serotypes 16 and 18, what is the recommendation?
Pap and HPV testing in 1 year. If the HPV test is still positive, she should have a colposcopy done, even if it is not serotypes 16 or 18. If the 16 or 18 HPV test is positive, that is also an indication to get an immediate colposcopy, even with a normal Pap.
What supplements have been shown to help with PMS?
Vitamin B6 and chasteberry
Which Pap test result is associated with a higher likelihood of indicating a cancerous lesion: Atypical glandular cells not otherwise specified (AGC-NOS) or High-grade squamous intraepithelial lesion (HSIL)?
Atypical glandular cells not otherwise specified (AGC-NOS) - 17% rate of being cancer vs 3% for HSIL.
PCOS is most associated with what type of cancer?
Endometrial
What has the best evidence for treatment of hypoactive sexual desire syndrome in women (criteria: (1) recurrent deficiency or absence of sexual desire or receptivity to sexual activity, and (2) distress about such a deficiency.)?
Topical testosterone
What is the treatment for menorrhagia due to endometrial hyperplasia without atypia in a woman who does not want a hysterectomy?
Progestational drugs. Progestins convert the proliferative endometrium to a secretory one, causing withdrawal bleeding and the regression of hyperplasia. The most commonly used form is cyclic oral medroxyprogesterone, given 14 days per month, but implanted intrauterine levonorgestrel is the most effective and also provides contraception.
What are the recommendations for backup contraception following the insertion of levonorgestrel IUD (e.g. Mirena)?
If the IUD is inserted more than 7 days after menstrual bleeding starts, the patient needs to abstain from sexual intercourse or use additional contraceptive protection for the next 7 days. If inserted within 7 days of the initiation of menstrual bleeding, no backup contraception is needed.
What is the best therapy for primary dysmenorrhea?
NSAIDs
What are the contraindications for a hormonal IUD?
Severe liver cirrhosis or liver cancer (can cause growth of hepatocellular adenomas) and women with breast cancer
How should hematospermia (blood in ejaculate) be managed in men under 40?
Hematospermia is usually benign and self-limited, so does not require further workup. Although STD testing is reasonable in sexually active males
