what are the initial tests for primary amenorrhea
- HCG (pregnancy)
- TSH
- Prolactin
- FSH
- Pelvic ultrasound (uterus?)
maximum use time of HRT?
what precautions do I need to take?
what are some contraindications?
5 yrs
IF UTERUS PRESENT: also administer progesterone
Contraindications:
- estrogen-dependent carcinoma (breast/endometrium)
- history of pulm. embolism or DVT
🚩 postcoital bleeding?
cervical cancer until proven otherwise
AUB: when is an endometrial biopsy indicated?
- Any postmenopausal bleeding
- AUB women >45
- AUB women <45
- BMI>30
- chronic estrogen exposure
- failed management of AUB
- high risk of endometrial cancer
- Atypical glandular cells on PAP
PALM-COEIN
Polyp
Adenomyosis
Leomyoma
Malignancy/Hyperplasia
Coagulopathy
Ovulatory disfunction
Endometrial
Iatrogenic/Inflamation/Infection
Not yet classified
🚩 postmenopausal bleeding? best initial test
endometrial cancer until proven otherwise
best initial test: endometrial BIOPSY!
contraindications of OCPs
- history of migraine with aura
- hypertension
- smokers >35
what is the active component of the contraceptive intramuscular injection?
depot medroxyprogesterone acetate
first-line contraceptive option offered to all women
IUD (mirena) - levonorgestrel (progesterone)
first-line for emergency contraception
Copper IUD
wet mount: clue cells =
bacterial vaginosis (Gardnerella vaginalis)
wet mount: motile flagellates
trichomonas vaginalis
wet mount: hyphe
candidiasis
🚩 red lesion with superficial white coating in the vulva
Paget disease (intraepithelial neoplasia)
dx: bipsy
tx: vulvectomy
what is the most common type of vulvar cancer? #2? #3?
Squamous cell carcinoma
Melanoma
Sarcomas
danazol
androgen derivative used to treat endometriosis
associated with acne, oily skin, weight gain, hirsutism
lupron / leuprolide acetate
GnRH agonist -> supresses estrogen
associated with hot flashes and decreased bone density
