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199 Cards in this Set

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What are some symptoms of reproductive system disorders?
Abnormal growth and development
Abnormal bleeding
Amenorrhea
Abdominal/genital pain
Vaginal itching, burning, odor
Vaginal/penile dishcarge, ulcers, blisters
Infertility, reproductive failure
Dyspareunia, impotence
dysuria
What are some disorders of the external genitalia?
vulvitis, folliculits, bartholins's cyst and abscess, epidermal cysts, nevi, vulvar dystrophy, vulvodynia, cancer
What are nevi?
Moles, a benign grwoth of the labia. Be sure to distinguish this from a melanoma
What are papillae?
Bumps that do not feel rough. These are normal!
What causes cervicitis?
-Acute- candida, chlamydia, genorrhea, trichomonas
-Chronic- eversion, post childbirth, post procedure
-stenosis- post procedre, post menopause
What causes satellite lesions?
Yeast
How dod you treat a yeast infection?
use antifungal with topical steroid to reduce inflammation to stop the itch cycle. Don't use the steroid cream for weeks, bring the pt back in
What is cervicits?
Inflammation of the cervix- when you touch it with a q-tip, it bleeds
What will the cervix look like with trichomonas?
strawberry cervix
What is eversion?
exposed columnar epithelium. Could be caused by child birth
What do you look for in a wet prep of cervicitis?
WBCs too numerous to count. You will get this from the posterior fornix
What are cervical polyps?
extrusion of columnar epithelium outside of the cervix, like a teardrop that extends out of the cervical os
What is the most common benign neoplastic growth of the cervix?
cervical polyps
If polyps are symptomatic, what will that symptom be?
bleeding after activity or sex
How do you get rid of a polyp?
Put sponge tip on it, grasp as close to the cervix as possible, twist until it comes off. Won't hurt b/c no nerve endings. Send to lab but cancer risk is very very small
What are some disorders of the uterus?
endometritis, endometriosis, adenomyosis, endometrial cancer, leomyomas
What is the most common pathogenesis of endometriosis?
Retrograde menstruation that goes up and out of the fallopian tubes and fall into bottom of the pelvis. Can be found everywhere (even lung, diaphragm)
What hormone is endometriosis dependent on?
**Estrogen**
What are some other pathogenesis of endometriosis?
-hematogenous or lymphatogenous transport
-coelomic metaplasia
-Estrogen dependent
What are some of the "variable and unpredictable" manifestations of endometriosis?
-dysmenorrhea, chronic pelivic pain, dysparaunia, uterosacral ligament nodularity, adnexal mass
-infertility (?) mild- moderate, may not be the direct cause
-asymptomatic
*What is the triad of endometriosis?*
Dysmenorrhea, dyspareunia (painful intercourse), dyschezia (painful defecation)
What symptoms might you see with endometriosis?
-secondary dysmenorrhea
-deep dyspareunia
-sacral backache with menses
-Pain or dysfuntion of organ involved
-Pain related to depth of lesion, arises from peritoneal surfaces innervated by peripheral spinal nerves (not ANS)
How do you dx endometriosis?
With visual inspection (laparoscopic exploration). however, it might not be seen since ectopic implants can be all different colors. Due to this, treat empirically and don't wait
What is the classic sign of endometriosis?
Powder burn pattern on uterus- dark spots, but can be other colors. If uterus bleeds, these spots bleed too no matter where they are!!!
How do you treat endometriosis?
With GNRH agonists
-Lupron- shuts down endogenous hormones. Doesn't pulse like GNRH so shuts it down
-Leads to menopause, vaginal dryness, hot flashes
-Should not use for longer than 6 months- hoping to put disease into regression to obtain pregnancy
-can dx by seeing if gets better on this drug
-the risk of prolonged treatment is osteoporosis, unless add back just enough estrogen to keep bones strong
What is adenomyosis?
extension of endometrial glands and stroma into the uterine musculature
-endometrium has grown into muscle of uterus so when have period, bleed into the muscle
What symptoms might a pt with adenomyosis complain of?
Midline, deep dysparaunea
Spongy, tender uterus
Might have slightly enlarged uterus
Many women will be asymptomatic
Dysmenorrhea
What population is more prone to adenomyosis?
over 40 years old
What is the cure for adenomyosis?
no cure, might get a hysterectomy
-might multicycle on OCs to decrease the number of bleeds per year
What is adenomyosis?
extension of endometrial glands and stroma into the uterine musculature
-endometrium has grown into muscle of uterus so when have period, bleed into the muscle
What symptoms might a pt with adenomyosis complain of?
Midline, deep dysparaunea
Spongy, tender uterus
Might have slightly enlarged uterus
Many women will be asymptomatic
Dysmenorrhea
What population is more prone to adenomyosis?
over 40 years old
What is the cure for adenomyosis?
no cure, might get a hysterectomy
-might multicycle on OCs to decrease the number of bleeds per year
What are leiomyomas?
-benign uterine wall neoplasms of smooth muscle origin, oftern referred to as fibroids
-"fireballs"
What are the 3 types of leiomyomas?
submucosal
subserosal
intramural
What are some characteristics of submucosal leiomyomas?
-Cause issues with bleeding
-Distort the lumen of the uterus
-Can get very large
-**Almost always benign**
-Occur more in African American women, 30% will have this by age 30
-Most tend to get bigger in pregnancy
How do submucosal leiomyomas present? What is the classic presentation?
-Present with painless, heavier bleeding at time of the menstrual cycle
-Classis is woman coming in saying period is getting heavier and longer --> pain eventually and more bleeding
-Can cause pressure on rectum, bladder problems and bladder capacity
What will you do for a woman with submucosal leiomyoma?
Try to control bleeding and watch fibroids for growth
Watch for serial growth with bimanual every 6 months during reproductive years, US (to confirm where and how big, gives an index of what the mass is made of)
Intervene if there is an acceleration in growth
What does Ca125 screen for?
Cancer recurrence, this is not a cancer screening test
What is endometrial hyperplasia?
overabundant growth of the endometrium generally caused by persistent levels of estrogen unopposed by progesterone
What are the two populations most at risk for endometrial hyperplasia? How would you treat them?
1. Menopausal women b/c they are not ovulating to produce progesterone. Might give progesterone one time to induce a heavy bleed. Perform a biopsy and then cycle her.
2. Chronic anoculator, PCOS. Give OCs or progesterone
When MUST a woman have a biopsy?
**If have not had a period for a year and starts to bleed or if US and transendometrial thickness is 5 mm or greater**
What might endometrial hyperplasia lead to?
Atypia (atypical cells) and then to cancer
What does the woman need if atypia leads to dysplasia?
a D&C
What symptoms will a woman with an endometrial polyp have? How might it be detected? How could you remove it?
-spotting with activity
-US can pick it up
-might be able to get it out with endometrial pipette
What are some structural gyn disorders?
-imperforate hymen
-Double vagina
-2 uterus
What are the two types of ovarian cysts?
Can be follicular (build up of fluid in first half of cycle) or corpus luteum (in second half of cycle, more painful, tend to be recurrent and might become hemorrhagic)
How do you treat an ovarian cyst?
Stop by stopping ovulation with OCs
What is an ectopic pregnancy?
a gestation that implants outside of the endometrial cavity- serious!
What drug might you give to a woman with an early dx of ectopic pregnancy?
methotrexate, make sure HCG levels go down. She must understand the risk of tubal rupture
What is hydrosalpinx?
fluid filled tube, normally follows infection of the fallopian tube
Name three disorders of pelvic support and uterine position.
cystocele
rectocele
uterine prolapse
What is a cystocele?
the bulging or descent of the bladder into the upper anterior vaginal wall
They are graded from 1-4- beyond level 1 will compromise bladder function
How do you see a cystocele?
Use the bottom blade of the speulum, ask pt to bear down, will see ascent and extrusion of the upper vaginal wall (you can grade this)
What is a pessary?
A mechanical device inserted into the vagina to hold the uterus up
What is a rectocele?
Lower posterior vaginal wall prolapse
-elevation and protrusion of posterior vaginal wall with speculum on top vaginal wall
What should you do for a pt with a rectocele?
-High fiber diet, stool softener
-repair is not great
What is the etiology of pelvic organ prolapse?
-Caused by denervation of pelvic floor muscles and/or disruption of the endopelvic fascia
-a break or weakness anywhere in the pubocervical or rectovaginal fascia results in prolapse
What is an enterocele?
Upper posterior vaginal wall prolapse nearly always associated with herniation of the pouch of douglas and likely to contain loops of bowel
What are symptoms of a cystocele?
-vaginal discomfort/pain
-stress urinary incontinence
-urinary retention/bladder outlet obstruction
What are symptoms of a rectocele?
-Vaginal pressure, discomfort
-Protrusion from the posterior vaginal wall
-Difficulty evacuating the rectum
-Need to reposition during bowel movement
What are symptoms of an enterocele?
-pelvic or vaginal pressure
-difficulty evacuating the rectum and emptying the blader
-lower back pain/discomfor which worsesns as the day progresses
-increased pain/discomfort with prolonged standing which is relieved by lying down
What is vaginal vault prolapse?
inversion of the vagina
-may be seen after vaginal or abdominal hysterectomy
-represents failure of the supports around the upper vagina
What are the symptoms of vaginal vault prolapse?
-pelvic or vaginal pressure
-difficulty evacuating the rectum and emtying the bladder
-lower bacl pain/discomfort which worsens as the day progresses
-increased pain/discomfort with prolonged standing relieved by lying down
What is the primary cause of acute cercicitis? Next?
Primary is chlamydia (treat with doxycycline or azithromycin) then gonorrhea
If bartholin gland abcess, what is probably the causative agent?
chlamydia.
NOTE that abcess grows quickly
What is a dermoid cyst?
common, embryonic germ cell layers, might have teeth, hair, etc
What should you tell people with ovarian cysts?
Their ovaries are unbalanced and the one with the cyst might twist on itself, causing extreme pain. This is an emergent situation
What part of the breast is most significant for disease?
Tail of spence followed by underneath the nipple
What is thearchy?
The development of the breast at puberty. Starts with breast bud under areola. Ductal system develops under the influence of estrogen
What happens to the breasts during the nestrual cycle?
Ductal and alveolar growth
going on/off hormones contributes to nodules in breast- fibroids are normal
Where is prolactin secreted from?
Anterior pituitary
What happens to the breasts in menopause?
-lobules regress
-glandular tissue replaced with fat
When are mammograms recomended?
after age 40
name some benign breast conditions?
lipoma, fibroadenoma, intraductal papilloma, mastalgia, galactorrhea
What does the montgomery gland do?
produces secretion, moisture for the nipple
What are lipoma?
fatty tumors
soft, superficial, no discrete border
Normally don't have to remove unless bothersome
How do you rule out cancer of any breast mass?
histologically- don't know what something is make of unless biopsy and evaluate
What are fibroadenoma?
Solitary mass 2-4 cm in size that are well circumscribed (this doesn't mean borders are smooth)
-comes from glandular epithelium
-firm, rubbery feeling
Who are more likely to get fibroadenomas?
More commin in African-American women
mass in woman under age 25 is almost always this
recurrence rate is 10-20%
How do you assess a fibroadenoma?
With breast imaging- US or mammogram depending on the radiologist
What is an intraductal papilloma?
nodule near areola that is associated with nipple discharge
What will be the symptoms of an intraductal papilloma?
-nipple discharge (might be bloody which is more alarming), could be intermittent or constant
- fullness/ tenderness below the nipple prior to expressing discharge
How do you assess for intraductal papilloma? Diagnose?
around the clock palpation of the areola with pressure directed in the direction of teh nipple to determine where discharge is coming from
-75% of nipple discharge in women not pregnant or lactating is due to this
-send for breast imaging and histological dx
-diagnosed by ductogram followed by excisional biopsy
What causes intraductal papilloma?
proliferation of duct epithelium
Who is most likely to get intraductal papilloma?
women in 40s
What are the two types of fibrocystic change?
mastalgia
nodularity
What is the best time for a breast exam? Worst?
Best= on period
worst= right before
What is "fibrocystic change"?
-This means that you don't know what you are feeling and NOT benign
-be careful documenting this b/c women have been denied insurance
-no distinct mass, maybe an area of thickness that you want to follow
What influences fibrocystic change? What part of the breast is more affected?
-Increased by menses, hormonal changes that are not altered, ductal alveolar growth and increased vascularity
-upper outer quadrant more affected
What has been seen to decrease the incidence of benign breast disease?
oral contraceptives
What is mastalgia?
Breast pain (burning, tenderness) caused by endogenous or exogenous hormones
What are some causes of mastalgia?
-hormonal- common in first few months of OCs or in pregnancy
-trauam
What are different treatments for mastalgia? What should you consider?
-support bra (not underwire)
-combined OCs (if cyclic)
-Danazol- extreme! causes early menopause and refer them out
-Tamoxifen- chemo, extreme
-Bromocriptone- use din past for nipple discharge
Vitamin E- little data
NOTE consider breast imaging
Dietary reduction of methylxanthines
What is galactorrhea?
-spontaneous milky breast discharge, fat globules on microscopy
-30% no cause found
- might be bilateral or unilateral
What lab test would you run for galactorrhea?
Serum prolactin level. It will be elevated with pituitary adenoma
What are the symptoms of pituitary ademona?
-galactorhea
-hyperprolactinemia
-amenorrhea
For a women with galactorrhea what will be seen on microscopy? pap? hemocult?
-micro see fat globules
-Pap of discharge- see abnormal cells
-hemocult- presence of occult blood is a RED FLAG
What tests would you run for galactorrhea?
microscopy, pap, hemocult, TSH/prolactin
-prolactin should be drawn early in the morning!
What is the treatmen for pituitary adenoma?
-bromocriptine (parladel)- preg category B, dizziness, fatigue, nausea
-doctinex
-surgery!
What must happen with a women with pituitary adenoma before she will resume menstruation?
prolactin levels must come down. over 100 is high, over 20 is abnormal
what does a woman with suspected pituitary adenoma need?
a CT
What meds might induce galactorrhea?
-combined OCs
-reserprine
-phenothiazines
-amphetamines
-imipramine
-methydopa
in what systmic diseased might you see galactorrhea?
-hepatic cirrhosis
-hypothyroidism
-acromegaly
-renal failure
-cushing's disease
What CNS conditions might cause galactorrhea?
Pituitary adenoma
head trauma
hypothalamic tumor
What is paget's disease of teh breast?
cancer that is seen as skin manifestation on nipple. needs to be referred out
A breast focused history should include what?
-Pain- localized, constant, diffuse, sharp, dull, cyclic, uni/bilateral, radiating.
-mass- did she discover it or did mass make her find it?
-Nipple discharge- describe
-age of pt
-personal history of cancer
-family history- breast, uterine, ovarian cancer in first degree relative
-hormone use
-injury
-dates and results of mammograms
-other imaging studies
Tanners stages
1= baby/toddler
2= childhood
3= puberty, breast buds, manarche, growth spurt, when hormones kick in
4=young adult
5=maturation
**What are the 5 P's of the clinical breast exam?**
Position- pt and breast
Perimeter- of examined area (mid-axillary to sternum, infra-clavicular to lowest rib)
Palpation-technique
Pressure- applied (vary it)
Pattern- of search (overlap!)
What do you need to assess if a mass is detected?
mobility, size, contour, borders, thickness
What do you need to chart after a breast exam?
-Chart positive and negative findings
-Use dotted line to denote area of glandular thickening, solid line/circle indicates discrete mass
-describe masses in cm
-divide breast into quadrants using nipple as landmark
-note shape (round, oval, etc)
-note tenderness, warmth, signs of inflammation
-consistency- soft, firm, hard
-mobile or fixed
What is the lifetime cancer risk?
1 in 8 by age 85
What ethnic group has increased breast cancer risk?
Ashkenasi jewish, eastern mediterannean
How often and when shoudl a woman get a mammogram?
Age 40 or earlier than mothers dx, every year or every other eyar in 40s and after 50 it is every year
What is the influence of hormones and breast cancer?
No link between OCs and breast cancer
Breast cancer on hormones do better than other women
What does BRCA test for?
BRCA 1 and 2 tests determine if there is a genetic risk for breast bancer. If have the gene then risk for developing cancer is high. 5-10% of breast and ovarian cancers are hereditary
What is the increased risk for breast cancer if a first degree relative had it?
100%
What causes cervical cancer?
**It is due to the persistence of high risk HPV**
-and uncommon occurrence
What are the cancer causing HPV strains?
Types 16 and 18
What strains commonly cause EGW (external genital warts)?
Types 6 and 11, these are not oncogenic
How do we find out what type of HPV a woman has?
A DNA test from vaginal secretions, this will be blocked into high and low risk categories. There is no FDA approved test for different types
What does gardisil prevent?
70% of type 16 and 18 HPV
What population makes up the majority of invasive cervical cancer cases?
unscreened and can't access care
What is the impact of screenign on the incidence of cervical cancer?
-decreases incidence
-relative protection decreases as interval between pap smears increases
-50% of women with newly diagnosed invasive cervical cancer have never had a pap smear, 10% have not had on in 5 years
When can you extend the interval between testing?
When pap and HPV are both negative
When will HPV be automatically screened for?
When pap is abnormal. If pap is normal must request HPV test
At what point in fetal development is the original squamo columnar junction developed?
20 weeks gestations
What is the process that the vagina goes through beginning at puberty?
With estrogen the vagina is exposed to acid from lactobacilli --> burning process --> epithelium matures --> more squamous epithelium and less columnar epithelium --> junction receds into endocervical canal
Desrcibe the steps between HPV exposure and cancer
HPV infection --> dysplasia b/c cells are vulnerable and have had contact with virus --> up ladder from minor hyperplasia --> major hyperplasia --> cervical cancer
What process does a woman without HPV go through?
Normal metaplsia (the SCJ regressing)
What is dysplasia?
disordered growth casued by HPV infection
What is CIN?
cervical intraepithelial neoplasia. This is graded from 1 (low grade squamous lesion) to 2/3. this is the step in between HPV infection and invasive cancer
What is AIS
adenocarcinoma in situ
What is CIN1?
Low grade squamous indaepthelial lesion (SIL)
Invasive cancer goes through...?
basement membrane
is pap diagnostic of cancer?
no!!! is it a screening test
Abnormal cells have enlarged...?
Nucleus
When should pap screening be initiated?
About 3 years after first vaginal intercourse and no later than 21 years of age
HSIL?
high grade SIL
After what age is a woman less likely to spontaneously clear the HPV infection?
age 30, be more concerned with this pt
30 and over should be offered high risk HPV testing and routine paps. If they have positive pap and pos HPV do colpo
Is routine HPV testing in women under 30 recommended?
No, prevalence of HPV is high and mild infections/ mild cellular abnormalities will be spontaneously cleared by the immune system
If negative pap and negative HPV, when should she be screened?
3 years
How do you dx cervical cancer?
colposcopy
What is ASCUS?
atypical squamous cells of undetermine significance. if in adolescent follow up in 2 years
What are the recomendations for follow up screen and treat?
-HSIL- immediate screen and treat
-CIN 1- observation
What should you test for if a patient has atypical glandular (columnar) cells (AGC)?
HPV
If normal pap and HPV positive?
repeat in 6-12 months. if still then send for colpo
What should you do if you canno exclude HSIL?
send for colposcopy, with ASC-H you cannot exclude HSIL
What is LSIL? who is likely to have it and what will probably happen/
-low-grade squamous intraepithelial lesion
-youn sexually active women
most will regress in young women
What is the risk for adolescents with ASCUS or LSIL?
no risk of incasive cancer, high clearance rate, repap annually, HPV test or colpo not indicated
What is the transformation zone?
area between original and current junction- common to see lesions in this area from HPV
Why are adolescents at greater risk for HPV and other STD's?
because junction is very prominent
What is HSIL?
high grade intraepithelial lesion that combines CIN2 (mild dysplasia) and CIN3 (severe that can lead to carcinoma in situ)
-can LEEP, but not adolescents
-colpo
Endocervical curettage if not pregnanc
How do you manage HSIL?
-colposcopy required
-excisional cone biopsy is possible is don't get a good colpo, can't see 360 degrees of SC junction
What kind of lesion will really bleed on biopsy?
high grade
How would you manage CIN 2/3 in adolescents?
observe CIN 2, colpo and pap q6 months for 2 yars
treat CIN 3
What is AGC? What will you do?
atypical glandular cells, sources could be cervix, endocervical or endometrial. Big risk for adenocarcinoma in situ or invasive adenocarcinoma
-do colp and endocervical curettage
-endometrial biopsy for atypical endometrial cells
-if evaluation is negative then do pap q6 if HPV pos, q12 if neg
What is the site of change?
SC juntion
Is metaplasia normal?
YES! active, normal process
What is endemic in young female pop?
low grade lesion, if high grade then you must colpo it
What strains does gardisil cover?
6, 11, 16, 18
what are the stages in the cycle of violence?
tension building, violation and explosion, seduction/ making peace
-this cycle might take years
What is domestic violence about?
power and control, to humiliate
What are two different sequences of separation/
-Landernburger- binding, enduring, disengaging, recovering
-Wuest- process of reclaiming self: counteracting abuse, breaking free, not going back, moving on
What health behavior is associated with domestiv violence?
smoking and substance abuse, somatization
Who should be screened for abusive relationships?
screen all females over age 14
-screen with new pt, new complaint, at each prenatal and post partum visit, STI, abortion, ER, admission to hospital
What does HARK stand for?
Humiliation, Afriad, Rape, Kick
What does RADAR stand for?
Remember to ask, Ask directly, Document findings, Assess safety, Review options
What are lesbian clients at an increased risk for?
-breast/ovarian/endometrail/cervical/ lung cancers
-obesity
-heart disease
-depression
What vaginal infection are lesbian women more susceptible to?
Bacterial vaginosis
What does aromatase activity do?
converts androgen and other tissues, such as fat stores, to estrogen. This is why heavier women often have heavier menstrual cycles
What do thecal cells do?
of the ovary, suppress androgen production
What does inhibin do?
keeps women from having too many eggs develop
Where does most estradiol come from?
The dominant follicle
What is primary amenorrhea?
no menstrual period by age 15/16 with secondary sex, or no menses and no secondary sex by age 12
What is secondary amenorrhea?
ne menstrual period for at least 3 cyclic intervals or 6 months
What is Asherman's syndrome?
Woman has D&C that is excessive and scars the uterine lining so can't receive hormone signals and endometrium can't build
What should always be examined with bleeding irregularities?
**Thyroid** hypo--> heavy, hyper --> light
What is the affect of Turner's syndrome on fertility?
streak ovaries. Have compartment to carry pregnancy, but no ovaries so will need a lot of help
What is premature ovarian failure/
no ovulation prior to age 40
What are the types of etiology of menstrual do's?
1. Outflow do
2. Ovarian do
3. Anterior pituitary do
4. hypothalamic do
What do you give for progesterone challange?
must be in oil. capsule for 14 days or a shot
-If no w/drawal bleed it is FSH/LH related and refer them
What is dysmenorrhea?
-Primary- painful menstruation with no organic cause, generally thought to be associated with prostaglandin synthesis/release by endometrium
-Secondary- painful due to an identifiable cause
-starts a few years after menarche b/c first years are anovulatory
What is the differential dx for dysmenorrhea?
endometriosis, PID, pregnancy, GI condition, primary anxiety/stress, bladder, pelvic tumor/cysts, cervical stonosis, adenomyosis
What indicates interstitial cystits?
pain with negative culture
How might you treat dysmenorrhea?
Prostaglandin inhibitors (NSAIDS)
OCPs to inhibit ovulation
What is the most common form of abnormal uterine bleeding?
Menometorahgia- prolonged, heavy bleeding at irregular intervals
What are some causes of abnormal uterine bleeding?
Malignancies, infections, myomata (submucosal or intrauteral growth with distortion=fibroid), adenomyosis (bleeding into muscle of uterus, will have midline dysparaunia), polyps, coagulation disorders, endocrinopathy, eating disorders, hepatic, iatrogenic
What ab might you consider for endometritis?
doxycycline b/c has anti-inflammatory and ab properties
Is cervical eversion benign?
no
What is the difference with abnormal vs dysfunctional bleeding?
dysfunctional is not abnormal and is what you are left with when everything else is ruled out. Dysfucntional= prolonged or excessive vaginal bleeding due to endometrial sloughing in the absence of pelvic structure disorder
What happens in ovulatory dysfunctional bleeding?
reduced estrogen levels at ovulation, prolonged life of corpus luteum, irregular and asynchronous endometrium, abnormal prostaglandin metabolism
What do you learn from a biopsy?
rules out hyperplasia and atypia (beginning of abnormal cells and one step past hyperplasia). Need to do one if greater than 5 mm on US
**What do you do for a woman with hemorrhage?**
Must reset the system with estrogen, high dose such as premarin or lots of OCPs. Must give preogeserone to
Other than progesterone for heavy bleding and estrogen for hemorrhage, what would you give a woman with dysfunctional bleeding?
NSAIDS
Define pelvic pain
noncyclic pain for 3 months, cyclic for 6 that interferes with normal activities
What is the only drug approved for interstitial cystitis?
elmaron
What med might you give for endometriosis and pelvic pain?
GnRH agonist will shut down menstruation from the top- can only do short term and commonly have breakthrough bleeding. Need to add-back estrogen if give longer than 6 months
Why do add-back therapy?
inhibit hot flashes and bone loss