Gynecology

Breast Disorders

Breast Mass Approach Return after menstruation ↓ in size → Fibrocystic changes No change <35y → U/S Clear fluid → FNA Relieved → Follow-up q 3m Not completely gone → Excisional biopsy Bloody fluid → Excisional biopsy Mass → Excisional biopsy >35 → Mammography/core or excisional biopsy Not Proliferative...

Estrogens

Estrone (E1) → Estrogen of adipose tissue Estradiol (E2) → Main estrogen Estriol (E3) → Estrogen of pregnancy (placenta) Estetrol (E4)

Virilization

CAH → ⬆︎Urinary 17-OH Progesterone

Infertility

Ovarian reserve → Early follicular FSH ± Estradiol Order for workup Penis Sildenafil Counseling Semen ICSI Mucus Estrogen Artificial Insemination Ovulation Clomiphene Pergonal (Menotropin, hMG) Anatomy ICSI IVF Tuboplasty Surrogate Endometriosis Laser ablation Idiopathic Adoption

Secondary Amenorrhea

Secondary Amenorrhea Definition → No menses for 6 months Etiology Pregnancy Breastfeeding Anovulation PCOS Pituitary adenoma ↑Prolactin ↑TRH PRIMARY hypothyroidism SECONDARY hyperthyroidism Hyperthyroidism Medications Antidepressants OCP Estrogen deficiency Ovarian failure Menopause Premature ovarian failure Hypothalamic pituitary insufficiency Outflow obstruction/stenosis Asherman’s syndrome Stress Extreme weight loss Excessive exercise

Puberty

Precocious Puberty Types Central → GnRH dependent Peripheral → GnRH independent Diagnosis Wrist X-ray → Bone age GnRH stimulation test Give leuprolide (GnRH agonist) ↑ LH → Central No change in LH → Peripheral

Incontinence

Hypertonic bladder Motor urge Oxybutinin Amitriptyline Neurogenic bladder Hypotonic Overflow incontinence Bethanecol Intermittent catheterization

Gynecology Infections

Bartholin Gland Cyst Pain, tenderness, dyspareunia Mass Medial labia majora Lower vestibular area I&D → Culture fluid for STD Vaginitis ↑ pH of vagina Antibiotics → kills Lactobacillus Diabetes Normal flora overgrowth Douching Disease Bacterial Vaginosis Candidiasis Trichomoniasis Pathogen Gardnerella Candida albicans Trichomonas vaginalis Discharge Gray-white Fishy odor NO inflammation White...

Adnexal Mass

Ovarian Hyperthecosis Etiology Nests of luteinized theca cells scattered in the ovarian stroma ↑↑ production of androgens ↑ risk of endometrial hyperplasia/carcinoma Presentation Virilization in a postmenopausal woman Obesity More severe hirsutism than PCOS Shaving common Virilization Clitoral enlargement Temporal balding Deep voice Male habitus Amenorrhea/Irregular menses Severe insulin...

Pelvic Anatomy

Vulvar/Vaginal Problems

Pediatric Labial fusion Excess androgen (21-β hydroxylase deficiency) Sarcoma Botryoides Rhabdomyosarcoma Vaginal discharge Bunches of grapes within vagina Epithelial Abnormalities Lichen sclerosus White skin from labia to anus ↑ cancer risk postmenopause → Paget or Carcinoma Treatment → Topical steroid Squamous cell hyperplasia Chronic irritation results in hyperkeratosis In chronic...

Moles

Gestational Trophoblastic Disease Etiology Benign Complete Sperm + Empty egg 46 XX No fetal tissue Incomplete Sperm + 2 Eggs 69 XXY Contains fetal tissue Malignant Invasive Mole Choriocarcinoma Risk Factors Mom age <20y, >40y ↓ Folate ↓ β-carotene Presentation First trimester bleeding Hyperemesis gravidarum Preeclampsia/eslampsia <24w ↑↑ Uterus...