Medically - Mifepristone & MTX

Suction or sharp curette

Destructive scraping

1. combination pill

2. progestin-only pill

3. contraceptive patch

4. contraceptive ring

5. DMPA

6. implantable contraceptive rods

21 days of active pills followed by 7 days of placebo pills.  Same dose of estrogen & progesterone in each of the active pills

(12 week cycles are avilable: 11 wk active, 1 wk placebo)

Depot medroxyprogesterone acetate

significantly reduces risk of endometrial cancer

Implanon-3y (progesterone) single rod

Jadelle-5y double rod

Sino-implant-4y double rod

Lippe loop-unmedicated outside US

Mirena-thickens cervical mucus-5y

Paragard-10y

Menstruation/Follicular phase

Ovulation

Luteal phase

First day of bleeding=LMP

decline of estrogen & progesterone>secretory endothelium

PGs lead to uterine contractions>ischemia>uterine contractions

FSH>mature follicle>production of E2 by granulosa cells

E2>decreases FSH & increases LH

E2 rise early in follicular phase, healing endometrium & ending menstruation

increasing E2 causes LH surge

LH surge triggers ovulation on day 11-13

OOcyte is expelled from follicle

Follicle converted to corpus luteum

Mittleschmertz-twing of pain at time of ovulation

Shift to progesterone predominance

Luetinization-LH(+) Rc in corpus luteum to produce and secrete progesterone

Progesterone decreases secretion of FSH & LH via (-) feedback

Corpus luteum involutes and progesterone declines (no pregnancy)

decline in P4 releases (-) feedback

FSH levels rise to initiate new follicular phase

1+ in 5 days preceding menses:

Depression, angry outbursts, irritability, anxiety, confusion, social withdrawl, breast tenderness, abdominal bleeding, headache, swelling of extremities

Relieved w/in 4 days; Sx ree during follicular phase; experience dysfunction in social or economic performance

NSAIDs (dysmenorrhea, breast pain & leg edema)

Spironolactone (100mg/day luteal phase)

SSRIs (fluxetine, sertraline, paroxetine, citalopram)

OCP, danazole, GnRH to suppress ovulation

follicles are worn out or resistant to (+) of FSH & LH

Turners, Savages, premature menopause, blizzards, chemo, menopause

presence/absence of breast & uterus, FSH levels;

bhCG, PE, Serum FSH, U/S

progesteron administration.  if w/drawal bleeding occurspatient has fxnl outflow tract and normal estrogen.  If no wdrawal bleeding py has hypoestrogenic state

no pelvic pathology involved

usually startes 6-2 mos after menarche

due to excessive PG release

Dx: clinical hx and pelvic exam w/o abnromalities

Tx: NSAIDS, heat, exercise, reassurance

Vaginal pH by strip for 2-5min, microscopy

pH>4.5 in premenopausal woman suggests B.V. or trichomiasis

candidal buds-candidiasis

motile trichomonas=trichomoniasis

coccobacilli(clue cells)=vaginosis

PMNs=VV or trich

Excessive WBCs w/o any of teh above=cervicitis (chlamydia or gonorrhea)

Metronidazole*, Clindamycin, Tinidazole

Not necessary to tx partner

If symptomatic: Metronidazole, or Clindamycin

If asymptomatic: tx if high risk only

intense vulvar/vaginal itching

burning, irritation, eryhema & swelling

Cottage cheese discharge w/o odor

vaginal <4.5

wet mount w/ KOH "spaghetti & meatballs"

uncomplicated: antimycotic rx, oral fluconazole single dose

complicated: fluconazole dbl dose

topical imidazole or nystatin

if recurrent infection, use fluconazole

Genetic probe for urethral specimen for culture

EIA (enyme immunoassay)

NAAT (nucleic acid amplification)-test urine & urethral specimens *Gold standard*

urine screen

Azythromycin, doxycline

partner tx

Ceftriaxone IM or Cefixime orally

as well as azithromycin for Chlamydia

Tx partner

cervical motion tenderness or uterine or adnexal tenderness in presence of lower abdominal or pelvic pain

Temp>101

Mucopurulent cervical discharge

Abundant WBCs on microscopy of vaginal secretions

Elevated ESR, & CRP

(+) gonorrhea or chlamydia culture

U/S suggesting TOA

Laparoscopy

Ceftoxitin + doxycycline or clindamycin

Partner tx is necessary

Herpes Simplex

1(oral) 2(genital)

Outbreak: Acyclovir, famiciclovir

Episodic Infection: Acyclovir, famiciclovir

MAcular papular rash on palms & soles appears 4-8 wks after primary chancre

LAD, Fever, HA;

resolves spontaneously in 2-6 wks & entrs latent phase

Non surgical:kegal exercise & vaginal pessary

Surgical: TAH, partial resection of cervix, uterine suspension

Overactive detrusor muscle w/ unihibited contractions

Contractions cause rise in bladder pressure that overrides urethral pressure

Pt leaks urine w/o change in pressure

Loos of pelvic support leading to descension of bladder neck from intra-abdominal cavity

Painless loss of urine concurrent w/ Valsalva

cyclical, bilateral mastalgia & engorgement

difuse bilateral nodulairty, most prominent just before menstruation and in reproductive years

Pain is treated by avoidance of trauma and utilization of undergarments that provide good support;

elimination of cafeine, FNA, hormone therapy not advised

localized, painful inflammation of breast w/ flu-like sxs

cna be cause by blocked milk ducts or staph aureus

Amoxicillin/clavulanate; cipro or clindamycin if MRSA

Continue breast feeding or hot compress to unblock ducts

Unapposed E2 (Increased risk of endometrial Cancer)-acceptable if no uterus

E2+P4 if uterus intact (due to endometrial cancer)

Smallest dose possible for shortest duration possible

Ca, Vit D, Bisphosphonates (fosaax, boniva, actonel), SERMs (tamoxifen, raloxifene)

HRT is NOT a first line use for osteoporosis

19-26y - 50%

27-34y - 40%

35-39y - 30%

19-26y - 45%

27-34y - 40%

35-39y - 15%

12 wks

(non-electric @ 16-20wks)

+/- 1-2w 1st tri

+/- 2w 2nd tri

+/- 2-3w 3rd tri

DB, Hb & Hct @ 28 weeks

vaginal-rectal culture for group B strep, Hb & Hct @ 35 weeks

series of 5 assessments of fetal well being

NST, breathing mvmnts, mvmnt, tone, amnio fluid volume