A Women’s Guide to Gynecologic Care

Alison C. Rinaberger, MDCenter for Women’s Health

www.SpringfieldClinic.com/DoctorIsIn

Objectives:

• Discuss normal gynecologic changes through the years

• Introduce important gynecologic conditions that may occur at each age group

• Discuss medical and surgical treatments of common gynecologic conditions

• Present important aspects of pregnancy

• Answer questions about gynecologic health that woman are afraid to ask their doctor

Puberty

• When is it to early/late?

• Menarche

• Hypothalamus-Pituitary-Ovary Axis

https://search.yahoo.com/yhs/search?p=HPO+axis&ei=UTF-8&hspart=mozilla&hsimp=yhs-003

Puberty: The Menstrual Cycle• Notes: Normal menses – q 21-34 d,

regular intervals, lose less than80ml, 5 days

• allaboutmedicalscience.blogspot.com

Adolescence

• Human Papillomavirus (HPV)

– What is HPV?

– Vaccination• Garadsil-4

• Gardasil-9

Adolescence

• Sexually transmitted infection (STI)

• Testing recommendations

• Signs and symptoms

• Prevention

• Treatment

• Safe Sex

Contraception• Long acting reversible contraceptives

– Intrauterine device (IUD)

• Mirena, Skyla, Paraguard

– Subdermal implant

• Nexplanon

• Progestin only contraceptives

– “mini” pill, Depo provera, Mirena IUD, Skyla IUD

• Estrogen and progestin contraceptives

– pill, patch or vaginal ring

• Permanent contraception

20’s/30’s/40’s

• - AUB treatment• - Expectant management• - Hormonal therapy• -Oral contraceptive• - IUD• - Surgical management• -Endometrial ablation• -Hysterectomy

20’s/30’s/40’s

• Abnormal uterine bleeding (AUB)

– Irregular menses

– Heavy menstrual bleeding

– Amenorrhea

– PALM COEIN• Polyp, Adenomyosis, Leiomyoma, Malignancy,

• Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified

20’s/30’s/40’s

• AUB treatment

• Expectant management

• Hormonal therapy

• Oral contraceptive

• IUD

• Surgical management

• Endometrial ablation

• Hysterectomy

20’s/30’s/40’s

• Uterine leiomyoma

• AKA –Fibroids

• Signs and symptoms

• Treatment

20’s/30’s/40’s

• Adnexal Masses/Ovarian cysts

– Symptoms: Pelvic pain, pelvic pressure

– Treatment: Expectant or surgical

• Ovarian torsion

– Gynecologic emergency

20’s/30’s/40’s

• Endometriosis

– Symptoms• pelvic pain, dysmenorrhea, infertility

– Treatment• contraceptive, Lupron, surgery

• Adenomyosis

20’s/30’s/40’s

• Vaginal infections

– Bacterial vaginosis

– Vaginal yeast infection

• Prevention of recurrent vaginal infections

– Identify trigger

20‘s/30‘s/40’s

• Pelvic Inflammatory Disease (PID)

– Infection of the female reproductive organs

– Symptoms• Pain, fever, vaginal discharge, painful urination,

nausea/vomiting

– Causes• Untreated STI, surgical procedure, childbirth, abortion

– PID can result in infertility

20‘s/30‘s/40’s

• Fertility

– Peaks in 20’s

– Drops considerably at age 35

• Infertility

– No pregnancy after 1 year of unprotected intercourse

– Assisted Reproductive Technology (ART)

– Male factor infertility

20’s/30’s/40’s• Pregnancy

– Pre Pregnancy visit

– First trimester bleeding

– Nausea/vomiting

– Constipation

– Screening for gestational diabetes

– Tdap vaccination

– Flu shot

– Group B Strep testing

20’s/30’s/40’s

• Miscarriage

– Loss of baby prior to 20 weeks gestation

– 50% of pregnancies end in miscarriage

– 15% of recognized pregnancy end in miscarriage

– Cause usually not identified

20’s/30’s/40’s• Ectopic pregnancy

– Embryo implants somewhere other than the uterus

– Risk factors

• IUD, tubal ligation, PID, ART, damage to the fallopian tubes

– Symptoms

• Pain and vaginal bleeding with positive pregnancy test

– Treatment

• Methotrexate

• Surgery

– This can be a life-threatening problem.

Menopause

• Cessation of menses for at least 1 year without any other pathologic/physiologic cause.

• Primary ovarian insufficiency

• Perimenopause

• Symptoms

– hot flushes, irregular menses, mood changes, sleep disturbance

Menopause Hot Flushes 75-80% of menopausal women

Risk factors:

• Obesity• Smoking• Reduced physical activity• African-American>Caucasian

Treatment:

• Behavioral• Medication• Alternative therapy• Hormone replacement

therapy

Postmenopausal Bleeding

• Causes

– polyp, atrophy, fibroid, hyperplasia, cancer, source other than uterus

• Ultrasound

• Endometrial biopsy

• Treatment

– Medical versus surgical

Osteoporosis• Low bone mineral density that results in increase fracture risk

• Screening

– Dual-energy x-ray absorptiometry (DEXA)

– Age 65 or earlier with risk factors

• T score -2.5 SD is diagnostic

• Fracture Risk Assessment Tool (FRAX)

• Treatment

– Calcium and vitamin D

– Exercise

– Medications

Female Sexual Dysfunction

• 40% of women experience but only 12% report the problem

• Risk factors:

– Depression, anxiety, stress, fatigue, history of physical or sexual abuse, pathologic problem that may cause pain

• Causes:

– Medications, pelvic floor dysfunction, endocrine disorders, relationship problems, body image problems

• Treatment:

– Counseling, physical therapy, lifestyle changes,lubricants, devices, hormone therapy

Uterovaginal prolapse• Herniation of the pelvic organs to or beyond the vaginal

walls• Risk factors

– parity, advancing age, obesity and repetitive increases in intraabdominal pressure

• Symptoms– pelvic pain, pelvic pressure/bulge in vagina, void and

defecation problems• Treatment

– Expectant, pessary, pelvic floor physicaltherapy, surgery

Urinary incontinence

• Stress urinary incontinence

• Urge urinary incontinence

• Treatment

– Physical therapy, medication, surgery

Questions?