Download Clinical Strategies Gynecology and Obstetrics by P D Chan, Susan M. Johnson PDF

By P D Chan, Susan M. Johnson

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Hysteroscopy may be necessary, and dilation and curettage is a last resort. Transfusion may be indicated in severe hemorrhage. 3. Iron should also be added as ferrous gluconate 325 mg tid. IV. Primary childbearing years – ages 16 to early 40s A. Contraceptive complications and pregnancy are the most common causes of abnormal bleeding in this age group. Anovulation accounts for 20% of cases. B. Adenomyosis, endometriosis, and fibroids increase in frequency as a woman ages, as do endometrial hyper­ plasia and endometrial polyps.

Treatment of urogenital atrophy in women not taking systemic estrogen 1. Moisturizers and lubricants. Regular use of a vaginal moisturizing agent (Replens) and lubri­ cants during intercourse are helpful. Water solu­ ble lubricants such as Astroglide are more effec­ tive than lubricants that become more viscous after application such as K-Y jelly. A more effec­ tive treatment is vaginal estrogen therapy. 2. Low-dose vaginal estrogen a. Vaginal ring estradiol (Estring), a silastic ring impregnated with estradiol, is the preferred means of delivering estrogen to the vagina.

Cranial MRI is recommended for all women with primary hypogonadotropic hypogonadism, visual field defects, or headaches. c. Serum prolactin and thyrotropin (TSH) should be measured, especially if galactorrhea is present. d. If there are signs or symptoms of hirsutism, serum testosterone and dehydroepiandrosterone sulfate (DHEA-S) should be measured to assess for an androgen-secreting tumor. e. If hypertension is present, blood tests should be drawn for evaluate for CYP17 deficiency. 2 ng/mL). III.

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