TIME FOR PLAN B
Combined hormonal contraception (estrogen-progesterone) has the not-so-bad side effect of decreasing risk for these 2 types of cancer.
What are:
Endometrial &
Ovarian?
Non-cyclic breast pain has a wide differential. List 3 of the top 7 most common causes.
What are:
Medication use (contraceptive agents, hormone replacement therapy, psychiatric medications),
Underlying breast disease (fibrocystic disease, infection, prior trauma, cancer),
Stretching of the Cooper ligaments,
Costochondritis,
Trauma,
Coronary artery disease,
Gastroesophageal reflux disease, &
Intercostal nerve pain?
These 3 most common causes of vaginitis always require prescription medical treatment, as opposed to the less common causes like irritant, allergic, and atrophic vaginitis, that can often be managed with lifestyle modifications and OTC products.
What are:
Bacterial vaginosis,
Candidiasis, &
Trichomoniasis?
While anovulatory bleeding is common during the first few years after menarche and during perimenopause, it's important to remember its association with these endocrine disorders, as well - name at least 2 of them.
What are:
Polycystic ovary syndrome,
Thyroid disorders, &
Hyperprolactinemia?
Because patients with ovarian cancer usually present at an advanced stage, their symptoms usually consist of abdominal/pelvic pain along with ROS being positive for one or more of these 3 complaints.
What are:
Bloating,
Constipation, &
Early satiety?
There are currently 5 FDA-approved intrauterine devices for highly effective long-acting reversible contraception. While 1 of them is a copper device, and the other 4 all release this synthetic hormone, which inhibits ovulation and thickens cervical mucus to obstruct sperm penetration.
What is:
Levonorgestrel?
Most common in women ages 20-39 years old, cyclic breast pain is the likely diagnosis if these 3 characteristics of mastalgia are present. If the clinical breast exam is normal, conservative management is appropriate.
What are:
Diffuse/bilateral pain,
Occurs during the pre-menstrual phase, &
Resolves with onset of menstruation?
(Conservative management = education, reassurance of the absence of malignancy, advice to wear a supportive brassiere, & topical NSAID therapy)
This study should be sent performed annually for surveillance in all cervical cancer survivors.
What is:
Cervical or vaginal cytology?
In evaluation of abnormal uterine bleeding, beginning with a history and physical is always a good idea, but pelvic examination alone can often determine the source of bleeding if either of these 2 things are discovered.
What are:
Trauma to the genital track, &
Uterine enlargement or irregularity?
Prophylactic bilateral salpingo-oophorectomy after completion of childbearing is recommended for women with any of these 3 gene mutations.
What are:
BRCA1,
BRCA2, &
MMR?
(In BRCA carriers, this decreases risk of ovarian cancers by 80% and decreases all-cause mortality to age 70 years by 77%)
This most effective form of emergency contraception can reduce the risk of pregnancy by 99%!
What is:
Copper IUD, placed within 5 days of intercourse?
This medication is the only FDA-approved agent for cyclic breast pain, but its use is limited by side effects, including amenorrhea, hirsutism, and adverse changes in the lipid profile.
What is:
Danazol?
(Low-dose tamoxifen is NOT FDA-approved, but is sometimes used for this indication - remember its side effects though, including hot flashes, vaginal dryness, VTE, teratogenicity)
Early cervical cancer is frequently asymptomatic, but if not, the most common are one or both of these 2 symptoms.
What are:
Abnormal or heavy vaginal bleeding &
Vaginal discharge?
(advanced cervical cancer symptoms include pelvic or back pain & bowel/bladder symptoms)
These 2 first-line treatments for the genitourinary syndrome of menopause help to alleviate the vaginal and sexual symptoms respectively.
What are:
Vaginal moisturizers for dryness/irritation &
Vaginal lubricants for intercourse?
Patients with stage I ovarian cancer with favorable histology may be treated with surgery alone; all other patients should receive chemotherapy with an agent in this class.
What is:
Platinum-taxane?
Of the 2 oral agents available for emergency contraception, this medication is the one that is effective for longer (up to 5 days after inadequately protected intercourse) but is available by prescription only.
What is:
Ulipristal acetate?
(PO levonorgestrel is OTC, but only effective for up to 3 days after, and is less effective in women w/ BMI >26)
There are a few agents to choose from for primary chemoprevention for breast cancer among both SERMs (selective estrogen receptor modulators) and aromatase inhibitors. However, for premenopausal patients, our only option is this agent.
Tamoxifen?
(Raloxifene has not been studied so should not be used; both aromatase inhibitors, exemestane and anastrozole, are not effective in premenopausal women)
This selective estrogen receptor modulator is FDA-approved specifically for treatment of dyspareunia associated with vulvovaginal atrophy.
What is:
Ospemifene?
For women with bothersome abnormal uterine bleeding who wish to preserve fertility, use of this hormonal agent during the second half of the menstrual cycle will restore cyclic withdrawal bleeding.
What is:
Medroxyprogesterone acetate?
General diagnostic criteria for polycystic ovary syndrome (PCOS) agree that proving polycystic ovaries on ultrasound is not always required; other criteria include one or both of these findings.
What are:
Ovulatory dysfunction (amenorrhea, oligomenorrhea, infertility) &
Laboratory or clinical evidence of hyperandrogenism (hirsutism, acne)?
Barrier contraceptive methods are among the least effective of all modes of contraception, so some opt to combine use with a spermicidal agent. Although male and female condoms reduce risk of STIs in general, this viral reason is why some populations should avoid adding the spermicide.
What is:
Spermicide may increase risk for HIV transmission?
(by disrupting the vaginal epithelial wall)
This is an additional screening test recommended for any patient taking an aromatase inhibitor - name both the study and frequency recommended.
What is:
Bone density study every other year?
(to assess for osteoporosis; if taking tamoxifen, additional screening needed = yearly gynecological exam due to increased risk of endometrial cancer)
These 2 medications are the only FDA-approved agents for management of female sexual dysfunction, and both are for use only in premenopausal women - the first is for female sexual interest/arousal disorder without depression, and the second is a subcutaneous injection that can be used a maximum of 8 times per month.
What are:
Flibanserin (serotonin receptor agonist/antagonist) &
Bremelanotide?
(use of both is limited by side effect profiles - Flibanserin = dizziness, hypotension, somnolence, syncope; Bremelanotide = skin darkening, nausea, vomiting)
Routine laboratory testing for diagnosis of menopause is not recommended, but patients with possible early menopause should have these 4 laboratory tests performed.
What are:
Pregnancy (hCG),
FSH,
TSH, &
Prolactin?
Patients diagnosed with polycystic ovary syndrome (PCOS) should be screened for obesity as well as these 4 common comorbidities; serum testosterone and DHEAS are only necessary to check if virilization/hirsutism are rapid.
What are:
Diabetes,
Hypertension,
Dyslipidemia, &
Obstructive sleep apnea?
(but don't be tricked - an androgen-secreting ovarian or adrenal tumor should be suspected in a woman with acute onset of rapidly progressive hirsutism or virilization)