Ovarian cancer is a catchall term encompassing a wide variety of relatively uncommon heterogeneous diseases notable for having a gradual decrease in incidence over the past decade. Epithelial ovarian carcinoma predominates, especially the high-grade serous variant distinguished by few reliable signs or symptoms, exceptional difficulty in early detection, and poor prognosis despite aggressive surgery and chemotherapy. The recent discovery that many of these tumors actually arise from the fallopian tube has led to rapid acceptance of opportunistic salpingectomy as a convenient, low-risk method of prevention. Other advances in genetic testing, minimally invasive surgery, and novel-targeted therapies have greatly expanded the management of this disease in the past few years. Sex cord-stromal tumors, chiefly the granulosa cell variant, are rarely encountered, occur across a wide range of ages, are largely impervious to chemotherapy, and yet highly curable. Malignant ovarian germ cell tumors are even rarer, generally present during the teens, are exquisitely sensitive to chemotherapy, and also very curable. Providing expert care to women with ovarian cancer has become increasingly complex due to emerging practice-changing data at multiple points of diagnosis, treatment, and surveillance. Fortunately, the past few years have greatly expanded our understanding of this dreaded disease. This review contains 5 tables, and 29 references. Key Words: epithelial ovarian cancer, maintenance therapy, neoadjuvant chemotherapy, primary debulking surgery
{"title":"Ovarian Cancer","authors":"Kirsten Jorgensen, V. Wang, J. Schorge","doi":"10.2310/obg.19171","DOIUrl":"https://doi.org/10.2310/obg.19171","url":null,"abstract":"Ovarian cancer is a catchall term encompassing a wide variety of relatively uncommon heterogeneous diseases notable for having a gradual decrease in incidence over the past decade. Epithelial ovarian carcinoma predominates, especially the high-grade serous variant distinguished by few reliable signs or symptoms, exceptional difficulty in early detection, and poor prognosis despite aggressive surgery and chemotherapy. The recent discovery that many of these tumors actually arise from the fallopian tube has led to rapid acceptance of opportunistic salpingectomy as a convenient, low-risk method of prevention. Other advances in genetic testing, minimally invasive surgery, and novel-targeted therapies have greatly expanded the management of this disease in the past few years. Sex cord-stromal tumors, chiefly the granulosa cell variant, are rarely encountered, occur across a wide range of ages, are largely impervious to chemotherapy, and yet highly curable. Malignant ovarian germ cell tumors are even rarer, generally present during the teens, are exquisitely sensitive to chemotherapy, and also very curable. Providing expert care to women with ovarian cancer has become increasingly complex due to emerging practice-changing data at multiple points of diagnosis, treatment, and surveillance. Fortunately, the past few years have greatly expanded our understanding of this dreaded disease.\u0000This review contains 5 tables, and 29 references.\u0000Key Words: epithelial ovarian cancer, maintenance therapy, neoadjuvant chemotherapy, primary debulking surgery","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132118800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The exacerbation of pre-existing psychiatric conditions and the development of a new-onset psychiatric disorder during pregnancy directly affects the care of pregnant women. Depression and anxiety are highly prevalent in reproductive age women and may be exacerbated in the perinatal and postpartum periods. Post-traumatic stress disorder is another common condition seen in this population and may worsen under the stress of pregnancy, delivery, and childrearing. Substance abuse is also pervasive in this population, requiring obstetricians to have a thorough understanding of how to manage and treat pregnant women with dependence disorders. Psychiatric conditions and substance abuse often co-exist. These and other disorders present significant risk to the mother and fetus. It is essential therefore for obstetric care providers to understand how to screen for, diagnose, and treat psychiatric disorders during pregnancy and in the postpartum period. This review contains 4 tables, and 58 references. Keywords: perinatal depression, postpartum depression, postpartum psychosis, anxiety in pregnancy, substance abuse in pregnancy, post-traumatic stress disorder in pregnancy, eating disorders in pregnancy, pregnancy screening
{"title":"Psychiatric Diseases in Pregnancy","authors":"J. Ludgin, Deanna Y. Sverdlov, E. Norwitz","doi":"10.2310/obg.19054","DOIUrl":"https://doi.org/10.2310/obg.19054","url":null,"abstract":"The exacerbation of pre-existing psychiatric conditions and the development of a new-onset psychiatric disorder during pregnancy directly affects the care of pregnant women. Depression and anxiety are highly prevalent in reproductive age women and may be exacerbated in the perinatal and postpartum periods. Post-traumatic stress disorder is another common condition seen in this population and may worsen under the stress of pregnancy, delivery, and childrearing. Substance abuse is also pervasive in this population, requiring obstetricians to have a thorough understanding of how to manage and treat pregnant women with dependence disorders. Psychiatric conditions and substance abuse often co-exist. These and other disorders present significant risk to the mother and fetus. It is essential therefore for obstetric care providers to understand how to screen for, diagnose, and treat psychiatric disorders during pregnancy and in the postpartum period.\u0000This review contains 4 tables, and 58 references.\u0000Keywords: perinatal depression, postpartum depression, postpartum psychosis, anxiety in pregnancy, substance abuse in pregnancy, post-traumatic stress disorder in pregnancy, eating disorders in pregnancy, pregnancy screening","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125750914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heavy menstrual bleeding is a common presenting problem in the adolescent population. The average age of menarche is between 12 and 13 years. The most common reason for heavy menstrual bleeding soon after menarche is from an immature hypothalamic ovarian access, which spontaneously resolves once cycles become ovulatory. However, the broad differential diagnosis for heavy menses in adolescents includes coagulopathy, thyroid disease, sexually transmitted infections, specifically chlamydia, and chronic medical conditions. Von Willebrand disease is the most common bleeding disorder that can present with heavy menstrual bleeding at menarche or shortly after. A thorough history and physical exam with occasional labs needs to be completed and can assist in narrowing the differential diagnosis. Treatment of heavy menstrual bleeding consists of hormonal and nonhormonal options: combination oral contraceptive pills, patches, or rings taken continuously or cyclically; progesterone-only pills; progesterone implants; progesterone intrauterine devices; cyclic tranexamic acid; cyclic aminocaproic acid; and GnRH agonists with add-back therapy. This review contains 3 tables, and 28 references. Key Words: adolescent menses, anovulation, bleeding disorder, heavy menstrual bleeding, immature hypothalamic ovarian axis, menarche, treatment of heavy menses, Von Willebrand disease
{"title":"Heavy Menstrual Bleeding in the Adolescent","authors":"Kimberly Huhmann, A. Zuckerman","doi":"10.2310/obg.19118","DOIUrl":"https://doi.org/10.2310/obg.19118","url":null,"abstract":"Heavy menstrual bleeding is a common presenting problem in the adolescent population. The average age of menarche is between 12 and 13 years. The most common reason for heavy menstrual bleeding soon after menarche is from an immature hypothalamic ovarian access, which spontaneously resolves once cycles become ovulatory. However, the broad differential diagnosis for heavy menses in adolescents includes coagulopathy, thyroid disease, sexually transmitted infections, specifically chlamydia, and chronic medical conditions. Von Willebrand disease is the most common bleeding disorder that can present with heavy menstrual bleeding at menarche or shortly after. A thorough history and physical exam with occasional labs needs to be completed and can assist in narrowing the differential diagnosis. Treatment of heavy menstrual bleeding consists of hormonal and nonhormonal options: combination oral contraceptive pills, patches, or rings taken continuously or cyclically; progesterone-only pills; progesterone implants; progesterone intrauterine devices; cyclic tranexamic acid; cyclic aminocaproic acid; and GnRH agonists with add-back therapy.\u0000This review contains 3 tables, and 28 references.\u0000Key Words: adolescent menses, anovulation, bleeding disorder, heavy menstrual bleeding, immature hypothalamic ovarian axis, menarche, treatment of heavy menses, Von Willebrand disease","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114391162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amenorrhea, the absence of menses, occurs in approximately 3 to 4% of women.4,7 It may be present as primary amenorrhea (the absence of menarche) or secondary amenorrhea (the absence of menses after menarche). The evaluation of the patient with amenorrhea requires an understanding of female anatomy and embryology as well as the hypothalamic-pituitary-ovarian axis. A logical systematic approach to adolescents and women with amenorrhea leads to the appropriate diagnosis and management. When considering the appropriate evaluation and management of amenorrhea, several classification schemes may be considered. The following review outlines the necessary background to understand the various clinical conditions. In addition, the step-wise approach to diagnosis and management is presented. This review contains 4 figures, 3 tables, and 45 references. Key Words: amenorrhea, anomalies, embryologic development, hyperandrogenism, hyperprolactinemia, hypothalamic dysfunction, ovarian insufficiency, puberty, thyroid dysfunction
{"title":"Amenorrhea: A Systematic Approach to Diagnosis and Management","authors":"J. Cron","doi":"10.2310/obg.19117","DOIUrl":"https://doi.org/10.2310/obg.19117","url":null,"abstract":"Amenorrhea, the absence of menses, occurs in approximately 3 to 4% of women.4,7 It may be present as primary amenorrhea (the absence of menarche) or secondary amenorrhea (the absence of menses after menarche). The evaluation of the patient with amenorrhea requires an understanding of female anatomy and embryology as well as the hypothalamic-pituitary-ovarian axis. A logical systematic approach to adolescents and women with amenorrhea leads to the appropriate diagnosis and management. When considering the appropriate evaluation and management of amenorrhea, several classification schemes may be considered. The following review outlines the necessary background to understand the various clinical conditions. In addition, the step-wise approach to diagnosis and management is presented.\u0000This review contains 4 figures, 3 tables, and 45 references.\u0000 Key Words: amenorrhea, anomalies, embryologic development, hyperandrogenism, hyperprolactinemia, hypothalamic dysfunction, ovarian insufficiency, puberty, thyroid dysfunction","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115935325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Preterm birth causes significant morbidity and mortality among newborns and is a financial burden on the healthcare system. One etiology for extreme prematurity is cervical insufficiency, a mechanical failure of normal cervical function, resulting in painless cervical dilation in the second trimester. The exact mechanism is unknown, but current research suggests that cervical insufficiency is caused by a combination of subclinical infection and inflammation, along with structural changes in the cervical stroma. Cervical changes associated with cervical insufficiency are gradual, beginning with changes occurring at the level of the internal os that lead to cervical shortening and subsequent cervical dilation. There are several risk factors that can be identified by clinical history and physical exam to stratify patients at risk. Cervical shortening is seen using transvaginal or transperineal ultrasonography, and evidence-based guidelines for screening high-risk patients for cervical shortening are available. The treatment for cervical insufficiency is cerclage placement. Deciding which patients benefit from cerclage can be complex and involves consideration of obstetric history, clinical presentation, and cervical length. This review contains 10 figures, 1 table, and 72 references. Key Words: abdominal cerclage, cervical funneling, cervical insufficiency, cervical length measurement, cervical shortening, dynamic cervix, preterm birth, transvaginal cerclage, TYVU progression
{"title":"Cervical Insufficiency and Cervical Cerclage","authors":"M. Mhatre, M. House","doi":"10.2310/obg.19057","DOIUrl":"https://doi.org/10.2310/obg.19057","url":null,"abstract":"Preterm birth causes significant morbidity and mortality among newborns and is a financial burden on the healthcare system. One etiology for extreme prematurity is cervical insufficiency, a mechanical failure of normal cervical function, resulting in painless cervical dilation in the second trimester. The exact mechanism is unknown, but current research suggests that cervical insufficiency is caused by a combination of subclinical infection and inflammation, along with structural changes in the cervical stroma. Cervical changes associated with cervical insufficiency are gradual, beginning with changes occurring at the level of the internal os that lead to cervical shortening and subsequent cervical dilation. There are several risk factors that can be identified by clinical history and physical exam to stratify patients at risk. Cervical shortening is seen using transvaginal or transperineal ultrasonography, and evidence-based guidelines for screening high-risk patients for cervical shortening are available. The treatment for cervical insufficiency is cerclage placement. Deciding which patients benefit from cerclage can be complex and involves consideration of obstetric history, clinical presentation, and cervical length.\u0000This review contains 10 figures, 1 table, and 72 references.\u0000Key Words: abdominal cerclage, cervical funneling, cervical insufficiency, cervical length measurement, cervical shortening, dynamic cervix, preterm birth, transvaginal cerclage, TYVU progression","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127262232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vulvar and vaginal irritation/redness and vaginal discharge are common referrals to the pediatric and adolescent gynecologist. In nearly 75% of cases the etiology of the pre-pubertal patient’s signs and symptoms is non-specific and resolves with proper vulvar hygiene. Infections, ulcerations, labial adhesions, foreign bodies, constipation, voiding dysfunction, and trauma are other causes of vulvar and vaginal complaints. Gathering a detailed history and performing a thorough physical exam help to determine the etiology and best treatment. Staphylococcal aureus and Streptococcus pyogenes infections are frequently isolated on vaginal cultures and treated with organism specific antibiotics. Ulcerations are usually from a self-limiting viral infection (EBV, CMV, influenza) and heal with supportive cares—acetaminophen and sitz baths. Labial adhesions recede with topical estrogen cream in up to 89% of cases and rarely need surgical separation. When vulvovaginitis persists despite hygiene measures and no evidence of infectious etiology assessment and treatment of constipation and voiding dysfunction can provide relief of symptoms. This review contains 1 table and 28 references. Key words: Vulvovaginitis, vulvar hygiene, vagina hygiene, vaginal infection, labial adhesions, vulvar trauma, genital ulcer, vaginal foreign body, constipation, pre-pubertal voiding dysfunction
{"title":"Prepubertal Vulvovaginitis","authors":"Kimberly Huhmann, Hong-Thao Thieu","doi":"10.2310/obg.19107","DOIUrl":"https://doi.org/10.2310/obg.19107","url":null,"abstract":"Vulvar and vaginal irritation/redness and vaginal discharge are common referrals to the pediatric and adolescent gynecologist. In nearly 75% of cases the etiology of the pre-pubertal patient’s signs and symptoms is non-specific and resolves with proper vulvar hygiene. Infections, ulcerations, labial adhesions, foreign bodies, constipation, voiding dysfunction, and trauma are other causes of vulvar and vaginal complaints. Gathering a detailed history and performing a thorough physical exam help to determine the etiology and best treatment. Staphylococcal aureus and Streptococcus pyogenes infections are frequently isolated on vaginal cultures and treated with organism specific antibiotics. Ulcerations are usually from a self-limiting viral infection (EBV, CMV, influenza) and heal with supportive cares—acetaminophen and sitz baths. Labial adhesions recede with topical estrogen cream in up to 89% of cases and rarely need surgical separation. When vulvovaginitis persists despite hygiene measures and no evidence of infectious etiology assessment and treatment of constipation and voiding dysfunction can provide relief of symptoms.\u0000This review contains 1 table and 28 references.\u0000 Key words: Vulvovaginitis, vulvar hygiene, vagina hygiene, vaginal infection, labial adhesions, vulvar trauma, genital ulcer, vaginal foreign body, constipation, pre-pubertal voiding dysfunction","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131718921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The healthcare community and lay public have become more aware of transgender (TG) people in the past decade as celebrities have publicly transitioned and activists have pushed back against restrictive laws. Movies, television, nonfiction books, and novels increasingly represent the experience of people who are TG. News organizations and entertainment outlets have given attention to the lives, needs, and challenges of TG and gender-nonconforming individuals. Nonetheless, TG individuals are often fearful when seeking healthcare. Experiences of shame, judgment, and rejection with providers lead to anxiety in future encounters. The number of clinical providers who feel prepared to offer care for TG individuals is limited. Many TG individuals have been denied basic primary and preventive healthcare as a result of their TG status. Understanding the concepts of TG and gender nonconformance expands the skill set of the healthcare professional for providing culturally competent care to all patients and their family members. This review contains 26 figures, and 59 references. Key Words: cis-sexual, gender binary, gender confirmation surgery, gender dysphoria, gender nonconforming, intersex, LGBTQ, queer, transgender, WPATH
{"title":"Reproductive Health in LGBTQ Populations","authors":"M. Meservey, Y. Gomez-Carrion","doi":"10.2310/obg.19015","DOIUrl":"https://doi.org/10.2310/obg.19015","url":null,"abstract":"The healthcare community and lay public have become more aware of transgender (TG) people in the past decade as celebrities have publicly transitioned and activists have pushed back against restrictive laws. Movies, television, nonfiction books, and novels increasingly represent the experience of people who are TG. News organizations and entertainment outlets have given attention to the lives, needs, and challenges of TG and gender-nonconforming individuals. Nonetheless, TG individuals are often fearful when seeking healthcare. Experiences of shame, judgment, and rejection with providers lead to anxiety in future encounters. The number of clinical providers who feel prepared to offer care for TG individuals is limited. Many TG individuals have been denied basic primary and preventive healthcare as a result of their TG status. Understanding the concepts of TG and gender nonconformance expands the skill set of the healthcare professional for providing culturally competent care to all patients and their family members.\u0000\u0000This review contains 26 figures, and 59 references.\u0000Key Words: cis-sexual, gender binary, gender confirmation surgery, gender dysphoria, gender nonconforming, intersex, LGBTQ, queer, transgender, WPATH","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129624302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Radiation therapy plays a significant role in the treatment of nearly all gynecologic cancers, including endometrial cancer, cervical cancer, vaginal cancer, and vulvar cancer. Radiotherapy can be given as the primary modality for curative treatment of gynecologic cancers, most often for cervical, vaginal, and vulvar cancers, but can also be used adjuvantly in the postoperative setting. Radiation can be delivered in the form of external beam radiation therapy or as gynecologic implants for brachytherapy, which is radiation that is delivered internally. This review highlights the data supporting radiation therapy for gynecologic cancers and explains the different methods of radiation delivery. This review contains 5 figures, and 4 tables, and 40 references. Key Words: adjuvant treatment, brachytherapy, cervical cancer, endometrial cancer, IMRT, ovarian cancer, radiation therapy, vaginal cancer, vulvar cancer
{"title":"Adjuvant Radiation for Gynecologic Cancers","authors":"J. Jang","doi":"10.2310/obg.19169","DOIUrl":"https://doi.org/10.2310/obg.19169","url":null,"abstract":"Radiation therapy plays a significant role in the treatment of nearly all gynecologic cancers, including endometrial cancer, cervical cancer, vaginal cancer, and vulvar cancer. Radiotherapy can be given as the primary modality for curative treatment of gynecologic cancers, most often for cervical, vaginal, and vulvar cancers, but can also be used adjuvantly in the postoperative setting. Radiation can be delivered in the form of external beam radiation therapy or as gynecologic implants for brachytherapy, which is radiation that is delivered internally. This review highlights the data supporting radiation therapy for gynecologic cancers and explains the different methods of radiation delivery.\u0000This review contains 5 figures, and 4 tables, and 40 references. \u0000Key Words: adjuvant treatment, brachytherapy, cervical cancer, endometrial cancer, IMRT, ovarian cancer, radiation therapy, vaginal cancer, vulvar cancer","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114962801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The typical PCOS phenotype of anovulation, androgen excess, and polycystic ovarian morphology can overlap with normal adolescence, thus making the diagnosis more difficult. Early recognition of adolescents at a risk for PCOS allows for earlier intervention with the potential for improved cardiovascular and metabolic health. Mental health issues and poor quality of life are frequently associated with PCOS in adolescent women and, therefore, should be identified and addressed. As with many issues confronting the adolescent, peer and family support should be encouraged. Lifestyle changes and weight loss should be thought of as first-line therapy for young women with PCOS. Combined hormonal contraceptives remain the medical therapy of choice for the treatment of menstrual irregularity, hirsutism, acne, and contraception. Metformin and spironolactone may be considered, with metformin particularly beneficial in young women with metabolic abnormalities. This review contains 2 tables and 50 references. Key Words: antiandrogens, antimüllerian hormone, hirsutism, hyperandrogenism, hyperinsulinemia, insulin resistance, menstrual irregularity, obesity, oral contraceptive pills, polycystic ovary
{"title":"Polycystic Ovary Syndrome in the Adolescent","authors":"Tara A Singh, Kathleen F. Harney","doi":"10.2310/obg.19115","DOIUrl":"https://doi.org/10.2310/obg.19115","url":null,"abstract":"The typical PCOS phenotype of anovulation, androgen excess, and polycystic ovarian morphology can overlap with normal adolescence, thus making the diagnosis more difficult. Early recognition of adolescents at a risk for PCOS allows for earlier intervention with the potential for improved cardiovascular and metabolic health. Mental health issues and poor quality of life are frequently associated with PCOS in adolescent women and, therefore, should be identified and addressed. As with many issues confronting the adolescent, peer and family support should be encouraged. Lifestyle changes and weight loss should be thought of as first-line therapy for young women with PCOS. Combined hormonal contraceptives remain the medical therapy of choice for the treatment of menstrual irregularity, hirsutism, acne, and contraception. Metformin and spironolactone may be considered, with metformin particularly beneficial in young women with metabolic abnormalities.\u0000This review contains 2 tables and 50 references.\u0000Key Words: antiandrogens, antimüllerian hormone, hirsutism, hyperandrogenism, hyperinsulinemia, insulin resistance, menstrual irregularity, obesity, oral contraceptive pills, polycystic ovary","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126736322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vulvovaginitis is a common complaint in adolescents. There are specific and nonspecific causes. Specific causes include sexually transmitted infections and so it is important to take a sexual history in any adolescent presenting with vulvovaginal complaints. A sexual history should be taken in a sensitive and confidential manner. Diagnosis of vulvovaginitis requires an external genital examination and may require a pelvic examination based on other presenting symptoms. Microscopy is typically used to make a diagnosis. More sensitive or specific point of care tests are commercially available, but they can be cost prohibitive. Treatment of vulvovaginitis is based on underlying pathology and often a review of vaginal hygiene may be necessary.In special patient populations, extended or repeat treatment may be necessary. This review contains 3 figures, 2 tables, and 21 references. Key Words: adolescent, bacterial vaginosis, candidiasis, confidentiality, discharge, dysuria, sexually transmitted infections (STIs), trichomonas, vaginitis, wet prep
{"title":"Adolescent Vulvovaginitis","authors":"Mary E. Romano","doi":"10.2310/obg.19109","DOIUrl":"https://doi.org/10.2310/obg.19109","url":null,"abstract":"Vulvovaginitis is a common complaint in adolescents. There are specific and nonspecific causes. Specific causes include sexually transmitted infections and so it is important to take a sexual history in any adolescent presenting with vulvovaginal complaints. A sexual history should be taken in a sensitive and confidential manner. Diagnosis of vulvovaginitis requires an external genital examination and may require a pelvic examination based on other presenting symptoms. Microscopy is typically used to make a diagnosis. More sensitive or specific point of care tests are commercially available, but they can be cost prohibitive. Treatment of vulvovaginitis is based on underlying pathology and often a review of vaginal hygiene may be necessary.In special patient populations, extended or repeat treatment may be necessary.\u0000This review contains 3 figures, 2 tables, and 21 references.\u0000Key Words: adolescent, bacterial vaginosis, candidiasis, confidentiality, discharge, dysuria, sexually transmitted infections (STIs), trichomonas, vaginitis, wet prep","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114838031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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