By Paul D. Chan, MD
Gynecology and Obstetrics for either inpatients and outpatients is featured during this renowned booklet. It emphasizes analysis and administration of universal problems that ensue in girls.
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Example text
6 percent, respectively). Approximately 25 percent of women with atypical hyperplasia have coexistent endometrial cancer. B. Risk factors for endometrial hyperplasia are the same as those for endometrial cancer. The risk for both disorders is increased tenfold in women who use unopposed estrogen-replacement therapy. Risk factors for Endometrial Cancer Risk factor Relative risk (RR) Increasing age Unopposed estrogen therapy Late menopause (after age 55) Nulliparity Polycystic ovary syndrome (chronic anovulation) Obesity Diabetes NA 2-10 2 2 3 Hereditary nonpolyposis colorectal cancer Tamoxifen 22-50 percent lifetime risk Early menarche Estrogen secreting tumor Family history of endometrial, ovarian, breast, or colon cancer NA NA NA 2-4 3 2/1000 C.
CBC and platelet count and a urine or serum pregnancy test should be obtained. 2. Screening for sexually transmitted diseases, thyroid function, and coagulation disorders (partial thromboplastin time, INR, bleeding time) should be completed. 3. Endometrial sampling is rarely necessary for those under age 20. F. Treatment of infrequent bleeding 1. Therapy should be directed at the underlying cause when possible. If the CBC and other initial laboratory tests are normal and the history and physical examination are normal, reassurance is usually all that is necessary.
PMDD should be differentiated from premenstrual exacerbation of an underlying major psychiatric disorder, as well as medical conditions such as hyper- or hypothyroidism. 2. About 13 percent of women with PMS are found to have a psychiatric disorder alone with no evidence of PMS, while 38 percent had premenstrual exacerbation of underlying depressive and anxiety disorders. 3. 39 percent of women with PMDD meet criteria for mood or anxiety disorders. 4. The assessment of patients with possible PMS or PMDD should begin with the history, physical examination, chemistry profile, complete blood count, and serum TSH.