Nr 602 final topics
Week 8:
ACOG guidelines regarding well women exams
ACOG Pap smear guidelines
Start @ 21, every 3
Age 30+ PAP & HPV repeat every 5 if negative (co-test) or 3 yr no co-test
@65 may stop if (-) hx
...
Nr 602 final topics
Week 8:
ACOG guidelines regarding well women exams
ACOG Pap smear guidelines
Start @ 21, every 3
Age 30+ PAP & HPV repeat every 5 if negative (co-test) or 3 yr no co-test
@65 may stop if (-) hx for 10 yrs or hysterectomy w/o hx of cancer
Amenorrhea (Primary and Secondary)
Primary and Secondary Amenorrhea
Primary amenorrhea: No menarche by the age of 15 years (with or without development of secondary
sexual characteristics). Half of cases are caused by chromosomal disorders (50%) such as Turner syndrome.
Puberty is delayed if there is no breast development by age 13 years, absence of pubic
hair at age 14 years, and no menarche by age 15 years.
Secondary amenorrhea: No menses for three cycles, or 6 months if previously had menses. Most
common cause is ).
Secondary Amenorrhea Associated With Exercise and Underweight
Excessive exercise and/or sports participation have a higher incidence of amenorrhea (and infertility) due to
relative caloric deficiency
"Female athlete triad"; anorexia nervosa/restrictive eating, amenorrhea, and osteoporosis
Labs
Pregnancy test (serum human chorionic gonadotropin [hCG])
Serum prolactin level (rule out prolactinoma-induced amenorrhea)
Serum TSH; also follicle-stimulating hormone (FSH) and luteinizing hormone (LH; rule out
premature ovarian failure)
If amenorrhea for more than 6 months, measure bone density
Treatment Plan
Educate about increasing caloric intake and decreasing exercise
Prescribe calcium with vitamin D 1,200 to 1,500 mg daily and vitamin E 400 IU daily
Complications
Osteopenia/osteoporosis (stress fractures)
Myocardial atrophy, arrhythmia (sudden death), bradycardia, hypotension
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