Women’s Health
OCPS
OCP of choice is alesse
seasonale is a new 3 month cycle pill, but the same is safe with standar pills, just keep taking the actual drug for 12 weeks, discarding the placebos, then skip a week before starting over.
Antibiotics do not effect OCP efficacy except for Anti-TB agents (J Amer Acad Derm 46(6):917, 2002)
IUDs
Mirena
5 years
progesterone eluting
brown strings
decreased periods
Paragard
copper eluting
increased periods
clear/white strings
10 years
strings should be 2.5 cm
Morning After Pill
Morning after regimen is 1 plan b (levonorgestrel .75 mg) or ovral at presentation and then 12 hours later. It will not hurt an existing pregnancy.
Can take both plan b tabs at once with no increased pregnancies or side effects (multicenter randomized trial. Lancet 2002;360:1803-10)
best article (Annals of Intern Med Emergency Contraception 6 August 2002 | Volume 137 Issue 3 | Pages 180-189)
Orally administered mifepristone, an antiprogestin, is also effective as emergency contraception. Randomized, controlled trials have shown that a single oral 600-mg dose of mifepristone was more effective and less noxious than the Yuzpe regimen (13) or danazol (14). Another trial (15) found that lower doses (50 mg and 10 mg) were as effective as the 600-mg dose.
The preferred management of vomiting shortly after taking emergency contraception is unknown (58). Some investigators suggest that vomiting indicates that sufficient quantities of steroid have been absorbed. Others recommend repeating the dose, particularly if the vomiting occurs shortly after the dose is taken (within 1 hour). In cases of severe vomiting, the pills can be administered vaginally. Small studies of regular oral contraceptive pills administered by this route indicate that the hormones are absorbed through the vaginal epithelium (74, 75); this has been found to be true for other pills as well (76-78).
RU-486
no deaths by this agent, though prostoglandins can not say the same
STDs
STDs
Vaginal Bleeding
A tampon or pad holds 25 cc of blood
Cervical Polyps/CA.
Fibroids (Submucosal Myomas).
Uterine CA
Ovarian Cysts
Dysfunctional Uterine Bleeding (DUB)
very common at menarche, also c birth control pills. Anovulatory cycles. R/o coagulation defects and especially consider VWD.
give estrogen (Premarin 25 mg IVPB Q4-6) and send home on OCPs (estrogen only is needed initially.) Use the high dose OCPs, such as or if giving the low dose, use BID dosing without the placebo for 6-8 weeks. Wait one week and then start progesterone. After a few weeks, withdraw the progesterone to allow bleeding.
Dysfunction Uterine Bleeding (DUB)
very common at menarche, also c birth control pills. Anovulatory cycles. R/o coagulation defects and especially consider VWD.
give estrogen (Premarin 25 mg IVPB Q4-6) and send home on OCPs (estrogen only is needed initially.) Use the high dose OCPs, such as or if giving the low dose, use BID dosing without the placebo for 6-8 weeks. Wait one week and then start progesterone. After a few weeks, withdraw the progesterone to allow bleeding.
Ortho-Novum 1/50 or Norinyl 1+50 2-4 pills OD for 3-5 days
then 1 pill OD for rest of month.
Ortho-Novum 1/50 or Norinyl 1+50 2-4 pills OD for 3-5 days then 1 pill OD for rest of month.
If bleeding is severe:
Give 4 tabs ortho tricyclin (need pill with 35 mg estradiol) for 2 days, 3 tabs for 2 days, 2 tabs for 2 days, and 1 tab for 2 days. Pt’s need to be given an anti-emetic as well.
Vaginal Bleeding in Pregnancy
Acute Pelvic Pain
Do pelvic unless you expect placenta previa, in which case get UTS then do pelvic
Adlers Sign-to differentiate between appendicitis and tuboovarian pathology in RLQ pain. Find point of maximal tenderness while the patient is supine. Have them roll onto left side. If pain shifts towards center then may be tubo-ovarian.
Ovarian Torsion
ovary can twist on its vasculature (cyst or tumor predispose)
Suspect with enlarged ovary or pelvic surgery (eg. Tubal ligation)
Classic: colicky pain in lower quadrant radiating to flank or groin accompanied by n/v.
50% may have abd mass
False negative ultrasound including doppler in 61% of pregnant woemn and 45% of non-pregnant women (AJOG 2010;202:536;e1-6)
Ovarian Cysts
follicular or corpus luteum
Uterine Perforation
usually after procedure or during pregnancy
Fibroids-ischemic necrosis, torsion, infection
Dysmenorrhea
Tuboovarian Abscess
Ultrasound is actually not very sensitive (The Journal of Emergency Medicine, Vol. 40, No. 2, pp. 170175, 2011)
Endometriosis
Endometriosis-false implantation of endometrial tissue
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