Wet smear – pseudophyae
and spores w/ large # WBC
Miconazole (Monistat), Clotrimazole
(Gyne-Lotrimin), Diflucan, Terconazole
(Terazol-3) cream
If patient on antibiotic daily yogurt or
lactobacillus pills
Bacterial
Vaginosis (BV)
Overgrowth of
anaerobic bacteria
in vagina
Unpleasant “fish-like” odor worse after
intercourse. Discharge that is copious and
has milk-like consistency. Exam shows
light gray discharge coating on vaginal
walls. No vulvar or vaginal irritation
Wet smear – clue cells
(squamous epithelial cells
w/ lg bacteria), few WBC;
Whiff test – KOH applied to
sample – smells fishy
Vaginal pH >4.5
Metronidazole (Flagyl), Clindamycin
cream, Not STD, no partner treatment
needed
Abstain from sex until treatment
complete
Trichomonas
Vaginitis
(Trichomoniasis)
Protozoan parasite
w/ flagella
c/o pruritic, reddened vulvovaginal area,
dysuria. Copious grayish-green bubbly
vaginal discharge. Partner may have same
symptoms
Exam: “strawberry” cervix
w/ some bleeding
Metronidazole (Flagyl)
Treat sexual partner; avoid sex until
treatment complete
Atrophic
Vaginitis
Lack of estrogen in
tissue of urogenital
tract
Vaginal dryness, itching, pain w
intercourse. No discharge, less rugae,
pale color, may bleed on physical exam
Pap smear shows atrophic
changes
Elevated FSH/LH
Temporary use of topical estrogen
cream, if intact uterus, need
progesterone
Osteoporosis
Loss of bone
density from
estrogen def.
“Skinny white woman who smokes and
drinks” – seen in Caucasian and Asian
women.
Affects women and men
DXA scan: T-score < -2.5
(Osteopenia - -1.5 to -2.4)
Weight-bearing exercises, calcium w/ Vit
D (1200/800mg),
bisphosphonates: 1
st
line – Fosamax (alendronate), Actonel
(risedronate), Selective Estrogen
Receptor Modulator – Evista (raloxifene)
after menopause, Miacalcin (not 1
st
line)
HET/ERT to increase bone density
Pap Smears:
Bethesda system
Atypical Squamous cells of undetermined significance:
Atypical Glandular Cells of Undetermined Significance:
Low-grade Squam.
Intraepithelial Lesions/
<20yo – repeat in 12 months
refer for endometrial biopsy
High-
grade Squamous epithelial lesions:
>21 – oder pap with “reflex” (HPV DNA)
HPV
testing – refer for colposcopy and biopsy
Oncogenic HPV 16, 18 – refer for colposcopy/biopsy
Oral Contraceptives
Combined oral contraceptives
o
Monophasic
pills (Loestrin) –
21 active pills; placebo last
7d
o
Triphasic
(Ortho tri-cyclen) -
21 active pills; placebo last
7d. Hormones wk 3 varies.
Good for acne
o
Extended
Cycle
(Seasonale)
– 84 days active pill w/ 7 free
days. 4 periods/yr
o
Ethinyl
Estradiol
/Drospirenone (Yaz)
– drospirenone as
progesterin; great for acne,
PCOS, hirsuitism, PMDD. High
risk for DT/hyperkalemia.
Must check K+ levels if on
ACEI/ARB/K+ sparing diuretic
Progestin-Only
o
Micronor
– 28 days starting
(mini-pill) – safe for
breastfeeding
o
Contraindications: hx DVT,
smoker over 35, increase for
stroke, acute liver infection,
known CAD, pregnancy,
reproductive cancers
WOMEN’S HEALTH
Contraceptive contraindications
Absolute
contraindications
“MY CUPLETS”
o
Migraines w/ focal
neurologica aura
o
CAD/CVA
o
Undiagnosed genital bleeding
o
Pregnant
o
Liver tumor/active liver
disease
o
Estrogen-dependent tumor
o
Thrombus/emboli
o
