An elevated free testosterone level is a sensitive

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levels or a free androgen index. An elevated free testosterone level is a sensitive indicator of androgen excess. Other androgens, such as dehydroepiandrosterone sulfate (DHEA-S), may be normal or slightly abovethe normal range in patients with polycystic ovarian syndrome (PCOS). levels of sex hormone–binding globulin (SHBG) are usually low in patients with PCOS.*** Patients with androgen-secreting ovarian or adrenal tumors can present with hirsutism, amenorrhea, and signs of virilization. Although the clinical picture of symptom onset and progression is more predictive than androgen levels, their testosterone level may be greater than 150 ng/dL and their DHEA-S level may be above 800 mcg/dL. DHEA-S is derived from the adrenal gland, and therefore, elevation of DHEA-S would be suggestive of an adrenal origin.*** The follicle-stimulating hormone (FSH) level should be checked to rule out primary ovarian failure. In patients with PCOS, FSH levels are within the reference range or low. Luteinizing hormone (LH) levels are elevated forTanner stage, sex, and age. The LH-to-FSH ratio is usually greater than 3.Thyroid dysfunction, rather than PCOS, may be the source of amenorrhea and hirsutism. (In patients with PCOS, thyroid function tests are within the reference range.)Glucose, Insulin, and Lipids will typically be elevated - c87. Mammogram and self breast exam recommendations21
Women ages 40 to 44should have the choice to start annual breast cancer screening with mammograms (x-rays of the breast) if they wishto do so.Women age 45 to 54should get mammograms every year.Women 55 and oldershould switch to mammograms every 2 years, or can continue yearly screening.Screening should continue as long as a woman is in good health and isexpected to live 10 more years or longer.All womenshould be familiar with the known benefits, limitations, and potential harms linked to breast cancer screening. The ACS does not recommend clinical breast examination for breastcancerscreening among average-risk women at any age.(Qualified Recommendation)Cervical CA Screening Women 21 to 65 (Pap Smear) or 30-65 (in combo with HPV testing)The USPSTF recommends screening for cervical cancer in women age 21 to 65 years with cytology (Pap smear) every 3 years or, for women age 30 to 65 years who want to lengthen the screening interval, screening witha combination of cytology and human papillomavirus (HPV) testing every 5 years. See the Clinical Considerationsfor discussion of cytology method, HPV testing, and screening interval.22

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