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STEP-UP
O BSTFJm «JD
gynecology
Frank W. Ling, MD Sandra Ann Carson, MD
C linical P rofessor A d ju n c t P rofessor of O bste trics and G ynecology
D epartm ent o f O bste trics and G ynecology A lp e rt M e d ica l S chool of B row n U niversity
V a n d e rb ilt U nive rsity S chool of M e d icin e and M eha rry P rovidence, Rhode Island
M e d ica l College D irector, A m erican Board o f O bste trics and G ynecology
N ashville, Tennessee Dallas, Texas
Partner, W om en’s H ealth S pecialists
G erm antow n, Tennessee
D irector, The Foundation fo r Exxcellence in W om en's
Wesley C. Fowler, Jr., MD
H ealth Care A ssociate Dean fo r M edica l A lum ni A ffa irs
D allas, Texas P rofesso r o f O bstetrics And G ynecology
U nive rsity o f N orth Carolina S chool o f M e d icine
Chapel Hill, N orth Carolina
Russell R. Snyder, MD P resident, The Foundation fo r Exxcellence in W om en's
V ice-C hair and D irector, D ivision o f G ynecology Health Care
D epartm ent o f O bstetrics and G ynecology Dallas, Texas
U nive rsity of Texas M e d ica l Branch
G alveston, Texas
D irector, The Foundation fo r Exxcellence in W om en's
H ealth Care
D allas, Texas
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Step-up to obstetrics and gynecology / [edited by] Frank W. Ling, Russell R. Snyder, Sandra Ann Carson,
Wesley C. Fowler. — 1st edition,
p .; cm. — (Step-up series)
Includes bibliographical references and index.
ISBN 978-1-4511-1244-3 (alk. paper)
I. Ling, Frank W., editor. II. Snyder, Russell R. editor. III. Carson, Sandra A. (Sandra Ann), editor. IV. Fowler,
Wesley C., Jr., 1940- editor. V. Series: Step up series.
[DNLM: 1. Pregnancy Complications—Examination Questions. 2. Pregnancy Complications—Outlines. 3.
Genital Diseases, Female—Examination Questions. 4. Genital Diseases, Female—Outlines. WQ 18.2]
RG111
618.076—dc23
2014008800
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S ection Editors
FRANK W. LING, MD SANDRA ANN CARSON, MD
Section 2: Obstetrics Section 4: Reproductive Endocrinology and Infertility
Clinical Professor Adjunct Professor of O bstetrics and Gynecology
Department of Obstetrics and Gynecology Alpert M edical School of Brown University
Vanderbilt University School of M edicine and Providence, Rhode Island
M eharry M edical College Director, Am erican Board of O bstetrics and
Nashville, Tennessee Gynecology
Partner, Women's Health Specialists, PLLC Dallas, Texas
Germantown, Tennessee
Director, The Foundation for Exxcellence in Women's W ESLEY C. FOW LER, JR., MD
Health Care Section 5: Gynecologic Oncology
Dallas, Texas Associate Dean for M edical A lumni Affairs
Professor of O bstetrics And Gynecology
RUSSELL R. SNYDER, MD University of North Carolina School of M edicine
Section 1: Overview o f Women's Health Chapel Hill, North Carolina
Section 3: Gynecology President, The Foundation for Exxcellence in
Vice-Chair and Director, Division of Gynecology W omen's Health Care
Department of Obstetrics and Gynecology Dallas, Texas
University of Texas M edical Branch
Galveston, Texas
Director, The Foundation for Exxcellence in Women's
Health Care
Dallas, Texas
v
C ontributing A uthors
✓
MICHAEL T. ADLER, MD BETTY CHOU, MD
Chapter 25: Postterm Pregnancy and Intrauterine Fetal Chapter 16: Common M edical and Surgical Problems in
Demise Pregnancy
Chapter 26: Obstetric Procedures Chapter 20: Fetal Growth Abnormalities: Fetal Growth
A ssistant Professor of Obstetrics and Gynecology Restriction and M acrosomia
Department of O bstetrics and Gynecology Director, Johns Hopkins Women's Services at
University of Texas M edical School at Houston Odenton
Houston, Texas Assistant Professor
Department of Obstetrics and Gynecology
PAMELA D. BERENS, MD Johns Hopkins Bayview M edical Center
Chapter 2: The Obstetrician/Gynecologist's Role in Baltimore, Maryland
Screening and Preventive Care
Chapter 14: Postpartum Care/Complications ALICE CHUANG, MD
Professor, Vice Chair of Clinical Affairs Chapter 45: Cell Biology and Principles o f Cancer
Department of O bstetrics and Gynecology Therapy
University of Texas M edical School at Houston Chapter 46: Gestational Trophoblastic Neoplasia
Houston, Texas Chapter 50: Ovarian and Adnexal Disease
Associate Professor
MOSTAFA A. BORAHAY, MD, FACOG Departm ent of Obstetrics and Gynecology
Chapter 34: Dysmenorrhea and Chronic Pelvic Pain University of North Carolina
Assistant Professor Chapel Hill, North Carolina
Women's Reproductive Health Research (WRHR)
Scholar LESLIE CLARK, MD
Department of O bstetrics and Gynecology Chapter 45: Cell Biology and Principles o f Cancer
University of Texas M edical Branch Therapy
Galveston, Texas Resident
Departm ent of Obstetrics and Gynecology
University of North Carolina
AMY M. BURKETT, MD
Chapel Hill, North Carolina
Chapter 18: Hypertension in Pregnancy
Department of O bstetrics and Gynecology
BRENDAN D. CONNEALY, MD
Summa Health Systems
Chapter 6: Endocrinology o f Pregnancy
Northeastern Ohio Universities College of
Chapter 12: Immediate Care o f Newborn
Medicine
M FM Fellow
Akron, Ohio
Departm ent of Obstetrics and Gynecology
University of Texas M edical School at Houston
CHRISTINNE CANELA, MD Houston, Texas
Chapter 41: Hirsutism and Virilization
Physician Director of M edical Quality DOUGLAS R. DANFORTH, PHD
Department of O bstetrics and Gynecology Chapter 5: Reproductive Physiology
Carilion Roanoke M emorial Hospital Associate Professor
Roanoke, Virginia Departm ent of Obstetrics and Gynecology
The Ohio State University M edical Center
Columbus, Ohio
CONTRIBUTING AUTHORS • VÍ¡
JILL EDWARDSON, M D, MPH JAOU-CHEN HUANG, MD
Chapter 16: Common M edical and Surgical Problems in Chapter 43: Infertility
Pregnancy Reproductive Endocrinologist
Assistant Professor Departm ent of Obstetrics and Gynecology
Departm ent of Obstetrics and Gynecology M emorial Hermann Hospital
Johns Hopkins M edical Center Houston, Texas
Baltimore, Maryland
NANCY A. HUEPPCHEN, MD
CYNTHIA B. EVANS, MD Chapter 16: Common M edical and Surgical Problems
Chapter 42: M enopause in Pregnancy
Associate Professor Chapter 20: Fetal Growth Abnormalities: Fetal Growth
Departm ent of Obstetrics and Gynecology Restriction and M acrosomia
The Ohio State University M edical Center Director of M edical Education
Columbus, Ohio Associate Professor
Departm ent of Obstetrics and Gynecology
JASON FRANASIAK, MD Johns Hopkins University School of M edicine
Chapter 49: Cancer o f the Uterine Corpus Baltimore, Maryland
Physician at Reproductive M edicine Associates of
New Jersey PATRICIA HUGUELET, MD, FACOG
Obstetrics and Gynecology Chapter 17: Infectious Diseases in Pregnancy
Gladstone, New Jersey Assistant Professor
Departm ent of Obstetrics and Gynecology
MELISSA M. GOIST, MD University of Colorado, Anschutz M edical Center
Chapter 15: Ectopic Pregnancy Aurora, Colorado
Assistant Professor
Departm ent of Obstetrics and Gynecology ANDREW F. HUNDLEY, MD
The Ohio State University M edical Center Chapter 32: Pelvic Support Defects, Urinary
Columbus, Ohio Incontinence, and Urinary Tract Infection
Division Director, Female Pelvic M edicine and
SUSAN GOLDSM ITH, MD Reconstructive Surgery
Chapter 8: Preconception and Antepartum Care Departm ent of Obstetrics and Gynecology
Assistant Professor The Ohio State University M edical Center
Departm ent of Obstetrics and Gynecology Columbus, Ohio
Northwestern University Feinberg School of Medicine
Chicago, Illinois MICHELLE M. ISLEY, MD, MPH
Chapter 28: Sterilization
MATTHEW GRACE, MD Assistant Professor
Chapter 47: Benign Vulvar Disease Departm ent of Obstetrics and Gynecology
Assistant Professor The Ohio State University M edical Center
Departm ent of Obstetrics and Gynecology Columbus, Ohio
University of North Carolina
Chapel Hill, North Carolina CHERYL J. JOHNSON, MD
Chapter 1: The Woman's Health Examination
CATHERINE HANSEN, M D, MPH Departm ent of Obstetrics and Gynecology
Chapter 37: Sexual Function and Dysfunction Summ a Health System
Assistant Professor Ohio State University
Departm ent of Obstetrics and Gynecology Akron, Ohio
University of Texas M edical Branch
Galveston, Texas BENJAMIN A. KASE, MD
Chapter 7: M aternal-Fetal Physiology
GERI D. HEWITT, MD Departm ent of Obstetrics and Gynecology
Chapter 39: Puberty Tripler Army Medical Center
Assistant Professor Honolulu, Hawaii
Departm ent of Obstetrics and Gynecology
The Ohio State University M edical Center
Columbus, Ohio
viii • CONTRIBUTING AUTHORS
AMANTIA KENNEDY, MD SILKA PATEL, MD
Chapter 46: Gestational Trophoblastic Neoplasia Chapter 13: Abnormal Labor and M alpresentation
A ssistant Professor Assistant Professor
Department of O bstetrics and Gynecology Departm ent of Obstetrics and Gynecology
University of North Carolina Johns Hopkins School of Medicine
Chapel Hill, North Carolina Baltimore, Maryland
SAMI GOKHAN KILIC, MD, FACOG, FACS PAMELA A. PROMECENE, MD
Chapter 36: Gynecologic Procedures Chapter 3: Ethics in Obstetrics and Gynecology
Assistant Professor Chapter 10: Normal Labor and Delivery
Department of O bstetrics and Gynecology Associate Professor of O bstetrics and G ynecology-
University of Texas M edical Branch Clinical
Galveston, Texas Assistant Dean for Graduate M edical Education
Departm ent of Obstetrics and Gynecology
EDUARDO LARA-TORRE, MD University of Texas M edical School at Houston
Chapter 41: Hirsutism and Virilization Houston, Texas
Chapter 44: Premenstrual Syndrome and Premenstrual
Dysphoric Disorder TRACY L. PROSEN, MD
Residency Program Director Chapter 19: M ultifetal Gestation
Department of O bstetrics and Gynecology Assistant Professor
Carilion Roanoke M emorial Hospital Departm ent of Obstetrics, Gynecology and Women's
Roanoke, Virginia Health
University of M innesota
FRANK W. LING, MD Minneapolis, M innesota
Chapter 35: Breast Disorders
Clinical Professor KELLIE S. RATH, MD
Department of O bstetrics and Gynecology Chapter 4: Embryology and Anatomy
Vanderbilt University School of M edicine and OhioHealth Gynecologic Cancer Surgeons
M eharry M edical College Columbus, Ohio
Nashville, Tennessee
Partner, W omen's Health Specialists BRITTON D. RINK, MD
Germantown, Tennessee Chapter 9: Prenatal Diagnosis, Genetic Disorder
Director, The Foundation for Exxcellence in Women's Assessment, and Teratology
H ealth Care Director, Prenatal Genetics and Ultrasound
Dallas, Texas Assistant Professor
Departm ent of Obstetrics and Gynecology
QUINN LIPPM ANN, M D, MPH The Ohio State University M edical Center
Chapter 48: Cervical Dysplasia and Carcinoma Columbus, Ohio
Oth Post-MD
Department of Reproductive Medicine ANA M. RODRIGUEZ, MD
University of California San Diego Chapter 27: Contraception
San Diego, California Assistant Professor
Departm ent of Obstetrics and Gynecology
AMANDA B. M URCHISON, MD University of Texas M edical Branch
Chapter 22: Preterm Labor Galveston, Texas
Chapter 23: Third-Trimester Bleeding
A ssistant Residency Program Director JACQUELINE ROHL, MD, MPH
Department of O bstetrics and Gynecology Chapter 29: Reproductive Tract Congenital
Carilion Roanoke M emorial Hospital Anomalies
Roanoke, Virginia Assistant Professor
Department of Obstetrics and Gynecology
JESSICA L. NYHOLM , MD The Ohio State University M edical Center
Chapter 11: Intrapartum Fetal Surveillance Columbus, Ohio
A ssistant Professor
Department of Obstetrics, Gynecology and Women's
Health
University of M innesota
M inneapolis, M innesota
CONTRIBUTING AUTHORS • ¡X
ANDREW J. SATIN, MD CHESNEY THOM PSON, MD
Chapter 13: Abnormal Labor and M alpresentation Chapter 17: Infectious Diseases in Pregnancy
The Dorothy Edwards Professor and Professor and Vice-Chair
Director of G ynecology and Obstetrics Chief o f General Obstetrics and Gynecology
Obstetrician /Gynecologist-in-Chief Departm ent of Obstetrics and Gynecology
Johns Hopkins Hospital University of Colorado
Johns Hopkins Medicine Aurora, Colorado
Baltimore, Maryland
PATRICE M. W EISS, MD
JONATHAN SCHAFFIR, MD Chapter 44: Premenstrual Syndrome and Premenstrual
Chapter 33: Endometriosis Dysphoric Disorder
Assistant Professor Departm ent Chair
Departm ent of Obstetrics and Gynecology Departm ent of Obstetrics and Gynecology
The Ohio State University M edical Center Carilion Roanoke Memorial Hospital
Columbus, Ohio Roanoke, Virginia
RUSSELL R. SNYDER, MD HOLLY A. WEST, MPAS, PA-C
Chapter 40: Amenorrhea and Abnormal Uterine Bleeding Chapter 40: Amenorrhea and Abnormal Uterine Bleeding
Vice-Chair and Director, Division of Gynecology Assistant Professor
Departm ent of Obstetrics and Gynecology Departm ent of Obstetrics and Gynecology
University o f Texas M edical Branch University of Texas M edical Branch
Galveston, Texas Galveston, Texas
Director, The Foundation for Exxcellence in Women's
Health Care YASUKO YAMAMURA, MD
Dallas, Texas Chapter 21: Isoimmunization
Chapter 24: Premature Rupture o f Membranes
KATHERINE STRAFFORD, MD Assistant Professor
Chapter 30: Reproductive Tract Benign Conditions Department of Obstetrics, Gynecology and Women's
Assistant Professor Health
Departm ent of Obstetrics and Gynecology University of Minnesota
The Ohio State University M edical Center M inneapolis, Minnesota
Dublin, Ohio
MATT ZERDEN, MD
OLGA F. SWANSON, MD Chapter 50: Ovarian and A dnexal Disease
Chapter 31: Vulvovaginitis and Sexually Transmitted Fellow
Diseases Departm ent of Obstetrics and Gynecology
Obstetrics and Gynecology University of North Carolina
Houston Heights Women's Healthcare Center Chapel Hill, North Carolina
Houston, Texas
JEFF R. TEM PLE, PHD
Chapter 38: Sexual Assault and Domestic Violence
Assistant Professor
Departm ent of Obstetrics and Gynecology
University o f Texas M edical Branch
Galveston, Texas
P reface
The Foundation for E xxcellence in W omen's Health Care and these medical
authors and educators proudly present this first edition of Step-Up to Obstetrics
and Gynecology. Designed to aid the medical student to prepare for end-of-rotation
and national standardized examinations, it aims to present the depth and breadth
of obstetrics and gynecology in a concise outline format. It w ill enhance but not
replace standard textbooks and other sources, which were developed for the
learner during the core clerkship in the specialty.
We expect Step-Up to Obstetrics and Gynecology w ill be an effective learning tool
for future physicians dedicated to serving their female patients regardless of the
specialty they choose. Key concepts and facts are reinforced w ith "Q uick H its" in
the margins, and important concepts are supplemented with clinical photographs,
illustrations, tables, and algorithms. Patient-oriented clinical scenarios presented
in the form of m ultiple-choice questions allow the student to self-assess their
knowledge.
Supported in part by the Am erican Board o f Obstetrics and Gynecology,
Inc., the Foundation for E^ jl cellence in W omen's Health Care is dedicated to
prom oting the health of w om en and the professional development of their
physicians. The two "X s" in the Foundation's nam e is a constant reminder of our
focus. We sincerely hope that those who use Step-Up to Obstetrics and Gynecology
find it to be all that w e planned.
Frank W. Ling, MD
Russell R. Snyder, MD
Sandra Ann Carson, MD
Wesley C. Fowler, MD
Nancy B. Dent, PhD, Executive Director,
The Foundation fo r E x c e lle n c e
in Women's Health Care
January 2014
Ü t#
ft fi
e x xcellen ce
C ontents
Section Editors v
Contributing Authors vi
Preface x
1. The W o m a n ’s H ealth E x a m in a tio n ...................................................................................3
2. The O b s te tric ia n /G y n e c o lo g is t’s Role in S creening
and P reventive C a re ...........................................................................................................13
3. Ethics in O b s te tric s and G y n e c o lo g y .........................................................................22
4. E m b ryolo g y and A n a to m y ...............................................................................................24
5. R ep ro d uctive P h y s io lo g y ................................................................................................. 36
6. E n d o crin o lo g y o f P r e g n a n c y ..........................................................................................49
7. M a te rn a l-F e ta l P h y s io lo g y ...............................................................................................55
8. P re con ce p tion and A n te p artum C a re ........................................................................... 63
9. Prenatal D ia g n o sis, G e n e tic D is o rd e r A sse ssm en t,
and T e ra to lo g y .................................................................................................................... 68
10. N orm a l Lab o r and D e liv e r y ............................................................................................ 79
11. In tra p a rtu m Fetal S u rv e illa n c e ....................................................................................... 85
12. Im m ediate C are o f N e w b o r n ..........................................................................................90
13. A b n orm a l Lab o r and M a lp re s e n ta tio n .........................................................................96
14. P ostp a rtu m C a re /C o m p lic a tio n s ................................................................................ 101
15. E cto p ic P re g n a n c y ...........................................................................................................112
16. C om m o n M e d ica l and S u rgica l P roblem s in P re g n a n c y .................................... 117
17. In fe ctio u s D ise a se s in P re g n a n c y ..............................................................................124
18. H ype rte n sion in P re g n a n c y ..........................................................................................138
19. M u ltife ta l G e s ta tio n ........................................................................................................ 145
20. Fetal G ro w th A b n o rm a litie s: Fetal G ro w th R e strictio n
and M a c ro s o m ia ................................................................................................................150
21. Is o im m u n iz a tio n ................................................................................................................155
22. Preterm L a b o r .................................................................................................................. 160
23. T h ird-T rim e ste r B le e d in g ...............................................................................................163
24. P rem ature R upture o f M e m b ra n e s ..............................................................................167
25. P ostterm P regnancy and In tra u te rin e Fetal D e m is e ............................................171
26. O b s te tric P ro c e d u re s ......................................................................................................175
xii • CONTENTS
Section 3 G ynecology
27. C o n tra c e p tio n .................................................................................................................... 189
28. S te r iliz a tio n ....................................................................................................................... 204
29. R epro d uctive Tract C o n g e n ita l A n o m a lie s ............................................................... 210
30. R epro d uctive Tract B e nign C o n d itio n s .................................................................... 218
31. V u lv o v a g in itis and S e xu ally Tra n sm itte d D is e a s e s .............................................. 231
32. P e lvic S u p p o rt D efects, U rin a ry In co n tine n ce ,
and U rin a ry Tract In fe c tio n ............................................................................................ 243
33. E n d o m e trio sis.................................................................................................................... 256
34. D y sm en o rrhe a and C h ro n ic P elvic P a in ..................................................................261
35. B re ast D is o r d e r s ............................................................................................................. 266
36. G y n e co lo g ic P ro c e d u re s ...............................................................................................274
37. Sexual F unction and D y s fu n c t io n ..............................................................................281
38. Sexual A s s a u lt and D o m e stic V io le n c e .................................................................... 289
39. P u b e rty .................................................................................................................................297
40. A m e no rrh e a and A b n orm a l U te rin e B le e d in g ........................................................303
41. H irsu tism and V ir iliz a tio n ...............................................................................................312
42. M e n o p a u se ......................................................................................................................... 319
43. In fe r tility .............................................................................................................................. 323
44. P re m en stru a l S yndrom e and P rem enstrual
D y s p h o ric D is o r d e r ........................................................................................................ 326
45. C e ll B io lo g y and P rin cip le s o f C a n ce r T h e ra p y ..................................................... 333
46. G e sta tio n a l T ro p h o b la stic N e o p la s ia .........................................................................338
47. B e nign V u lva r D is e a s e ....................................................................................................342
48. C e rvica l D ysp la sia and C a r c in o m a ........................................................................... 348
49. C a n ce r o f th e U te rin e C o r p u s ..................................................................................... 354
50. O va rian and Adnexal D is e a s e ..................................................................................... 357
Index 367
S E C T IO N
Overview of
Women’s Health
www.medilibros.com
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The W om an's H ealth
Exam ination
I
I. M edical History
A. Chief complaint (CC): concise statement for reason of visit
B. History of present illness (HPI): chronologic description of present illness
1. Quality
2. Radiation
3. Duration
4. Alleviating factors
5. Exacerbating factors
C. Review of systems (ROS): inventory of all body systems (Box 1.1)
D. Gynecologic history
1. Menstrual history
a. Age at menarche (age at which menses began)
g g a s io
b. Last menstrual period (LMP) A gynecologic evaluation is
c. Previous menstrual period (PMP): establishes days between cycles an important part of primary
d. Cycle length health care and preventative
medicine for women.
e. Cycle flow
i. Clotting
ii. Number of pads or tampons
f. Menstrual pain (dysmenorrhea)
g. Abnormal uterine bleeding (AUB)
i. Irregular (metrorrhagia)
ii. Heavy (menorrhagia)
iii. Intermenstrual
iv. Postcoital
v. Postmenopausal
vi. Midcycle spotting (mittelschmerz)
vii. Breakthrough bleeding (BTB) if on hormonal therapy to control
cycles
h. Premenstrual symptoms
i. Physical
(a) Fluid retention
(b) Bloating
(c) Breast tenderness
(d) Headaches
(e) Pain
ii. Emotional
(a) Mood fluctuations
(b) Food cravings
(c) Anxiety
(d) Nervousness
(e) Sleep disturbances
(f) Libido changes
3
4 • STEP-UP TO OBSTETRICS AND GYNECOLOGY
BO X 1.1
Review of Systems [ROSl
E x a m in a tio n
1. C O N S T IT U T IO N A L □ NEGATIVE □ W EIG HT LOSS □ W EIGHT G AIN
□ FEVER □ FATIGUE □ OTHER TALLEST HEIGHT
2 . EYES □ NEGATIVE □ VIS IO N CH AN G E □ GLASSES/CONTACTS
□ OTHER
3 . EA R , N O S E , A N D TH RO A T □ NEGATIVE □ ULCERS □ SINUSITIS
□ HEADACHE □ HEARING LOSS □ OTHER
’s Health
4 . C A R D IO V A S C U LA R □ NEGATIVE □ ORTHOPNEA □ CHEST PAIN □ DIFFICULTY BREATHING O N EXERTION
□ EDEMA □ PALPITATION □ OTHER
5 . RE SP IR A T O R Y □ NEGATIVE □ W HEEZING □ HEMOPTYSIS
□ SHORTNESS OF BREATH □ COUGH □ OTHER
6 . G A S TR O IN T E S TIN A L □ NEGATIVE □ DIARRHEA □ BLOODY STOOL □ N A U SEA/VOM ITING/IND IGESTION
I
□ CONSTIPATION □ FLATULENCE □ PAIN □ FECAL IN CO NTINE NCE □ OTHER
7 . G E N IT O U R IN A R Y □ NEGATIVE □ HEMATURIA □ DYSURIA □ URGENCY
□ FREQUENCY □ INCOMPLETE EMPTYING □ INCONTINENCE
□ DYSPAREUNIA □ ABNORMAL OR PAINFUL PERIODS □ PMS
□ ABNORMAL VAGINAL BLEEDING □ ABNORMALVAGINAL DISCHARGE □ OTHER
8 . M U SC U LO SKELETAL □ NEGATIVE □ MUSCLE W EAKNESS
□ MUSCLE OR JOINT PAIN □ OTHER
9 a . S K IN □ NEGATIVE □ RASH □ ULCERS
□ DRY SKIN □ PIGMENTED LESIONS □ OTHER
9 b . B REAST □ NEGATIVE □ MASTALGIA
□ DISCHARGE □ MASSES □ OTHER
1 0. N EU R O LO G IC □ NEGATIVE □ SYNCOPE □ SEIZURES □ NUMBNESS
□ TROUBLE W ALKING □ SEVERE M EMORY PROBLEMS □ OTHER
1 1 . PSY C H IA T RIC □ NEGATIVE □ DEPRESSION □ CRYING
□ SEVERE ANXIETY □ OTHER
1 2. EN D O C RIN E □ NEGATIVE □ DIABETES C D h B o b i y E id I ■ | C jjy ^ T H J p g I
□ H O T FLASHES □ HAIR LOSS C j H E A T/C O ro INTOLERANCE □ OTHER
1 3. H EM A TO LO G IC/LYM P H A TIC □ NEGATIVE □ BRUISES
□ BLEEDING □ ADENOPATHY □ OTHER
1 4. A LLER G IC /IM M U N O LO G IC (SEEFIRST PAGE)
American College o f Obstetricians and Gynecologists Copyright © 2005 (AA322) 12345/98765
(From Beckmann CRB, Ling FW, et al. Obstetrics and Gynecology, 7th ed. Baltimore: Lippincott Williams & Wilkins; 2014.)
i. Perimenopausal/menopausal symptoms
i. Vasomotor symptoms (hot flushes or hot flashes); typically occur during
or are worse while asleep
Premenstrual symptoms ii. Mood changes
always occur in the second iii. Sleep disruption
half of the menstrual cycle
iv. Changes in libido
(luteal phase or secretory
phase). v. Decreased vaginal lubrication
2. Sexual history
a. Sexual orientation: men, women, both
b. Lifetime partners
c. Sexual function: desire, arousal, plateau, orgasm, resolution
d. Satisfaction with sexual function
Menopause is always a e. Contraception (current and past)
retrospective diagnosis i. Problems
consisting of 12 consecutive
ii. Complications
months of amenorrhea.
iii. Satisfaction
iv. Types
(a) Barrier
(b) Hormonal
(c) Implants
