Concise review for clinicians

Clinical Pearls in Women's Health

Case 1

A 32-year-old woman in her second trimester of pregnancy is found to have blood pressures ranging from 150-160/90-95 mm Hg on 3 separate occasions during the past 2 weeks. She has no edema, and a urine dipstick test reveals no proteinuria. She has no history of hypertension.

Case 2

A 45-year-old woman presents with changes in her menstrual period along with hot flashes and vaginal dryness. Menstrual periods have changed during the past 9 months, with cycles ranging from 20 to 60 days. She had light vaginal bleeding between the last 2 periods. She requests a prescription for an oral contraceptive to regulate bleeding and reduce hot flashes.

Oral contraceptives were well tolerated in the past. She underwent a tubal ligation at 35 years of age. She is a nonsmoker, has normal

Case 3

A 70-year-old woman reports to your office for reevaluation of hypertension. Her last cervical cytologic screening was 2 years ago, and she reminds you she is due for another Papanicolaou test this year. She is monogamous with her husband of 50 years. Prior screening Papanicolaou tests were performed regularly, including 3 times during the past 10 years, and the results were consistently negative. Family history is notable for cervical cancer in her mother.

Medications include the following:

Case 4

A 43-year-old woman, gravida 3, para 3, with very heavy, painful periods seeks your advice. Symptoms did not improve after endometrial ablation. She met with her gynecologist to review treatment options and would like to proceed with a hysterectomy. She has been advised to consider ovary removal along with the hysterectomy and asks for your opinion. She has a history of symptomatic ovarian cysts and premenstrual syndrome. Her family history is notable for a maternal grandmother with ovarian

Case 5

A 28-year-old woman presents for refill of her birth control pill prescription. She started taking birth control pills 1 year ago for contraception and to control heavy periods. Since then she has experienced several episodes of a severe headache during the first 2 days of the pill-free week monthly. Headaches are preceded by visual symptoms consisting of a black spot surrounded by flashing lights, enlarging during approximately 30 minutes and then fading away, and then followed by a left-sided

Case 6

A 34-year-old woman presents with heavy menses during the past 2 years. Her menstrual periods occur monthly and last 4 to 5 days. She has heavy bleeding with clots and cramping discomfort on the first 2 days. For several days before her periods she experiences mood irritability and breast tenderness. She is otherwise healthy.

She takes an iron supplement and no other medications. There is no family history of cancer. She would prefer not to take any estrogen-containing treatments and would