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Office gynecology for the primary care physician, part II: pelvic pain, vulvar disease, disorders of menstruation, premenstrual syndrome, and breast disease.

Approaches to patients with pelvic pain, vulvar disease, disorders of menstruation, premenstrual syndrome, and breast diseases are addressed. In the great majority of cases, it is appropriate for the primary care physician to initiate evaluation and management of these problems. It is hoped that the brief introductions contained here suggest a diagnostic approach to each disorder and guide referral to consultants as needed.

Breast Diseases↗

[Pituitary response to GnRH analogue testing in girls with a polycystic ovary syndrome].

UNLABELLED: THE AIM of our study was to estimate the gonadotropin level after GnRH analogue injection in girls with PCOS after suppression with dexamethasone. MATERIAL AND METHODS: 57 girls with hirsutism, mean age 15.9 years, were involved in the study. The research was performed in the early and middle follicular stage. Menstrual disorders were observed in 78% of them. The patients were divided into 3 groups: I -- with clinical and laboratory symptoms of PCOS (menstruation disorders, testosterone >65 ng/ml and/or LH/FSH >2; n=29), II -- with menstruation disorders and without elevated androgen level (n=15), III -- without menstruation disorders and without elevated androgen level (n=13). Basal blood samples were drawn at 8 a.m. GnRH analogue (Relefact LH-RH) 100 microg was then given subcutaneously and blood samples were drawn every 4 hours for 24 hours. RESULTS: Basal level of LH was the highest in group I (6,18+/-4,10 IU/l) in comparison with II (5.53+/-3.40 IU/l) and III (3.82+/-2.79 IU/l). After GnRH analogue administration mean LH concentration increased in all groups and peaked after 2 hours. Stimulated LH level was the highest in group I and differed statistically significantly from group III during the whole period of the test. The most significant difference occurred at 12 a.m. (p=0.003) and 10 a.m. (p=0.004). The FSH secretion in all tested groups was similar. It peaked, like LH, after 2 hours after GnRH analogue injection and decreased slightly during next 2 hours. A marked decrease was observed in the following period of time. CONCLUSIONS: 1. High and fast LH secretion responding to GnRH analogue indicates masculinization of the hypothalamo-pituitary axis in PCOS girls. 2. The hirsute girls without menstrual disturbances and hormonal abnormalities probably also have subtle masculinization of the pituitary response to stimulation by GnRH analogue.

Adolescent↗

[Mental disorders associated with disorders of menstruation function].

Based on the data of randomized clinical and psychopathological investigation of 100 somatically healthy females with masked depression the author conventionally distinguished three main variants of "gynecological masks" of endogenic depression. A four-year experience of outpatient management of these persons in psychiatric room of the outpatient setting was discussed.

Adult↗

[Modern aspects in the diagnosis and treatment of gynecologic diseases in childhood and adolescence].

Gynecological problems in juvenile and adolescent age deserve a special attention. Disorders appearing at this age are not identical with those developing in adults. Diagnostics and therapy of gynecological diseases in juvenile and adolescent age are far more complicated than the same procedures with adult women, while instruments and examination protocols have to be adjusted to the age of patients. To maintain the purpose of preserving the generative function and sexuality of an adult woman early detection and treatment of gynecological diseases of juvenile age are essential. The paper focuses at the analysis of the most frequently appearing disorders in juvenile and adolescent age: vulvovaginitis, foreign parts in vagina, development anomalies, synechia vulvae and injuries. It is essential to recognize certain diseases in order to prevent possible consequences in older age. Following diseases appearing in adolescents have also been analyzed: menstruation disorders (with an emphasis on menstruation disorder influenced by body weight), sexually transmitted diseases, pregnancy detection and complications.

Adolescent↗

[Conization and hysterectomy from the viewpoint of the surgically treated woman. Results of an inquiry among 814 conized and conized-hysterectomized women].

814 questionnaires of conized and conized-hysterectomized women were evaluated according to menstruation disorders, sexual behaviour, course of pregnancy, medical check-up, carcinophobia, mentality to the operation, pains caused by the operation, and changes of womanliness. 32 percent of the conized women (less than or equal to 45 years old) gave menstruation disorders, mostly hypermenorrhea and dysmenorrhea. Course of pregnancy was not influenced by the conization. Over 80 percent of the women (less than or equal to 45 and greater than 45 years old) said their sexual life were not changed by the conization, in difference to the conized-hysterectomized women: 56 percent (greater than 45 years old) and 69 percent (less than or equal to 45 years old). Half all women were more anxious to get cervical cancer after the conization. The conized women were significantly more to a medical check-up compare to conized-hysterectomized ones. Over 80 percent would like to repeat the conization before removing the uterus. Conized-hysterectomized women felt significantly more less according to womanliness compare to conized ones. 51 percent (less than or equal to 45 years old) and only 35 percent (greater than 45 years old) said no side effects after hysterectomy. Mostly the women complained of pains of the bladder, menses-like mastodynia, and labile circulatory system. There was no significant difference according the answers about abdominal or vaginal hysterectomy with or without adnexectomy.

Adult↗

Disorders of menstruation and their effect on the quality of life in women with congenital factor VII deficiency.

AIMS AND OBJECTIVES: To review menstrual problems in women with congenital FVII deficiency and to study their effect on the quality of life during menstruation in women with congenital FVII deficiency. METHOD: 14 women with congenital factor VII deficiency registered with the Haemophilia Centre at the Royal Free Hospital were interviewed and their case notes reviewed. All women completed Pictorial Blood assessment Chart (PBAC) for assessment of menstrual blood loss and a quality of life questionnaire during menstruation. Similar questionnaire and PBAC was completed by an age matched healthy control group of 23 women. RESULTS: Median age of study group was 35 yrs and of control group 34 yrs. Median FVII level of the study group was 31.5 IU/dL Two women had severe FVII deficiency (FVII level < 10 IU/dL) and 12 women had mild-moderate FVII deficiency. 57% women (8/14) from study group had menorrhagia (PBAC score > 100) compared with 17% (4/23) women from the control group. Six women (43%) from the study group were diagnosed with anaemia due to heavy periods, compared to two (9%) in the control group. The quality of life scores during menstruation were significantly worse in the women with FVII deficiency, compared to controls. CONCLUSION: Women with factor VII deficiency exhibit a spectrum of bleeding symptoms, menorrhagia being one of the commonest symptoms. This has adverse effect on their quality of life.

Activities of Daily Living↗