Showing 1-20 of 45 for: Essential Evidence Topics > Gynecologic 
- Abnormal uterine bleeding
Essential Evidence Topics, 11-Nov-2022
Overall Bottom Line: For patients of reproductive age with irregular menses, order/perform a pregnancy test, thyroid-stimulating hormone (TSH) and serum prolactin levels, and an endometrial biopsy in those older than 45 years. Consider endometrial biops
- Amenorrhea
Essential Evidence Topics, 1-Mar-2021
Overall Bottom Line: Women should be evaluated for a cause of amenorrhea if they have not started menarche by the age of 15 years. Women with a history of regular menses should be evaluated for a cause of amenorrhea if they have missed 3 cycles. Evalu
- Bartholin abscess
Essential Evidence Topics, 5-Jul-2021
Overall Bottom Line: Bartholin abscess (BA) is a common vulvar condition in women of reproductive age. Patients typically present with a soft, painful, fluctuant lump 1 to 3 cm in diameter on either side of the labia . Culture of abscess fluid is recomme
- Breast infection and abscess
Essential Evidence Topics, 29-Jul-2022
Overall Bottom Line: When an abscess is suspected clinically, ultrasound does not confirm it in up to 50% of cases. Most small abscesses can be treated with ultrasound-guided needle aspiration. Antibiotics that cover staphylococci and streptococci are
- Breast lump
Essential Evidence Topics, 29-Aug-2022
Overall Bottom Line: Clinical breast examination is not reliable for differentiating benign from malignant breast masses. American College of Radiology guidelines (ACR, 2016) recommend ultrasound for women younger than 30 years and mammography or digita
- Care for patients who identify as transgender
Essential Evidence Topics, 26-Oct-2022
Overall Bottom Line: Patients who are diagnosed with gender incongruence and/or gender dysphoria may not desire hormone therapy but those who are treated with hormone therapy have an improved sense of self and decreased anxiety as well as less dysphoria.
- Cervical and endometrial polyposis
Essential Evidence Topics, 20-Jul-2022
Overall Bottom Line: Most endocervical and endometrial polyps are asymptomatic. Endocervical polyps should be completely removed and submitted for histologic evaluation. Endometrial polyps can be visualized by transvaginal ultrasound, as the first ima
- Cervical cancer
Essential Evidence Topics, 21-Dec-2022
Overall Bottom Line: Offer the human papillomavirus (HPV) vaccine to adolescents who are 11 to 12 years of age. Vaccination is also recommended through age 26 years for those not adequately vaccinated when younger. Start cervical cancer screening at age
- Cervicitis
Essential Evidence Topics, 16-Sep-2021
Overall Bottom Line: Screen for chlamydia in all sexually-active women 24 years and younger and other asymptomatic women at increased risk. Test for chlamydia and gonorrhea with nucleic acid amplification tests (NAATs). Suspect chlamydia or gonorrhea
- Chancroid
Essential Evidence Topics, 13-Dec-2019
Overall Bottom Line: Chancroid is characterized by painful genital ulceration and inflammatory inguinal lymphadenopathy. Test for HSV and syphilis in all patients with genital ulcers. Effective treatments include azithromycin 1 g as a single dose, cip
- Chlamydia urethritis and cervicitis
Essential Evidence Topics, 11-Jun-2022
Overall Bottom Line: While often asymptomatic, men may have penile discharge, dysuria, or urethral pruritus and women may have abnormal vaginal discharge, dysuria, or intermenstrual vaginal bleeding. Screen all pregnant and nonpregnant women who are sex
- Contraception
Essential Evidence Topics, 9-Jun-2022
OVERALL BOTTOM LINE: Oral contraceptives (OCs) can be safely initially provided to patients without a pelvic or breast examination. Combined OCs are a good choice for patients who need efficacy, reversibility, and safety; they should not be used in thos
- Ductal carcinoma in situ of breast
Essential Evidence Topics, 8-Sep-2021
Overall Bottom Line: Ductal carcinoma in situ (DCIS) comprises a heterogeneous group of precancerous breast lesions, each having a somewhat different prognosis and management strategy. Because of this heterogeneity and because 80% of the lesions are nonpa
- Dysmenorrhea
Essential Evidence Topics, 23-Sep-2022
Overall Bottom Line: The history and physical examination are sufficient for a presumptive diagnosis of primary dysmenorrhea in most women. Most young women with a clinical presentation consistent with primary dysmenorrhea can be treated empirically wit
- Dyspareunia
Essential Evidence Topics, 23-Jun-2020
Overall Bottom Line: Dyspareunia is a clinical diagnosis based on a patient's report of painful intercourse; etiologies include organic, psychological, or mixed. A complete history, including sexual and psychosocial aspects, and careful pelvic examinati
- Dysuria
Essential Evidence Topics, 28-Jun-2021
Overall Bottom Line: Symptoms of dysuria plus a positive dipstick test result for nitrites is best to rule in UTI. Healthy women complaining of dysuria may be phone triaged and empirically treated for a UTI. Women reporting vaginal discharge/odor or a
- Ectopic pregnancy
Essential Evidence Topics, 18-Aug-2021
Overall Bottom Line: History and physical findings cannot reliably exclude or confirm the diagnosis of ectopic pregnancy (EP). Use diagnostic strategies that include both pelvic ultrasound and beta-human chorionic gonadotropin (hCG) measurements to diag
- Endometriosis
Essential Evidence Topics, 26-Jan-2022
Overall Bottom Line: Empiric diagnosis is reasonable based on clinical presentation. The levonorgestrel intrauterine device (LNG-IUD) can be used as first-line treatment for pain relief; GnRH analogues and laparoscopic ablation or excision are also effe
- Female athletic triad syndrome
Essential Evidence Topics, 30-Mar-2021
Overall Bottom Line: The history should focus on training regimen, menstrual history, previous fractures, family history of osteopenia, and signs of disordered eating. Explain the potential connection between poor nutrition and caloric intake coupled wi
- Fibrocystic breast disease
Essential Evidence Topics, 18-Nov-2022
Overall Bottom Line: Fibrocystic disease is a benign breast condition characterized by cyclic mastalgia. Fibrocystic disease is not associated with an increase in the risk of breast cancer. In the evaluation of breast pain or fibrocystic breasts, wome
