NURS 5432 Module 2 & 3 Women's Health
The failure of any menses to appear is termed "primary
amenorrhea," and evaluation is commenced either (1) at age
14 years if neither menarche nor any breast development has
occurred or if height is in the lowest 3% for ethnicity, or (2)
Primary Amenorrhea at age 16 years if menarche has not occurred
Secondary amenorrhea is defined as the absence of menses
for 3 consecutive months in women who have passed
Secondary Amenorrhea menarche.
Patients with primary amenorrhea require a thorough history
and physical examination to look for signs of the conditions
noted above. Headaches or visual field abnormalities
implicate a hypothalamic or pituitary tumor. Signs of
pregnancy may be present. Blood pressure elevation, acne,
and hirsutism should be noted. Short stature may be seen
with an associated GH or thyroid hormone deficiency. Short
stature with manifestations of gonadal dysgenesis indicates
Turner syndrome. Olfactory deficits are seen in Kallmann
syndrome. Obesity and short stature may be signs of Cushing
syndrome. Tall stature may be due to eunuchoidism or
Primary Amenorrhea acromegaly. Hirsutism or virilization suggests excessive
symptoms and physical exam testosterone.
An external pelvic examination plus a rectal examination
should be performed to assess hymen patency and the
presence of a uterus.
The initial endocrine evaluation should include serum FSH,
LH, PRL, total and free testosterone, TSH, FT4, and beta-
hCG (pregnancy test).
Girls who have a normal uterus and high FSH without the
Primary Amenorrhea labs classic features of Turner syndrome may require a karyotype
to diagnose X chromosome mosaicism
thyroid function tests, prolactin, FSH, LH, total testosterone,
Secondary Amenorrhea labs serum estradiol, Pregnancy test
2025/11/10
, NURS 5432 Module 2 & 3 Women's Health
ACS start at 25:
Primary HPV alone q 5 years or
co-testing q 5 years or
cytology alone q 3 years
ACS and ACOG guidelines
21-29 years ACOG start at 21:
cytology alone q 3 years
ACS:
Primary HPV testing alone q 5 years or
co-testing q 5 years or
cytology alone q 3 years
ACOG:
ACS and ACOG guidelines
co-testing q 5 years or
30-65 years
cytology alone q 3 years or
primary HPV testing alone q 5 years
Pap and HPV testing over 65 not recommended and not recommended if hysterectomy
years
Bethesda Classification Squamous cell abnormalities
· ASCUS - atypical squamous cells of undetermined
ASCUS significance
· LSIL OR LGSIL - low grade squamous intraepithelial
lesion
· LSIL OR LGSIL o CIN 1: HPV or mild dysplasia
· HSIL or HGSIL - high grade squamous intraepithelial
lesion
· HSIL or HGSIL o CIN 2: moderate dysplasia
o CIN 3: severe dysplasia
· Need endometrial bx
Changes in glandular cells
(AGCUS), presence of
endometrial cells,
adenocarcinoma, etc.
recommends?
2025/11/10
The failure of any menses to appear is termed "primary
amenorrhea," and evaluation is commenced either (1) at age
14 years if neither menarche nor any breast development has
occurred or if height is in the lowest 3% for ethnicity, or (2)
Primary Amenorrhea at age 16 years if menarche has not occurred
Secondary amenorrhea is defined as the absence of menses
for 3 consecutive months in women who have passed
Secondary Amenorrhea menarche.
Patients with primary amenorrhea require a thorough history
and physical examination to look for signs of the conditions
noted above. Headaches or visual field abnormalities
implicate a hypothalamic or pituitary tumor. Signs of
pregnancy may be present. Blood pressure elevation, acne,
and hirsutism should be noted. Short stature may be seen
with an associated GH or thyroid hormone deficiency. Short
stature with manifestations of gonadal dysgenesis indicates
Turner syndrome. Olfactory deficits are seen in Kallmann
syndrome. Obesity and short stature may be signs of Cushing
syndrome. Tall stature may be due to eunuchoidism or
Primary Amenorrhea acromegaly. Hirsutism or virilization suggests excessive
symptoms and physical exam testosterone.
An external pelvic examination plus a rectal examination
should be performed to assess hymen patency and the
presence of a uterus.
The initial endocrine evaluation should include serum FSH,
LH, PRL, total and free testosterone, TSH, FT4, and beta-
hCG (pregnancy test).
Girls who have a normal uterus and high FSH without the
Primary Amenorrhea labs classic features of Turner syndrome may require a karyotype
to diagnose X chromosome mosaicism
thyroid function tests, prolactin, FSH, LH, total testosterone,
Secondary Amenorrhea labs serum estradiol, Pregnancy test
2025/11/10
, NURS 5432 Module 2 & 3 Women's Health
ACS start at 25:
Primary HPV alone q 5 years or
co-testing q 5 years or
cytology alone q 3 years
ACS and ACOG guidelines
21-29 years ACOG start at 21:
cytology alone q 3 years
ACS:
Primary HPV testing alone q 5 years or
co-testing q 5 years or
cytology alone q 3 years
ACOG:
ACS and ACOG guidelines
co-testing q 5 years or
30-65 years
cytology alone q 3 years or
primary HPV testing alone q 5 years
Pap and HPV testing over 65 not recommended and not recommended if hysterectomy
years
Bethesda Classification Squamous cell abnormalities
· ASCUS - atypical squamous cells of undetermined
ASCUS significance
· LSIL OR LGSIL - low grade squamous intraepithelial
lesion
· LSIL OR LGSIL o CIN 1: HPV or mild dysplasia
· HSIL or HGSIL - high grade squamous intraepithelial
lesion
· HSIL or HGSIL o CIN 2: moderate dysplasia
o CIN 3: severe dysplasia
· Need endometrial bx
Changes in glandular cells
(AGCUS), presence of
endometrial cells,
adenocarcinoma, etc.
recommends?
2025/11/10
