NR 602 Final Study Guide/Nr 602 final topics Week 8: ACOG guidelines regarding well women exams spring 2023

Amenorrhea (Primary and Secondary) Primary and Secondary Amenorrhea  Primary amenorrhea: No menarche by the age of 15 years (with or without development of secondary sexual characteristics). Half of cases are caused by chromosomal disorders (50%) such as Turner syndrome.  Puberty is delayed if there is no breast development by age 13 years, absence of pubic hair at age 14 years, and no menarche by age 15 years.  Secondary amenorrhea: No menses for three cycles, or 6 months if previously had menses. Most common cause is ). Secondary Amenorrhea Associated With Exercise and Underweight  Excessive exercise and/or sports participation have a higher incidence of amenorrhea (and infertility) due to relative caloric deficiency  "Female athlete triad"; anorexia nervosa/restrictive eating, amenorrhea, and osteoporosis Labs  Pregnancy test (serum human chorionic gonadotropin [hCG])  Serum prolactin level (rule out prolactinoma-induced amenorrhea)  Serum TSH; also follicle-stimulating hormone (FSH) and luteinizing hormone (LH; rule out premature ovarian failure)  If amenorrhea for more than 6 months, measure bone density Treatment Plan  Educate about increasing caloric intake and decreasing exercise  Prescribe calcium with vitamin D 1,200 to 1,500 mg daily and vitamin E 400 IU daily Complications  Osteopenia/osteoporosis (stress fractures)  Myocardial atrophy, arrhythmia (sudden death), bradycardia, hypotension  Hypoglycemia, dehydration, electrolytes  Lanugo (fine downy hair), telogen effluvium (hair loss), xerosis (dry skin), infertility  Low body mass index (BMI), cachexia, anemia, respiratory failure American Cancer Society recommendations Breast cancer recommendations: Baseline mammogram: Start at age 50 years and repeat every 2 years until the age of 74 years Age 75 years or older: Insufficient evidence for routine mammogram Does not apply to women with known genetic mutations (BRCA1 or BRCA2), familial breast cancer, history chest radiation at a young age or previously diagnosed with high-risk breast lesion who may benefit from starting screening in their 40s NOTE: Age 40 to 49 years (individualize based on risk factors, if done). The American Cancer Society recommends starting routine screening at age 40 years. *U.S. Preventive Services Task Force (USPSTF) Recommendation Statement (January 2016). Cervical Cancer Screening Age Group. Recommendations for Pap/Liquid Cytology Age 20 years or younger Do not screen (even if sexually active with multiple partners). Cervical cancer is rare before age 21 years. Age 21 to 65 years Baseline at age 21 years. Screen every 3 years. Age 30 to 65 years Another option starting at age 30 years is to screen with combination of cytology plus human papillomavirus (HPV) testing every 5 years. Had hysterectomy with removal of cervix If hysterectomy with cervical removal was not due to cervical intraepithelial neoplasia (CIN grade 2) or cervical cancer, then can stop screening. Women older than 65 years wh