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Gyn Procedures


Women <21 yo w/ASCUS or LSIL repeat pap in 12 mos
Women <21 yo w/ HSIL colposcopy +/- cytology
Adult women w/ASCUS repeat cyto (6 & 12 mos), HPV DNA, and colposcopy
Adult women w/ASCUS-H colposcopy; if neg: cyto (6 & 12 mos), HPV DNA q 12 mos
Adult women w/ LSIL Colposcopy, then endometrial bx. If no CIN: repeat Pap in 6 & 12 months and HPV DNA in 12 months
Adult women w/ HSIL, CIN-2, CIN-3, or CIS on Pap: Colposcopy & bx. Outside cervix: LEEp or cryotherapy. Inside cervix: cone bx.
Adult women w/ AGC endomet/endocerv bx, then colpo
Tx of cervical abnormalities Cyrotherapy of Cervix; LEEP; Laser; Cervical Conization
Risks of tx of cervical abnormalities Antibodies to sperm; Cervical Stenosis; Incompetent Cervix; Missing a significant lesion
most common symptom of endometrial neoplasia: AUB
indications for endometrial ca testing AUB >35-40 yo; AGC on Pap (also needs Colposcopy); Benign Endometrial Cells on pap if woman post menopausal
endometrial ca RF Postmenopausal; FH/PMH ca (ov, BrCa, colon, endomet); Tamoxifen; PCOS; Obesity; Estrogen Tx w/o progestin; Prior Endometrial Hyperplasia; DM
endomet bx advantages in office; minimal dilation; anesthesia not req; prophylactic Abx not req; low cost
endomet bx CI PG; infxn; diathesis, cerv stenosis or ca (refer)
endomet bx: most common AE: Cramping
average uterine length = 6-8 cm
Simple/Complex Endometl Hyperplasia: causes unopposed estrogen: Premenopause Obesity; PCOS; eating disorders; Thyroid; Herbals; other anovulation
Simple/Complex Endometl Hyperplasia: causes unopposed estrogen: Postmenopause Obesity; HRT; herbals w/estrogen (soy); Ovar/ adrenal estrogen producing tumor
Endometrial hyperplasia w/o atypia: tx Provera; Micronized Progesterone; if HRT is resumed, resume at higher dose progestin for longer time, repeat bx 3-6 mos
When & how often should women get Paps? Q2 yrs starting at age 21. Q3 yrs (+HPC) if Pap neg & HPV neg, starting at age 30
If SCC found on Pap: resection, and/or chemo or radiation
Created by: Abarnard