Adolescent Women's Health
Reference
Adolescent Women’s Health - Vimeo 21/10/2023
PMDD / Dr Veronica Knight
Treatment
Diet, exercisek, low salt, fruit + veg, Ca, Mg. vit D, Agnus castus, B6, Psychology, CBT
SSRI
Drosperinone containing COCP continuous (Yaz, Yasmin), Zoely, Zoladex (add back Oestrogen, BMD)
Guidelines
Pearls
Higher rates in ADHD / ASD
Think PMDD with mood disturbance presentation (Bipolar / BPD)
Endometriosis / Dr Angela Boulton
Overview
Endometrial tissue outside uterus, chronic inflammatory reaction
Adults = 1 in 7 by age 42
Adolescents 25 to 73% of those presenting with pelvic pain on laparoscopy
Guidelines
ESHRE - All Guidelines
Jean Hailles - All Tools
Diagnosis
Transvaginal Ultrasound - Sens 65%, Spec 95%
MRI - Sens 79%, Spec 79%
Laparoscopy ONLY if negative imaging and failure of treatment and high suspicion
Treatment
NSAIDs
OCP
Start with 20 ethninyestradiol /100 levonorgestrel
Takes time to work
Mirena
Safe in adolescence
Visanne
81% pain reduction by 1 year
GNRH agonists Zoladex
With add back oestrogen
Anti-inflammatory diets
TENS
Exercise, pilates, walking, yoga
Pelvic floor physiotherapy
Chronic Pelvic Pain / Dr Ksenia Katyk
Overview
3 to 6 months of intermittent or constant pain perceived lower abdomen or pelvis
Chronic pain in 21% of women and 17% of men
Delay in diagnosis of 7 to 8 years
Endometriosis is 25 to 40% of chronic pelvic pain population
Risk Factors
Age < 30, BMI < 20
Smoking
Early menarche
PID
Assault
FGM
Anxiety / Depression
Protective
Oral contraceptive
Fish intake
Physical Exercise
Married / stable relationship
Higher parity
ACE study
Physical, emotional, sexual abuse
Physical or emoitional neglect
Divorce
Incarceration
Drugs and alcohol
Mental illness
DV
Primary Prevention
Identify early risk
Social and economoinal determinants
Maximise protective factors
COCP
Barrier protection
Minimise risk of pregnancy
Smoking cessation
Anti-inflammatory diet
Early mental health concerns
Educate parents - pelvicpain.org.au
Educate girls - PPEP talk
Secondary
Assess girls at risk family early
PPEP talk
Brainman video HIPS
Phsyical activity
Emotinoal health
Stress management
Nutrition
Tertiary
Education
MDT
Trauma-informed
Early referral
Minimse catastrophising
Minimise multiple referrals to multiple specialities = worse outcomes
Viscero-viseceral hyperalgesia is common - Bowel, bladder, functional disorders
Avoid re-operating
Referral
JHH waitlist - 12 months
Quicker if more ED presentations
Privately Dr Angela Boulton / other Angela ?Dunford
Contraception Choices / Dr Sally Sweeney
Guidelines
FSRH - Guidelines
Sexual Health / Dr Sally Woodward
Too Much Little Late / Dr Angela Dunford
Guidelines
PCOS - International Evidence-Based Guidelines 2023
Causes
HPOA / Immaturity
Endocrine
Clotting
Over or under weight
Info
80% of cycles anovulatory in first few years after menarche
Treatment
Tranexamic acid 50% reduction
1g QID orally, half dose if small
NSAIDS 25 top 50% reduction
Mefenamic acid
Progesterone only
Noresthisterone (Primolut)
Mirena
COCP
Levlen, Femme-tab, Microgynon
Bad for PCOS
Norimin for PCOS
Zoely / Slinda
Good side effect profile
Good for suppression 30% at 12 month even with sugar tablets
Other
No evidence weight gain on COCP
VTE - Most common in first few months
PCOS
No ultrasound for diagnosis unless 8 years post menarche
Treatment
Lifestyle
Lipids profiles
OGTT
Higher risk on metabolic syndrome in fathers and brothers
COCP first line
No benefit higher doses
Avoid girls band COCP Diane, Estelle, Brenda
Spironolactone 25 to 100mg
Female pattern baldness
Metformin
Can be used as monotherapy for irregular bleeding
Can start with 250mg daily and titrate up slowly
Adjunct to weight loss
Insulin levels useless
Amenorrhoea
Secondary characteristics
FSH/LH
U/S
Karyotype
Pearls
Thin about bleeding disorders
TXA 1g QID, half dose if small
If not considering contraception, primolut 5mg OD up to TDS
No periods at 15 or breasts at 13 consider work up
PCOS first line COCP +/- Metformin
Gender Diversity / Dr Katie Wynne
1% of people