Malady Wise

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Adolescent Women's Health

Maladywise

Reference

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

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

Sexual Health / Dr Sally Woodward

Too Much Little Late / Dr Angela Dunford

Guidelines

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

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