Master the board step 3

Gynecology
Premenstrual Syndrome
Premenstrual Tension
This is defined as distressing physical, psychological, and behavioral symptoms
recurring at the same phase of the menstrual cycle and disappearing during
the remainder of the cycle.
Premenstrual Dysphoric Disorder (PMDD)
This is more severe, involving major disruptions to daily functioning and
relationships.
Treatment
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SSRIs are the treatment of choice. SSRIs increase extracellular serotonin by
blocking the presynaptic receptor. Blocking this receptor leaves more serotonin
in the synaptic cleft for the postsynaptic cell to pick up.
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Low doses of vitamin B6 (pyridoxine) may improve symptoms.
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Diuretics have shown mixed results in the management of premenstrual
fluid retention.
Endocrine Disorders
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Hirsutism: Excessive male-pattern hair growth in a woman.
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Virilization: Excessive male-pattern hair growth in a woman plus other
masculinizing signs, such as clitoromegaly, baldness, lowering of voice,
increasing muscle mass, and loss of female body contours.
Almost all cases of hirsutism are either PCOS or idiopathic. More serious causes
of hirsutism (androgen-secreting tumors) need to be excluded in the workup.
Initial steps in workup:
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Testosterone
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DHEAS
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LH/FSH
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17-hydroxyprogesterone
Polycystic Ovarian Syndrome (PCOS)
This is the diagnosis when there is gradual-onset hirsutism, obesity, acne,
irregular bleeding, and infertility. There are chronic anovulatory cycles and
infertility. Diagnosis is mostly clinical. However, an elevated LH/FSH ratio
is used for confirmation. Bilaterally enlarged ovaries will be found on exam
and ultrasound.
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