USMLE Step 2 CK Lecture Notes 2019: Obstetrics/Gynecology (Kaplan Test Prep)

(Kiana) #1

Management. Directed toward the primary problem and the patient’s desires.


Oligomenorrhea  or  menstrual   dysfunction
Hyperandrogenism, clinically or biochemically
Polycystic ovaries on TV sonogram (≥12 peripheral cysts)

With    irregular   bleeding,   OCPs    will    normalize   the bleeding.   The progestin
component will prevent endometrial hyperplasia.
Hirsutism can be suppressed two ways: OCPs will (a) lower testosterone
production by suppressing LH stimulation of the ovarian follicle theca cells,
and (b) increase SHBG (thus decreasing free testosterone). Spironolactone
suppresses hair follicle 5-α reductase enzyme conversion of androstenedione
and testosterone to the more potent dihydrotestosterone.
Infertility. If patient desires pregnancy, ovulation induction can be achieved
through clomiphene citrate or human menopausal gonadotropin. Metformin, a
hypoglycemic agent that increases insulin sensitivity, can enhance the
likelihood of ovulation both with and without clomiphene.
Free download pdf