BOOK
Comprehensive Gynecology E-Book
Gretchen M Lentz | Rogerio A. Lobo | David M Gershenson | Vern L. Katz
(2012)
Additional Information
Book Details
Abstract
Comprehensive Gynecology provides you with complete, timely, and easy access to vital information on all the medical and surgical issues affecting your practice. Whether you’re a resident or practioner, you’ll get all the practical, in-depth coverage you need to stay at the forefront of your field. Now in its sixth edition, this core reference, formerly edited by Drs. Droegemueller, Stenchever, Mishell and Herbst, continues to be your primary resource for in-depth and up-to-date information.
- Stay up to date with the latest gynecologic advances through clear writing, a clinical focus, and a focus on evidence-based practices.
- Prepare for the challenges you’ll face in practice with a completely overhauled legal chapter containing factual scenarios.
- Stay current in your field with the most recent advances in breast care; endoscopy and hysteroscopy; menopausal bone health; legal issues affecting our practice; and much more.
- Access state-of-the-art guidance on the latest applications in diagnostic and interventional ultrasound - and many other essential aspects of today's practice - through detailed sections on the molecular biology of specific gynecologic malignancies and a new chapter on Fallopian Tube and Primary Peritoneal Cancer.
- Recognize the interactions and influences of female physiology on major disease processes with a new chapter on The Interaction of Medical Diseases and Female Physiology.
- Address every patient’s needs with the Emotional Issues in Gynecology chapter, now modified in partnership with a psychiatrist, and updated information on depression/anxiety treatment.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Comprehensive Gynecology: Expert Consult – Online and Print | iii | ||
| Copyright | iv | ||
| Contributors | v | ||
| Preface | vii | ||
| Acknowledgments | viii | ||
| Contents | ix | ||
| Part I: Basic Science | 1 | ||
| Chapter 1 : Fertilization and Embryogenesis : Meiosis, Fertilization | 1 | ||
| The oocyte and meiosis | 1 | ||
| Fertilization and early cleavage | 3 | ||
| Morula and blastula stage: early differentiation | 5 | ||
| Implantation | 7 | ||
| Early organogenesis in the embryonic period | 7 | ||
| Development of the genitourinary system | 7 | ||
| Renal development | 8 | ||
| Bladder and urethra | 8 | ||
| Sex differentiation | 8 | ||
| Genital duct system | 11 | ||
| Male Genital Ducts | 11 | ||
| Female Genital Ducts | 11 | ||
| External genitalia | 13 | ||
| Recommended Reading | 17 | ||
| Chapter 2 : Reproductive Genetics : Gene Structure, Mutation, Molecular Tools | 19 | ||
| Gene structure, expression, and mutation | 19 | ||
| Molecular tools and diagnosis in human genetics | 21 | ||
| Polymerase chain reaction | 21 | ||
| Restriction endonucleases and restriction fragment length polymorphisms | 21 | ||
| Microarray technology | 21 | ||
| Genetic testing: direct and indirect methods | 22 | ||
| Molecular cytogenetics | 24 | ||
| Patterns of inheritance | 25 | ||
| Autosomal dominant | 26 | ||
| Autosomal recessive | 26 | ||
| X-linked trait | 27 | ||
| X-linked dominant inheritance | 28 | ||
| Atypical patterns of inheritance | 28 | ||
| Trinucleotide-Repeat Disorders: Unstable Mutations | 28 | ||
| Fragile X Syndrome | 28 | ||
| Genomic Imprinting and Uniparental Disomy | 29 | ||
| Germline Mosaicism | 29 | ||
| Mitochondrial inheritance-maternal inheritance | 29 | ||
| Multifactorial inheritance | 30 | ||
| Chromosome abnormalities | 30 | ||
| Numerical Chromosomal Abnormalities | 30 | ||
| Structural Chromosome Abnormalities | 32 | ||
| Balanced Reciprocal Translocations | 32 | ||
| Microdeletion/Duplication or Contiguous Gene Syndromes | 35 | ||
| Chromosome abnormalities and pregnancy outcome | 36 | ||
| Molar Gestations | 36 | ||
| Cancer genetics | 36 | ||
| Chapter 3 : Reproductive Anatomy : Gross and Microscopic, Clinical Correlations | 39 | ||
| External genitalia | 39 | ||
| Vulva | 39 | ||
| Mons pubis | 39 | ||
| Labia majora | 39 | ||
| Labia minora | 39 | ||
| Hymen | 39 | ||
| Clitoris | 40 | ||
| Vestibule | 40 | ||
| Urethra | 40 | ||
| Skene's glands | 41 | ||
| Bartholin's glands | 41 | ||
| Vestibular bulbs | 41 | ||
| Clinical correlations | 41 | ||
| Internal genitalia | 41 | ||
| Vagina | 41 | ||
| Clinical correlations | 43 | ||
| Cervix | 44 | ||
| Clinical correlations | 45 | ||
| Uterus | 46 | ||
| Clinical correlations | 47 | ||
| Oviducts | 48 | ||
| Clinical correlations | 49 | ||
| Ovaries | 49 | ||
| Clinical correlations | 51 | ||
| Vascular system of the pelvis | 51 | ||
| Arteries | 52 | ||
| Inferior Mesenteric Artery | 52 | ||
| Ovarian Artery | 52 | ||
| Common Iliac Artery | 52 | ||
| Hypogastric Artery (Internal Iliac Artery) | 52 | ||
| Uterine Artery | 52 | ||
| Vaginal Artery | 52 | ||
| Internal Pudendal Artery | 52 | ||
| Veins | 52 | ||
| Clinical correlations | 53 | ||
| Lymphatic system | 53 | ||
| External iliac nodes | 53 | ||
| Internal iliac nodes | 53 | ||
| Common iliac nodes | 53 | ||
| Inferior gluteal nodes | 54 | ||
| Superior gluteal nodes | 54 | ||
| Sacral nodes | 54 | ||
| Subaortic nodes | 54 | ||
| Aortic nodes | 55 | ||
| Rectal nodes | 55 | ||
| Parauterine nodes | 55 | ||
| Superficial femoral nodes | 55 | ||
| Deep femoral nodes | 55 | ||
| Clinical correlations | 55 | ||
| Innervation of the pelvis | 56 | ||
| Internal genitalia | 56 | ||
| External genitalia | 56 | ||
| Clinical correlations | 56 | ||
| Diaphragms and ligaments | 57 | ||
| Pelvic diaphragm | 57 | ||
| Urogenital diaphragm | 57 | ||
| Ligaments | 59 | ||
| Broad Ligaments | 59 | ||
| Cardinal Ligaments | 59 | ||
| Uterosacral Ligaments | 60 | ||
| Clinical correlations | 60 | ||
| Nongenital pelvic organs | 60 | ||
| Ureters | 60 | ||
| Urinary bladder | 60 | ||
| Rectum | 62 | ||
| Clinical correlations | 62 | ||
| Other structures | 63 | ||
| Cul-de-sac of douglas | 63 | ||
| Parametria | 63 | ||
| Paravesical and pararectal spaces | 63 | ||
| Clinical correlations | 63 | ||
| Chapter 4 : Reproductive Endocrinology : Neuroendocrinology, Gonadotropins, Sex Steroids | 67 | ||
| The hypothalamus and GnRH | 67 | ||
| Anatomy | 67 | ||
| The Relationship of the Olfactory and GnRH Systems in Early Fetal Life | 67 | ||
| The GnRH Neuronal System | 67 | ||
| Transport of GnRH to the Anterior Pituitary | 68 | ||
| Physiology | 68 | ||
| The GnRH Pulse Generator | 68 | ||
| Mechanisms Responsible for GnRH Pulsatility | 68 | ||
| Modulatory influences on GnRH pulsatility | 69 | ||
| Metabolic influences and GnRH release | 70 | ||
| The anterior pituitary gland and the gonadotropins | 71 | ||
| Anatomy | 71 | ||
| Physiology | 71 | ||
| The GnRH Receptor | 71 | ||
| Activation of the GnRH Receptor | 71 | ||
| Estrogens and the GnRH Receptor | 72 | ||
| GnRH Pulse Frequency and Gonadotropin Release | 72 | ||
| GnRH Receptor Desensitization | 72 | ||
| GnRH Analogues and the GnRH Receptor | 73 | ||
| The Gonadotropins | 73 | ||
| Structure | 73 | ||
| The ovaries | 73 | ||
| Anatomy | 73 | ||
| Ovarian Gametogenesis (Oogenesis) | 73 | ||
| Ovarian Folliculogenesis | 74 | ||
| Physiology | 74 | ||
| The Gonadotropin Receptors | 74 | ||
| The Ovarian Steroids: Biosynthesis | 75 | ||
| The Aromatase Enzyme | 75 | ||
| The Ovarian Steroids: Blood Transport and Metabolism | 76 | ||
| Prostaglandins | 77 | ||
| Communication within the hypothalamic-pituitary-ovarian endocrine axis | 77 | ||
| The steroid receptors | 77 | ||
| The ovarian-hypothalamic-pituitary feedback loops | 80 | ||
| The Negative Steroid Feedback Loop | 80 | ||
| The Positive Estradiol Feedback Loop | 81 | ||
| Ovarian Peptides Feedback Loops | 81 | ||
| The menstrual cycle | 83 | ||
| The follicular phase | 83 | ||
| Recruitment of a Cohort of Antral Follicles | 83 | ||
| Selection of a Dominant Follicle | 84 | ||
| Growth of the Dominant Follicle: The Maturing Secondary or Antral Follicle | 84 | ||
| The ovulatory gonadotropin surge and ovulation | 86 | ||
| The luteal phase | 87 | ||
| Endocrine Factors and the Corpus Luteum | 89 | ||
| Corpus Luteum Regression (Luteolysis) | 89 | ||
| The luteal-follicular transition | 89 | ||
| The menstrual cycle and the endometrium | 89 | ||
| The endometrium in the proliferative (follicular) phase | 90 | ||
| The endometrium in the secretory (luteal) phase | 90 | ||
| Menstruation | 91 | ||
| The menstrual cycle and the cervical glands | 92 | ||
| Hormone assay techniques | 92 | ||
| Immunoassays | 92 | ||
| Preparation of Antibodies | 93 | ||
| The Choice of Assay Markers | 93 | ||
| The Separation of Bound and Unbound Antigen | 93 | ||
| The Immunoassay Reaction | 93 | ||
| The Standard Curve | 93 | ||
| Assay evaluation | 94 | ||
| Suggested readings | 95 | ||
| Chapter 5 : Evidence-Based Medicine and Clinical Epidemiology | 97 | ||
| Evidence-based medicine | 97 | ||
| Essentials of study design | 98 | ||
| Presentation of study results | 100 | ||
| Interpretation of study results | 102 | ||
| Chapter 6 : Medical-Legal Risk Management | 105 | ||
| Communication | 105 | ||
| Communication with the patient | 106 | ||
| Communication through medical records | 106 | ||
| Communication consistent with institutional policies | 107 | ||
| When a claim is made | 108 | ||
| Physician's defensive strategies | 108 | ||
| Abandonment | 108 | ||
| Part II : Comprehensive Evaluation of the Female | 113 | ||
| Chapter 7 : History, Physical Examination, and Preventive Health Care : General, Gynecologic, and Psychosocial | 113 | ||
| Direct observations before speaking to the patient (nonverbal clues) | 113 | ||
| Essence of the gynecologic history | 114 | ||
| Chief complaint | 114 | ||
| History of the present illness (HPI) | 114 | ||
| Pertinent gynecologic history | 114 | ||
| General health history | 115 | ||
| Family history | 116 | ||
| Occupational and social history | 116 | ||
| Safety issues | 116 | ||
| Review of systems | 116 | ||
| Essence of complete physical examination | 117 | ||
| Abdominal inspection | 117 | ||
| Abdominal palpation | 117 | ||
| Abdominal percussion | 118 | ||
| Abdominal auscultation | 118 | ||
| Pelvic examination | 118 | ||
| Inspection | 118 | ||
| Palpation | 118 | ||
| Speculum examination | 120 | ||
| Papanicolaou smear | 121 | ||
| Negative for Intraepithelial Lesion or Malignancy | 122 | ||
| Epithelial Cell Abnormality | 122 | ||
| Bimanual examination | 122 | ||
| Rectovaginal examination | 123 | ||
| Rectal examination | 123 | ||
| The annual visit | 124 | ||
| Special populations | 128 | ||
| Chapter 8 :The Interaction of Medical Diseases and Female Physiology | 129 | ||
| Pulmonary disease | 129 | ||
| The effects of estrogen on inflammation, allergy, and the immune system | 130 | ||
| Gastrointestinal disease | 132 | ||
| Vascular and hypertensive diseases | 132 | ||
| Renal disease | 132 | ||
| Hematologic and thrombotic diseases | 133 | ||
| Endocrine disease | 133 | ||
| Central nervous system disease | 133 | ||
| Seizure disorders | 133 | ||
| Migraine Headaches | 134 | ||
| Mental health issues | 134 | ||
| Cancer | 135 | ||
| Summary | 135 | ||
| Suggested readings | 136 | ||
| Chapter 9 : Emotional Aspects of GynecologyDepression, Anxiety, PTSD, Eating Disorders,Substance Abuse | 137 | ||
| Developmental issues in childhood and adolescence | 137 | ||
| Depression | 137 | ||
| Eating disorders | 140 | ||
| Obesity | 142 | ||
| Anxiety disorders and posttraumatic stress disorder | 145 | ||
| Psychotropic medications and oral contraceptives | 149 | ||
| Substance abuse and dependence | 149 | ||
| “Difficult” patients | 152 | ||
| Sexual function and dysfunction | 154 | ||
| Sexual response and menopause | 156 | ||
| Sexual dysfunction | 156 | ||
| Lesbian health care | 158 | ||
| Rape, incest, and domestic violence | 159 | ||
| Rape | 159 | ||
| Physician’s responsibility in the care of a rape victim | 160 | ||
| Medical | 160 | ||
| Medicolegal | 162 | ||
| Emotional support of the victim | 163 | ||
| Female circumcision | 163 | ||
| Incest | 163 | ||
| Abuse | 165 | ||
| Intimate partner violence | 165 | ||
| The elderly | 168 | ||
| Grief and loss | 168 | ||
| Death and dying | 170 | ||
| Bibliography | 171 | ||
| Chapter 10 : Endoscopy: Hysteroscopy and LaparoscopyIndications, Contraindications and Complications | 173 | ||
| Hysteroscopy | 173 | ||
| Hysteroscopic indications and contraindications | 173 | ||
| Hysteroscopic equipment and techniques | 174 | ||
| Operative hysteroscopy techniques | 176 | ||
| Complications | 178 | ||
| Laparoscopy | 179 | ||
| Laparoscopic indications and contraindications | 179 | ||
| Laparoscopic equipment and Techniques | 180 | ||
| Laparoscopic procedures | 182 | ||
| Laparoscopic complications | 183 | ||
| Patient safety in the surgical environment | 184 | ||
| Suggested readings | 185 | ||
| Part III General Gynecology | 187 | ||
| Chapter 11 : Congenital Abnormalities of the Female Reproductive Tract | 187 | ||
| Examination of the newborn for ambiguous genitalia | 187 | ||
| Perineal and vaginal defects | 188 | ||
| Clitoral Anomalies | 188 | ||
| Labial Fusion | 189 | ||
| Imperforate Hymen | 191 | ||
| Vaginal Agenesis | 191 | ||
| Treatment | 193 | ||
| Transverse Vaginal Septum | 193 | ||
| Vaginal Adenosis | 194 | ||
| Abnormalities of the cervix and uterus | 194 | ||
| Genetic Studies of Müllerian Fusion Difficulties | 194 | ||
| Symptoms and Signs | 196 | ||
| Diagnosis | 196 | ||
| Specific Anomalies | 196 | ||
| Absence of Cervix and Uterus | 196 | ||
| Unicornuate Uterus | 196 | ||
| Management | 196 | ||
| Ovarian abnormalities | 198 | ||
| Accessory Ovary and Supernumerary Ovary | 198 | ||
| Ovotestes | 198 | ||
| Chapter 12: Pediatric and Adolescent Gynecology: Gynecologic Examination, Infections, Trauma, Pelvic Mass, Precocious Puberty | 199 | ||
| Gynecologic examination of a child | 199 | ||
| General approach | 199 | ||
| Performance of the gynecologic examin a child | 199 | ||
| Ormal findings: hymen and vaginaof a prepubertal child | 201 | ||
| Examination of the adolescent female | 202 | ||
| Problems in prepubertal children | 202 | ||
| Vulvovaginitis | 202 | ||
| Other prepubertal gynecologic problems | 204 | ||
| Labial Adhesions (Sometimes Referred to as Adhesive Vulvitis) | 204 | ||
| Physiologic Discharge of Puberty | 206 | ||
| Urethral Prolapse | 206 | ||
| Lichen Sclerosus | 206 | ||
| Prepubertal bleeding without secondarysigns of puberty | 207 | ||
| Vaginal Bleeding | 207 | ||
| Foreign Bodies | 208 | ||
| Shigella Vaginitis | 208 | ||
| Rare Causes: Vaginal Tumors and McCune–AlbrightSyndrome | 208 | ||
| Sarcoma Botryoides and Endodermal Sinus Tumorsof the Vagina | 208 | ||
| Vaginoscopy for Prepubertal Bleeding withoutSigns of Puberty | 208 | ||
| Accidental genital trauma | 208 | ||
| Vulvar trauma: lacerations and straddle injury | 209 | ||
| Vulvar Hematomas | 209 | ||
| Sexual abuse | 209 | ||
| Scope of the Problem | 210 | ||
| History in Sexual Abuse | 210 | ||
| Legal Issues in Reporting Possible Sexual Abuse | 210 | ||
| Physical Examination and Evaluation for SexuallyTransmitted Infections | 210 | ||
| Hymens in the Evaluation of Sexual Abuse | 211 | ||
| Genital Warts | 211 | ||
| The ovary and adnexa in pediatric andadolescent gynecology: cysts, tumors,and torsion | 211 | ||
| Prenatal Ovarian Cysts | 212 | ||
| Neonatal Ovarian Cysts | 212 | ||
| Ovarian Cysts in Children and Adolescents | 212 | ||
| Ovarian Tumors in Childhood and Adolescents | 212 | ||
| Ovarian Torsion | 213 | ||
| Suggested reading | 214 | ||
| Chapter 13: Family Planning: Contraception, Sterilization, and Pregnancy Termination | 215 | ||
| Contraceptive use in the united states | 215 | ||
| Contraceptive effectiveness | 215 | ||
| Contraceptive cost | 217 | ||
| Coitus-related methods | 218 | ||
| Spermicides: foams, creams,and suppositories | 218 | ||
| Barrier methods | 219 | ||
| Diaphragm | 219 | ||
| Cervical cap | 219 | ||
| Male condom | 220 | ||
| Female condom | 220 | ||
| Barrier techniques and sexually transmitted infections | 221 | ||
| Periodic abstinence | 221 | ||
| Coitus interruptus (withdrawal) | 222 | ||
| Lactational amenorrhea method (lam) | 222 | ||
| Hormonal contraception | 222 | ||
| Oral contraceptives | 223 | ||
| Pharmacology | 224 | ||
| Physiology | 225 | ||
| Mechanism of Action | 225 | ||
| Metabolic effects | 226 | ||
| Hepatic effects | 227 | ||
| Carbohydrate | 228 | ||
| Lipids | 228 | ||
| Coagulation Parameters | 229 | ||
| Cardiovascular effects | 229 | ||
| Venous Thromboembolism | 230 | ||
| Myocardial Infarction | 231 | ||
| Stroke | 236 | ||
| Return to Fertility | 237 | ||
| Obesity | 238 | ||
| Neoplastic effects | 238 | ||
| Breast Cancer | 239 | ||
| Cervical Cancer | 240 | ||
| Endometrial Cancer | 240 | ||
| Ovarian Cancer | 241 | ||
| Liver Adenoma and Cancer | 241 | ||
| Pituitary Adenoma | 242 | ||
| Malignant Melanoma | 242 | ||
| Colorectal Cancer | 242 | ||
| Oral contraceptive use and overall mortality | 242 | ||
| Contraindications to oral contraceptive use | 242 | ||
| Beginning oral contraceptives | 243 | ||
| Adolescents | 243 | ||
| After Pregnancy | 243 | ||
| Cycling Women | 244 | ||
| Type of Formulation | 244 | ||
| Follow-up | 245 | ||
| Drug Interactions | 245 | ||
| Noncontraceptive health benefits | 245 | ||
| Benefits from Antiestrogenic Action of Progestins | 245 | ||
| Benefits from Inhibition of Ovulation | 246 | ||
| Other Benefits | 246 | ||
| Long-acting contraceptive steroids | 247 | ||
| Contraceptive patch | 247 | ||
| Contraceptive vaginal ring | 248 | ||
| Injectable suspensions | 248 | ||
| Depot Formulation of MPA | 248 | ||
| Pharmacokinetics | 249 | ||
| Return of Fertility | 250 | ||
| Endometrial Changes | 251 | ||
| Adverse Effects | 251 | ||
| Clinical | 251 | ||
| Weight Changes | 252 | ||
| Mood Changes | 252 | ||
| Headache | 252 | ||
| Metabolic Effects | 252 | ||
| Protein | 252 | ||
| Carbohydrate | 252 | ||
| Lipids | 252 | ||
| Bone Loss | 253 | ||
| Neoplastic Effects | 253 | ||
| Breast Cancer | 253 | ||
| Endometrial Cancer | 254 | ||
| Ovarian Cancer | 254 | ||
| Cervical Cancer | 254 | ||
| Noncontraceptive Health Benefits | 254 | ||
| Clinical Recommendations | 254 | ||
| Norethindrone Enanthate | 254 | ||
| Progestin-Estrogen (Once Monthly) InjectableFormulations | 255 | ||
| Subdermal implants | 255 | ||
| Emergency contraception | 256 | ||
| Intrauterine devices | 257 | ||
| Types of IUDs | 258 | ||
| Mechanisms of action | 259 | ||
| Time of insertion | 259 | ||
| Adverse effects | 260 | ||
| Incidence | 260 | ||
| Uterine Bleeding | 260 | ||
| Perforation | 261 | ||
| Complications related to pregnancy | 261 | ||
| Congenital Anomalies | 262 | ||
| Spontaneous Abortion | 262 | ||
| Septic Abortion | 262 | ||
| Ectopic Pregnancy | 262 | ||
| Prematurity | 263 | ||
| Infection in the nonpregnant IUD user | 263 | ||
| Contraindications | 265 | ||
| Overall safety | 265 | ||
| Sterilization | 265 | ||
| Male sterilization | 266 | ||
| Female sterilization | 266 | ||
| Induced abortion | 267 | ||
| Methods | 268 | ||
| Curettage Methods | 268 | ||
| Medication Abortion | 268 | ||
| Early Medical Abortion | 268 | ||
| Ancillary Techniques | 270 | ||
| Complications | 271 | ||
| Suggested readings | 272 | ||
| Chapter 14: Menopause and Care of the Mature Woman: Endocrinology, Consequences of Estrogen Deficiency, Effects of Hormone | 273 | ||
| Premature ovarian failure insufficiency | 273 | ||
| Management of premature ovarian insufficiency | 274 | ||
| The menopausal transition (perimenopause) | 275 | ||
| Types of ovarian changes | 275 | ||
| Hormonal changes with established menopause | 278 | ||
| Effects of menopause on various organ systems | 279 | ||
| Central nervous system | 279 | ||
| Collagen and other tissues | 282 | ||
| Genital atrophy | 283 | ||
| Bone health | 283 | ||
| Degenerative arthritis | 287 | ||
| Cardiovascular effects | 287 | ||
| Cancer risks in postmenopausal women | 290 | ||
| Ovarian cancer | 293 | ||
| Colorectal cancer | 293 | ||
| Other cancers | 293 | ||
| The decision to use estrogen | 293 | ||
| Risk-benefit assessment | 293 | ||
| Changes in mortality rates with estrogen use | 294 | ||
| Other risks associated with estrogen therapy | 294 | ||
| Approach to therapy | 295 | ||
| Hormone regimens | 295 | ||
| Use of a progestogen | 296 | ||
| Androgen therapy | 297 | ||
| Alternative therapies for menopause | 297 | ||
| Phytoestrogens | 297 | ||
| Suggested readings | 298 | ||
| Chapter 15: Breast Diseases: Diagnosis and Treatment of Benign and Malignant Disease | 301 | ||
| Anatomy | 301 | ||
| Developmental anomalies | 303 | ||
| Benign breast problems | 303 | ||
| Fibrocystic changes | 304 | ||
| Mastalgia (breast pain) | 306 | ||
| Mastitis and inflammatory disease | 306 | ||
| Nipple discharge | 307 | ||
| Intraductal papilloma | 307 | ||
| Fibroepithelial tumors: fibroadenomas and phyllodes tumors | 308 | ||
| Fat necrosis | 309 | ||
| Breast carcinoma | 309 | ||
| Epidemiology and risks for breast cancer | 309 | ||
| Demographic associations | 310 | ||
| Estrogen-related exposure risks | 311 | ||
| Lifestyle and dietary risk factors | 311 | ||
| Breast history and breast characteristics | 312 | ||
| Inherited and familial risks | 312 | ||
| Radiation exposure | 313 | ||
| Risk assessment and prevention | 313 | ||
| Chemoprophylaxis and chemotherapeutic risk reduction | 315 | ||
| Detection and diagnosis | 316 | ||
| Self-examination of the breasts | 316 | ||
| Clinical breast examination | 317 | ||
| Mammography | 317 | ||
| Digital mammography | 321 | ||
| Magnetic resonance imaging | 322 | ||
| Ultrasound | 323 | ||
| Computed tomography | 323 | ||
| Other imaging techniques | 323 | ||
| Core-needle biopsy and excisional biopsy | 324 | ||
| Fine-needle aspiration of suspected cysts | 324 | ||
| Classification | 325 | ||
| Management | 327 | ||
| Surgical Therapy | 329 | ||
| Medical Therapy | 330 | ||
| The gynecologist's role | 331 | ||
| Acknowledgments | 333 | ||
| Suggested reading | 334 | ||
| Chapter 16: Spontaneous and Recurrent Abortion: Etiology, Diagnosis, Treatment | 335 | ||
| Etiology | 338 | ||
| Chromosomal | 338 | ||
| Uterine anomalies | 341 | ||
| Anomalies of uterine development | 341 | ||
| Uterine anomalies after des | 341 | ||
| Cervical incompetence (cervical insufficiency) | 342 | ||
| Acquired uterine defects | 342 | ||
| Leiomyomas | 342 | ||
| Intrauterine Adhesions | 343 | ||
| Endocrine causes | 344 | ||
| Progesterone Deficiency | 344 | ||
| Thyroid Disease | 345 | ||
| Diabetes Mellitus, Insulin Resistance, and PolycysticOvary Syndrome | 345 | ||
| Immunologic factors | 346 | ||
| Celiac Disease | 346 | ||
| Thrombophilia | 347 | ||
| Inherited thrombophilias | 347 | ||
| Antiphospholipid antibodies and theantiphospholipid syndrome | 350 | ||
| Infections | 350 | ||
| Environmental factors | 351 | ||
| Smoking | 351 | ||
| Alcohol | 351 | ||
| Coffee and caffeine | 352 | ||
| Irradiation and magnetic fields | 352 | ||
| Environmental toxins | 352 | ||
| Exercise, stress, and depression | 353 | ||
| Diagnosis | 353 | ||
| Part IV: Gynecologic Oncology | 623 | ||
| Chapter 26: Molecular Oncology in Gynecologic Cancer: Immunologic Response, Cytokines, Oncogenes, and Tumor Suppressor Genes | 623 | ||
| The immunologic response | 623 | ||
| Innate Immunity | 623 | ||
| Adaptive Immunity | 624 | ||
| Humoral Immunity: B Cells and Immunoglobulins | 624 | ||
| Cellular Immunity: T Cells | 624 | ||
| Cytokines | 625 | ||
| Cytokines That Mediate Innate Immunity | 625 | ||
| Interleukins | 625 | ||
| Chemokines | 626 | ||
| Interferons | 626 | ||
| Cytokines That Mediate Adaptive Immunity | 626 | ||
| Cytokines That Mediate Hematopoiesis | 626 | ||
| Colony-Stimulating Factors | 626 | ||
| Tumor Cell Killing and Immunotherapy | 627 | ||
| Molecular oncology | 627 | ||
| Oncogenes | 627 | ||
| Peptide Growth Factors | 627 | ||
| Epidermal Growth Factor Receptor (EGFR) Family | 627 | ||
| Angiogenesis and Vascular Endothelial Growth Factor | 628 | ||
| Ephrin Family of Ligands and Receptors | 628 | ||
| Phosphoinositide 3-Kinase Pathway | 629 | ||
| Tumor Suppressor Genes | 629 | ||
| BRCA1 and BRCA2 | 629 | ||
| DNA Mismatch Repair Genes | 630 | ||
| Future Directions | 630 | ||
| Gynecologic malignancies | 631 | ||
| Endometrial Cancer | 631 | ||
| Endometrial Cancer and Tumor Suppressor Genes | 631 | ||
| Endometrial Cancer and Oncogenes | 631 | ||
| Immunotherapy and Endometrial Cancer | 632 | ||
| Ovarian Cancer | 632 | ||
| Ovarian Cancer and Tumor Suppressor Genes | 632 | ||
| Oncogenes and Ovarian Cancer | 632 | ||
| Immunotherapy and Ovarian Cancer | 632 | ||
| Cervical Cancer: Oncogenes, Tumor Suppressor Genes, and Immunotherapy | 632 | ||
| Conclusion | 632 | ||
| Acknowledgments | 633 | ||
| Chapter 27: Principles of Radiation Therapy and Chemotherapy in Gynecologic Cancer: Basic Principles, Uses, and Complications | 635 | ||
| Radiation therapy | 635 | ||
| Radiation Therapy Principles | 635 | ||
| Basic Radiation Physics | 636 | ||
| Therapeutic Radiation Production | 637 | ||
| Radiation Biology | 638 | ||
| Radiation Treatment: Brachytherapy and Teletherapy Therapy | 640 | ||
| Tissue Tolerance and Radiation Complications | 642 | ||
| Chemotherapy | 644 | ||
| Chemotherapy Principles and Guidelines | 645 | ||
| Approaches to Treatment | 645 | ||
| Chemotherapeutic Agents | 646 | ||
| Platinum Analogues | 646 | ||
| Taxanes | 647 | ||
| Antitumor Antibiotics | 647 | ||
| Topoisomerase I and II Inhibitors | 648 | ||
| Topotecan | 648 | ||
| Etoposide | 648 | ||
| Alkylating Agents | 649 | ||
| Antimetabolites | 649 | ||
| Vinca Alkaloids | 649 | ||
| Altretamine | 650 | ||
| Biologic and Targeted Agents | 650 | ||
| Bevacizumab | 650 | ||
| Targeted Agents | 650 | ||
| Anticancer Hormone Therapy | 650 | ||
| Drug Resistance | 650 | ||
| Evaluation of New Agents | 651 | ||
| Chapter 28: Intraepithelial Neoplasia of the Lower Genital Tract (Cervix, Vulva): Etiology | 653 | ||
| History, epidemiology, and infection | 653 | ||
| Cervical cytology testing | 654 | ||
| Cervical Cytology Reporting: The Bethesda System | 655 | ||
| Alternative to Cytology Screening for Cervical Cancer | 657 | ||
| Natural History of Cervical Intraepithelial Neoplasia | 657 | ||
| Evaluation of abnormal cytology: colposcopy | 658 | ||
| Treatment | 661 | ||
| Cervical Intraepithelial Neoplasia | 661 | ||
| CIN 1 | 661 | ||
| CIN 2 | 661 | ||
| CIN 3 | 662 | ||
| Treatment Methods | 662 | ||
| Ablative Methods | 662 | ||
| Cryotherapy | 662 | ||
| Thermoablation | 663 | ||
| CO2 Laser Ablation | 663 | ||
| Excisional Methods | 663 | ||
| Loop Electrosurgical Excision | 663 | ||
| Cold Knife Conization | 664 | ||
| Follow-Up | 664 | ||
| Vaginal intraepithelial neoplasia | 664 | ||
| Vulvar intraepithelial neoplasia | 664 | ||
| Natural History | 664 | ||
| Treatment | 665 | ||
| Chapter 29: Malignant Diseases of the Cervix: Microinvasive and Invasive Carcinoma: Diagnosis and Management | 667 | ||
| Histologic types | 667 | ||
| Carcinoma of the cervix | 669 | ||
| Clinical Considerations | 669 | ||
| Staging | 670 | ||
| Natural History and Spread | 671 | ||
| Prognostic Factors | 672 | ||
| Treatment | 673 | ||
| Pretherapy Evaluation | 673 | ||
| Treatment for Stage I | 674 | ||
| Stage IA | 674 | ||
| Stage IB | 674 | ||
| Operative Therapy: Radical Hysterectomy and Pelvic Node Dissection | 674 | ||
| Fertility-Sparing Surgery | 676 | ||
| Minimally Invasive Surgery | 676 | ||
| Sentinel Node Biopsy | 676 | ||
| Surgical Complications | 677 | ||
| Outcomes After Surgical Treatment | 677 | ||
| Radiation Treatment | 677 | ||
| Outcomes | 678 | ||
| Chemoradiation | 678 | ||
| Neoadjuvant Chemotherapy | 679 | ||
| Para-Aortic Node Involvement | 679 | ||
| Radiation Complications | 680 | ||
| Special Considerations | 680 | ||
| Cervical Stump Tumors | 680 | ||
| Carcinoma of the Cervix Inadvertently Removed at Simple Hysterectomy | 680 | ||
| Carcinoma of the Cervix in Pregnancy | 681 | ||
| Recurrence | 681 | ||
| Pelvic Recurrence | 682 | ||
| Pelvic Exenteration | 682 | ||
| Nonpelvic Recurrence | 683 | ||
| Chemotherapy as Treatment for Recurrence | 683 | ||
| Chapter 30: Neoplastic Diseases of the Vulva: Lichen Sclerosus, Intraepithelial Neoplasia, Paget’s Disease, and Carcinoma | 685 | ||
| Vulvar atypias | 685 | ||
| Specific Conditions | 685 | ||
| Vulvar Atypias: Intraepithelial Neoplasia | 685 | ||
| Carcinoma In Situ (Vulvar Intraepithelial Neoplasia III) | 687 | ||
| Paget's Disease | 687 | ||
| Diagnosis | 687 | ||
| Clinical Presentation | 687 | ||
| Diagnostic Methods | 687 | ||
| Treatment | 689 | ||
| Vulvar Atypias | 689 | ||
| Vulvar Intraepithelial Neoplasia | 690 | ||
| Human Papillomavirus Therapy | 691 | ||
| Paget's Disease of the Vulva | 692 | ||
| Malignant conditions | 693 | ||
| Squamous Cell Carcinoma | 693 | ||
| Morphology and Staging | 693 | ||
| Natural History, Spread, and Prognostic Factors | 693 | ||
| Stage IA: Carcinoma of the Vulva (Early or Microinvasive Carcinoma) | 695 | ||
| Definition and Clinicopathologic Relationships | 695 | ||
| Treatment | 696 | ||
| Invasive Carcinoma of the Vulva | 696 | ||
| Advanced Vulvar Tumors | 698 | ||
| Radiation Therapy and Recurrences | 698 | ||
| Quality of Life and Vulvar Carcinoma | 699 | ||
| Lymphatic Mapping and Sentinel Lymph Node Biopsy | 699 | ||
| Other Vulvar Malignancies | 699 | ||
| Bartholin's Gland Carcinoma | 699 | ||
| Basal Cell Carcinoma | 699 | ||
| Verrucous Carcinoma | 699 | ||
| Melanoma | 699 | ||
| Sarcoma | 701 | ||
| Granular Cell Myoblastomas | 701 | ||
| Chapter 31: Malignant Diseases of the Vagina: Intraepithelial Neoplasia, Carcinoma, Sarcoma | 703 | ||
| Premalignant disease of the vagina | 703 | ||
| Detection and Diagnosis | 703 | ||
| Treatment | 705 | ||
| Malignant disease of the vagina | 706 | ||
| Symptoms and Diagnosis | 706 | ||
| Tumors of the Adult Vagina | 707 | ||
| Squamous Cell Carcinoma | 707 | ||
| Treatment | 707 | ||
| Survival | 708 | ||
| Clear Cell Adenocarcinoma | 708 | ||
| Malignant Melanoma | 709 | ||
| Vaginal Adenocarcinomas Arising in Endometriosis | 710 | ||
| Vaginal Tumors of Infants and Children | 710 | ||
| Endodermal Sinus Tumor (Yolk Sac Tumor) | 710 | ||
| Sarcoma Botryoides (Embryonal Rhabdomyosarcoma) | 710 | ||
| Pseudosarcoma Botryoides | 711 | ||
| Chapter 32: Neoplastic Diseases of the Uterus: Endometrial Hyperplasia, Endometrial | 713 | ||
| Epidemiology | 713 | ||
| Endometrial hyperplasia | 715 | ||
| Categories | 715 | ||
| Simple Hyperplasia | 715 | ||
| Complex Hyperplasia (Without Atypia) | 715 | ||
| Complex Atypical Hyperplasia | 715 | ||
| Natural History | 716 | ||
| Diagnosis and Endometrial Sampling | 716 | ||
| Treatment | 717 | ||
| Endometrial carcinoma | 717 | ||
| Symptoms, Signs, and Diagnosis | 717 | ||
| Histologic Types | 717 | ||
| Staging | 720 | ||
| Prognostic Factors | 720 | ||
| Clinical Factors | 720 | ||
| Pathologic Factors | 720 | ||
| Patterns of Spread of Endometrial Carcinoma | 721 | ||
| Steroid Hormone Receptors | 723 | ||
| Evaluation | 723 | ||
| Treatment | 723 | ||
| Stage I | 723 | ||
| Stage I, Grade 1 | 724 | ||
| Stage I, Grades 2 and 3 | 724 | ||
| Stage II | 724 | ||
| Adjuvant Systemic Therapy for Early-Stage Endometrioid Endometrial Cancer | 724 | ||
| Stage I or II Uterine Papillary Serous Carcinoma | 725 | ||
| Stage III or IV Recurrent Endometrial Cancer | 725 | ||
| Chemotherapy for Advanced and Recurrent Uterine Papillary Serous Carcinoma | 726 | ||
| Hormone Therapy | 726 | ||
| Progestins for Advanced or Recurrent Disease | 726 | ||
| Selective Estrogen Receptor Modulators and Aromatase Inhibitors | 727 | ||
| Sarcomas | 727 | ||
| Leiomyosarcoma | 727 | ||
| Endometrial Stromal Sarcoma | 728 | ||
| Undifferentiated Sarcomas | 728 | ||
| Carcinosarcoma (Malignant Mixed Müllerian Tumors) | 729 | ||
| Müllerian Adenosarcoma | 729 | ||
| Chapter 33: Neoplastic Diseases of the Ovary: Screening, Benign and Malignant Epithelial and Germ Cell | 731 | ||
| Familial ovarian cancer | 732 | ||
| Classification of ovarian neoplasms | 733 | ||
| Epithelial ovarian neoplasms | 733 | ||
| Benign Epithelial Ovarian Tumors: The Adnexal Mass | 736 | ||
| Adnexal Mass and Ovarian Cancer | 736 | ||
| Evaluation of the Adnexal Mass | 737 | ||
| Ovarian Cancer Screening | 738 | ||
| Nonmalignant Neoplasms | 740 | ||
| Carcinomas | 740 | ||
| Diagnosis, Staging, Spread, Preoperative Evaluation, and Prognostic Factors | 740 | ||
| Treatment | 745 | ||
| Borderline Ovarian Tumors: Ovarian Carcinomas of Low Malignant Potential | 745 | ||
| Invasive Epithelial Carcinomas | 746 | ||
| Early-Stage Ovarian Carcinomas | 747 | ||
| Stage I | 747 | ||
| Stage II | 749 | ||
| Postoperative Management for Stages I and II | 749 | ||
| Primary Cytoreductive Surgery | 750 | ||
| Diaphragmatic Stripping or Resection | 750 | ||
| Splenectomy | 750 | ||
| Hepatic Resection | 750 | ||
| Bowel Resection | 751 | ||
| Retroperitoneal Lymphadenectomy | 751 | ||
| Postoperative Therapy for Advanced Epithelial Carcinomas (Stages III and IV) | 751 | ||
| Alterations in Frontline Treatment Strategies | 752 | ||
| Neoadjuvant Chemotherapy | 752 | ||
| Interval Cytoreduction | 752 | ||
| Additions to the Paclitaxel and Carboplatin Backbone | 752 | ||
| Intraperitoneal Therapy | 753 | ||
| Dose-Dense Chemotherapy | 754 | ||
| Evaluation of Chemotherapy Results | 754 | ||
| Second-Look Procedures | 755 | ||
| Maintenance Therapy | 755 | ||
| Cancer Antigen125 Surveillance after Primary Therapy | 756 | ||
| Recurrent Ovarian Cancer Management | 756 | ||
| Platinum-Refractory Disease | 756 | ||
| Platinum-Resistant Disease | 757 | ||
| Platinum-Sensitive Disease | 757 | ||
| Secondary Cytoreduction | 758 | ||
| Targeted Therapy | 758 | ||
| Poly (ADP-Ribose) Polymerase Inhibitors | 759 | ||
| Complications and Other Considerations | 759 | ||
| Malignant Effusions | 759 | ||
| Malignant Bowel Obstruction | 760 | ||
| Immunotherapy | 760 | ||
| Gene Therapy | 760 | ||
| Chemotherapy Sensitivity Assays | 761 | ||
| Radiation Therapy | 761 | ||
| Summary | 761 | ||
| Small cell carcinoma | 761 | ||
| Malignant mixed müllerian tumors (carcinosarcomas) | 761 | ||
| Germ cell tumors | 762 | ||
| Teratomas | 762 | ||
| Benign Cystic Teratomas (Dermoids) | 762 | ||
| Immature Teratomas | 763 | ||
| Other Germ Cell Tumors | 764 | ||
| Dysgerminomas | 764 | ||
| Endodermal Sinus Tumors (Yolk Sac Tumors) | 764 | ||
| Choriocarcinomas | 764 | ||
| Embryonal Carcinomas | 764 | ||
| Polyembryomas | 764 | ||
| Mixed Germ Cell Tumors | 764 | ||
| Treatment of Malignant Germ Cell Tumors | 765 | ||
| Specialized Germ Cell Tumors: Struma Ovarii and Carcinoids | 767 | ||
| Gonadoblastomas (Germ cell sex cord-stromal tumors) | 767 | ||
| Sex cord-stromal tumors | 767 | ||
| Granulosa-Theca Cell Tumors | 767 | ||
| Thecomas and Fibromas | 768 | ||
| Sertoli-Leydig Cell Tumors (Androblastomas) | 768 | ||
| Other Sex Cord-Stromal Tumors | 769 | ||
| Gynandroblastomas | 769 | ||
| Sex Cord Tumors with Annular Tubules | 769 | ||
| Leydig Cell and Hilus Cell Tumors | 769 | ||
| Lipid (lipoid) tumors | 769 | ||
| Metastatic ovarian tumors | 769 | ||
| Chapter 34: Fallopian Tube and Primary Peritoneal Cancer: Causes, Diagnosis, Natural History, and Treatment | 773 | ||
| Causes | 773 | ||
| Fallopian Tube Cancer | 773 | ||
| Primary Peritoneal Cancer | 773 | ||
| Serous Tubal Intraepithelial Carcinoma | 773 | ||
| Clinical findings | 774 | ||
| Fallopian Tube Cancer | 774 | ||
| Primary Peritoneal Cancer | 774 | ||
| Diagnosis | 774 | ||
| Ultrasound | 774 | ||
| Other Imaging Modalities | 774 | ||
| Cancer Antigen 125 Level | 774 | ||
| Staging | 774 | ||
| Pathologic findings | 774 | ||
| Fallopian Tube Carcinoma | 774 | ||
| Primary Peritoneal Cancer | 776 | ||
| Treatment | 776 | ||
| Surgery | 776 | ||
| Chemotherapy | 776 | ||
| Radiation Therapy | 776 | ||
| Surveillance | 777 | ||
| Prognosis | 777 | ||
| Chapter 35: Gestational Trophoblastic Disease: Hydatidiform Mole, Nonmetastatic and Metastatic Gestational | 779 | ||
| Hydatidiform mole | 779 | ||
| Epidemiology | 779 | ||
| Risk Factors | 779 | ||
| Age | 779 | ||
| Reproductive History | 779 | ||
| Diet | 780 | ||
| Histopathology and Cytogenetic Features | 780 | ||
| Clinical Features | 781 | ||
| Diagnosis | 782 | ||
| Human Chorionic Gonadotropin | 782 | ||
| Treatment | 782 | ||
| Suction Dilation and Curettage | 782 | ||
| Hysterectomy | 782 | ||
| Prophylactic Chemotherapy | 783 | ||
| Surveillance Following Hydatidiform Mole Evacuation | 783 | ||
| Quiescent Gestational Trophoblastic Disease | 784 | ||
| Phantom β-Human Chorionic Gonadotropin | 784 | ||
| Gestational trophoblastic neoplasia | 784 | ||
| Characteristics | 784 | ||
| Histopathology and Cytogenetic Features | 784 | ||
| Clinical Features | 785 | ||
| Locally Invasive Gestational Trophoblastic Neoplasia | 785 | ||
| Malignant Gestational Trophoblastic Neoplasia | 785 | ||
| Classification and Staging | 785 | ||
| Diagnosis | 786 | ||
| Treatment | 786 | ||
| Low-Risk Gestational Trophoblastic Neoplasia | 786 | ||
| High-Risk Gestational Trophoblastic Neoplasia | 787 | ||
| High-Risk Sites of Metastases | 788 | ||
| Central Nervous System Metastases | 788 | ||
| Pulmonary Metastases | 788 | ||
| Liver Metastases | 788 | ||
| Vaginal Metastases | 788 | ||
| Treatment of Placental Site Trophoblastic Tumor | 788 | ||
| Surveillance Following Gestational Trophoblastic Neoplasia | 788 | ||
| Recurrence | 788 | ||
| Pregnancy Following Gestational Trophoblastic Neoplasia | 788 | ||
| Psychosocial Considerations | 788 | ||
| Part V: Reproductive Endocrinology and Infertility | 791 | ||
| Chapter 36: Primary and Secondary Dysmenorrhea, Premenstrual Syndrome, and Premenstrual Dysphoric | 791 | ||
| Dysmenorrhea | 791 | ||
| Incidence and Epidemiology | 791 | ||
| Relationship to Menstruation and the Menstrual Cycle | 791 | ||
| Family History | 792 | ||
| Primary Dysmenorrhea | 792 | ||
| Pathogenesis | 792 | ||
| Diagnosis | 792 | ||
| Treatment | 792 | ||
| Other Therapy | 793 | ||
| Secondary Dysmenorrhea: Causes and Management | 794 | ||
| Cervical Stenosis | 794 | ||
| Ectopic Endometrial Tissue (Endometriosis) | 794 | ||
| Pelvic Inflammation | 794 | ||
| Pelvic Congestion Syndrome and Pelvic Venous Syndromes | 795 | ||
| Causative Factors | 795 | ||
| Behavioral Influences | 795 | ||
| Relation to Functional Bowel Disease | 795 | ||
| Other Causes | 796 | ||
| Premenstrual Syndrome and Premenstrual Dysphoric Disorder | 796 | ||
| Incidence and Epidemiology | 796 | ||
| Symptoms | 796 | ||
| Causes | 797 | ||
| Diagnosis | 799 | ||
| Treatment | 799 | ||
| Diet, Exercise, and Lifestyle Changes | 799 | ||
| Cognitive Behavioral Therapy | 800 | ||
| Pharmacologic Agents | 800 | ||
| Diuretics | 800 | ||
| Psychoactive Drugs | 801 | ||
| Progesterone and Estrogen | 801 | ||
| Oral Contraceptives | 801 | ||
| Nonsteroidal Anti-inflammatory Drugs | 802 | ||
| Danazol | 802 | ||
| Bromocriptine | 802 | ||
| GnRH Agonists | 802 | ||
| Surgical Treatment: Hysterectomy and Bilateral Oophorectomy | 802 | ||
| Chapter 37: Abnormal Uterine Bleeding: Ovulatory and Anovulatory Dysfunctional Uterine Bleeding | 805 | ||
| Causes | 805 | ||
| Organic Causes | 805 | ||
| Systemic Disease | 805 | ||
| Reproductive Tract Disease | 806 | ||
| Dysfunctional Causes | 806 | ||
| Ovulatory Dysfunctional Uterine Bleeding | 806 | ||
| Diagnostic Approach | 807 | ||
| Treatment | 808 | ||
| Anovulatory Dysfunctional Uterine Bleeding | 808 | ||
| Ovulatory Dysfunctional Uterine Bleeding | 808 | ||
| Local Progestogen Exposure | 808 | ||
| Nonsteroidal Anti-inflammatory Drugs | 809 | ||
| Antifibrinolytic Agents | 809 | ||
| Androgenic Steroids (Danazol) | 810 | ||
| Gonadotropin-Releasing Hormone Agonists | 810 | ||
| Management of Acute Bleeding | 811 | ||
| Pharmacologic Agents | 811 | ||
| Estrogens | 811 | ||
| Progestogens | 812 | ||
| Surgical Therapy | 812 | ||
| Dilation and Curettage | 812 | ||
| Endometrial Ablation | 812 | ||
| Hysterectomy | 813 | ||
| Summary of Approaches To Treatment | 814 | ||
| Chapter 38: Primary and Secondary Amenorrhea and Precocious Puberty: Etiology, Diagnostic Evaluation, Management | 815 | ||
| Delayed menarche | 815 | ||
| Primary amenorrhea | 818 | ||
| Causes | 818 | ||
| Breasts Absent and Uterus Present | 818 | ||
| Gonadal Failure (Hypergonadotropic Hypogonadism) | 818 | ||
| 45,X Anomalies | 819 | ||
| Structurally Abnormal X Chromosome | 819 | ||
| Pure Gonadal Dysgenesis (46,XX and 46,XY with Gonadal Streaks; Gonadal Agenesis) | 819 | ||
| 17α-Hydroxylase Deficiency with 46,XX Karyotype | 819 | ||
| Genetic Disorders with Hyperandrogenism | 819 | ||
| Central Nervous System-Hypothalamic-Pituitary Disorders | 819 | ||
| Lesions | 819 | ||
| Inadequate Gonadotropin-Releasing Hormone Release (Hypogonadotropic Hypogonadism) | 820 | ||
| Isolated Gonadotropin Deficiency (Pituitary Disease) | 820 | ||
| Breast Development Present and Uterus Absent | 820 | ||
| Androgen Resistance | 820 | ||
| Congenital Absence of the Uterus (Uterine Agenesis, Uterovaginal Agenesis, Rokitansky-Küster-Hauser Syndrome) | 820 | ||
| Absent Breast and Uterine Development | 821 | ||
| Secondary Sex Characteristics and Female Internal Genitalia Present | 821 | ||
| Differential Diagnosis and Management | 821 | ||
| Secondary amenorrhea | 822 | ||
| Causes | 822 | ||
| Uterine Cause | 822 | ||
| Central Nervous System and Hypothalamic Causes | 823 | ||
| Lesions | 823 | ||
| Drugs | 823 | ||
| Stress and Exercise | 823 | ||
| Weight Loss | 824 | ||
| Polycystic Ovary Syndrome | 824 | ||
| Functional Hypothalamic Amenorrhea | 824 | ||
| Pituitary Causes (Hypoestrogenic Amenorrhea) | 825 | ||
| Neoplasms | 825 | ||
| Non-neoplastic Lesions | 826 | ||
| Ovarian Causes (Hypergonadotropic Hypogonadism) | 826 | ||
| Diagnostic Evaluation and Management | 827 | ||
| Precocious puberty | 829 | ||
| Types of Disorders | 829 | ||
| Premature Thelarche | 830 | ||
| Premature Pubarche or Adrenarche | 831 | ||
| Gonadotropin-Releasing Hormone-Dependent Precocious Puberty | 831 | ||
| Gonadotropin-Releasing Hormone-Independent Precocious Puberty | 832 | ||
| Diagnosis | 832 | ||
| Treatment | 834 | ||
| Chapter 39: Hyperprolactinemia, Galactorrhea, and Pituitary Adenomas: Etiology, Differential Diagnosis | 837 | ||
| Physiology | 837 | ||
| Causes | 838 | ||
| Central Nervous System Disorders | 840 | ||
| Hypothalamic Causes | 840 | ||
| Pituitary Causes | 840 | ||
| Prolactinomas | 840 | ||
| Diagnostic techniques | 842 | ||
| Imaging Studies | 842 | ||
| Recommended Diagnostic Evaluation | 842 | ||
| Treatment | 843 | ||
| Expectant Treatment | 843 | ||
| Medical Treatment | 843 | ||
| Bromocriptine | 843 | ||
| Cabergoline | 844 | ||
| Outcomes | 844 | ||
| Operative Approaches | 846 | ||
| Radiation Therapy | 847 | ||
| Pregnancy and Treatment | 847 | ||
| Women with Hyperprolactinemia Who Wish to Conceive | 847 | ||
| Women with Hyperprolactinemia Who Do Not Wish to Conceive | 847 | ||
| Chapter 40: Hyperandrogenism: Physiology, Etiology, Differential Diagnosis, Management | 849 | ||
| Physiology | 849 | ||
| Causes | 852 | ||
| Idiopathic Hirsutism (Peripheral Disorder of Androgen Metabolism) | 852 | ||
| Polycystic Ovary Syndrome | 853 | ||
| Pathophysiologic Considerations | 857 | ||
| Consequences of Polycystic Ovary Syndrome | 858 | ||
| Isolated Polycystic Ovaries | 859 | ||
| Stromal Hyperthecosis | 860 | ||
| Androgen-Producing Tumors | 860 | ||
| Ovarian Neoplasms | 860 | ||
| Adrenal Tumors | 861 | ||
| Late-Onset 21-Hydroxylase Deficiency | 861 | ||
| Cushing's Syndrome | 863 | ||
| Differential diagnosis | 863 | ||
| Treatment | 864 | ||
| Specific Disorders | 864 | ||
| Ovarian and Adrenal Tumors | 864 | ||
| Late-Onset 21-Hydroxylase Deficiency | 864 | ||
| Polycystic Ovary Syndrome | 864 | ||
| Treatment of Manifestations | 865 | ||
| Skin Disorders | 865 | ||
| Metabolic and Weight Concerns | 866 | ||
| Idiopathic Hirsutism | 866 | ||
| Bibliography | 867 | ||
| Chapter 41: InfertilityEtiology, Diagnostic Evaluation, Management, Prognosis | 869 | ||
| Incidence | 869 | ||
| Infertility and Age | 869 | ||
| Fecundability: The Ability to Conceive | 869 | ||
| Causes of Infertility | 871 | ||
| Diagnostic Evaluation | 871 | ||
| Documentation of Ovulation | 872 | ||
| Semen Analysis | 872 | ||
| Evaluation and Laboratory Tests | 873 | ||
| Hysterosalpingography | 874 | ||
| Postcoital Test | 874 | ||
| Laparoscopy | 874 | ||
| Measurement of Thyroid-Stimulating Hormoneand Prolactin... | 875 | ||
| Luteal Deficiency | 875 | ||
| Immunologic Factors | 875 | ||
| Infectious Factors | 875 | ||
| Other Sperm Tests | 876 | ||
| Prognosis | 876 | ||
| Outcomes of Pregnancy | 878 | ||
| Treatment of the Causes of Infertility | 878 | ||
| Anovulation | 878 | ||
| Medical Treatment | 878 | ||
| Clomiphene Citrate | 878 | ||
| Metformin and Other Insulin Sensitizers | 880 | ||
| Rosiglitazone and Pioglitazone | 880 | ||
| Letrozole | 880 | ||
| Gonadotropins | 880 | ||
| Ovarian Hyperstimulation Syndrome | 882 | ||
| Gonadotropin-Releasing Hormone | 883 | ||
| Other Therapeutic Modalities | 883 | ||
| Weight and Lifestyle Management | 883 | ||
| Ovarian Electrocauterization | 883 | ||
| Male Cause of Infertility | 883 | ||
| Male Partner Evaluation | 883 | ||
| Uterine Causes of Infertility | 886 | ||
| Intrauterine Adhesions | 886 | ||
| Leiomyoma | 886 | ||
| Tuberculosis | 886 | ||
| Tubal Causes of Infertility | 886 | ||
| Distal Tubal Disease | 887 | ||
| Proximal Tubal Blockage | 888 | ||
| Adjunctive Therapy | 889 | ||
| Endometriosis | 889 | ||
| Unexplained Infertility | 890 | ||
| In Vitro Fertilization | 891 | ||
| Counseling and Emotional Support | 894 | ||
| Index | 897 | ||
| Glossary | e1 |