Latest Updates

Pessary management for the general gynecologist

Molly Dahl, MA, MD, Aldene Zeno, MD
    • The most common pessary used by gynecologists is the ring with support pessary. Multiple sizes of the ring with support are available. For patients with complete procidentia, the Gellhorn pessary is used most commonly. The majority of patients can be successfully fit with a pessary at their first visit.
    • Current evidence does not show an increase in pessary-related adverse effects in uncomplicated patients who undergo a vaginal exam less frequently than the traditional 3-month interval. Therefore, it is reasonable to space out pessary checks to every 6 months in uncomplicated patients using a support pessary.
    • Over the counter vaginal support devices are available for the treatment of SUI (Impressa®Poise). Patients can purchase a support device and sizing kit for self-management of SUI.

Sclerotherapy

Khalil H. Chamseddin, MD, Melissa L Kirkwood, MD
    • Polidocanol is now FDA approved in a foam formulation
    • Correction of axial great spahenous vein reflux first is essential for optimal success of venous sclerotherapy treatments
    • Venous duplex ultrasonography has revolutionized the treatment of varicose and spider veins.
    • Sclerotherapy is reproducible and noninvasive and can objectively identify areas of reflux in the great and small saphenous systems, as well as detect pathologic conditions in the deep venous system and incompetent perforating vessels. Sclerosants may be classified into three main categories: hypertonic solutions, chemical irritants, and detergents.
    • The detergent class of sclerosants form aggregates on endothelial cell surfaces and cause endofibrosis by disrupting the integrity of the cells. Polidocanol (POL) is the most commonly used sclerotherapy agent worldwide. Sodium tetradecyl sulfate (STS) is also a commonly used agent in the United States; both POL and STS are approved by the FDA.

Female Pelvic Pain: Assessment

Mario Castellanos, MD, Louise P King, MD
    • Recent studies demonstrated the prevalence of chronic pelvic pain is 5.7 to 26.6%, an important step toward improved care.
    • Chronic pelvic pain may have multiple simultaneous etiologies including somatic, visceral, and neuropathic sources.
    • Twenty-five percent of patients undergoing hysterectomy for chronic pelvic pain have endometriosis.

Dysmenorrhea in the Adolescent

Rebecca H. Evans, MD, Courtney N. Knill, MD
    • Efficacy and safety of continuous dosing of oral contraceptives, the contraceptive patch, and the contraceptive ring for this patient population
    • Efficacy and safety of long-acting reversible contraceptive (LARC) devices in the nulliparous adolescent population with dysmenorrhea
    • Efficacy and safety of tranexamic acid in adolescents with dysmenorrhea as a non-hormonal treatment option
    • Improvement in diagnostic capabilities of pelvic sonography including 3 dimensional imaging
    • Avoidance of opioids in the treatment algorithm for adolescents with dysmenorrhea given the knowledge of associated harms and limited long-term efficacy

Vaginitis 

Rachel A Blake, MD, OB GYN Resident, Monica Mendiola, MD, OB GYN Residency Director
    • Care for the pregnant and HIV patients
    • Care for recurrent vaginitis

Uterine Fibroids

Hye-Chun Hur, MD, MPH, Kari Plewniak, MD
    • Advances in nonsurgical treatments for symptomatic fibroids
    • Fertility-sparing fibroid surgeries
    • Minimally invasive techniques for fibroid surgery
    • Nonsurgical minimally invasive treatments for fibroids
    • Controversies surrounding adhesion barriers

Abnormal Menstrual Bleeding

Leanne Dumeny, MS, BS, MD-PhD, Candice P. Holliday, MD, JD, Chu Hsiao, BS, MD-PhD, Lisa Spiryda, MD-PhD
    • PALM-COEIN classification
    • Expansion of medical management strategies: IUD, tranexamic acid
    • Minimally invasive surgical options
    • Greater recognition of the psychosocial impact on quality of life

Hypertension

Marc P Bonaca, MD, MPH
    • Increasing recognition of the importance of home-based and ambulatory blood pressure monitoring reflected in expanded indications for use
    • Specific guidance from professional societies with regard to patients with chronic kidney disease
    • Recent clinical outcomes trials adding important data about optimal treatment targets
    • 2020 ISH and 2017 ACC/AHA practice guidelines indicating role of telehealth strategies in management of hypertension in adults.
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