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181. Infertility workup for the women's health specialist

, delivery route, and associated complications) c previous methods of contraception c coital frequency and timing c sexual dysfunction c past surgery (procedures, indications, and out- comes) focused on abdominal and pelvic procedures c previous hospitalizations, serious illnesses, or injuries c gynecologic history (eg, pelvicinflammatory disease, sexually transmitted infections, endometriosis, leiomyomas) c sexual history c reviewoforgansystems,includinghistoryofthyroid disease, galactorrhea, hirsutism

2019 Society for Assisted Reproductive Technology

182. An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of PCOS in Adolescence Full Text available with Trip Pro

Features As in adults, signs of hyperandrogenism in adolescents can be clinical or biochemical. Hirsutism is defined as excessive, coarse, terminal hairs distributed in a male fashion, and PCOS is the most common cause of hirsutism in adolescence [ ]. The severity of hirsutism may not correlate with serum androgen levels; moreover, there are ethnic/genetic differences that may affect the degree of hirsutism [ - ]. Hirsutism must be distinguished from hypertrichosis defined as excessive vellus hair (...) and guidelines for the diagnosis and management of PCOS during adolescence. The complex pathophysiology of PCOS involves the interaction of genetic and epigenetic changes, primary ovarian abnormalities, neuroendocrine alterations, and endocrine and metabolic modifiers such as anti-Müllerian hormone, hyperinsulinemia, insulin resistance, adiposity, and adiponectin levels. Appropriate diagnosis of adolescent PCOS should include adequate and careful evaluation of symptoms, such as hirsutism, severe acne

2019 Pediatric Endocrine Society

183. Contraceptive Choices for Young People

be warranted with specialist review. In all women, co-cyprindiol can be restarted at any time if acne or hirsutism recurs on stopping treatment. 74 C BAcne does not appear to be associated with DMPA use. 36 The progestogen-only implant can be associated with improvement, worsening or onset of acne. 75–80 Whilst there may be an increased risk with the levonorgestrel-releasing intrauterine system (LNG-IUS) it is not usually a reason for discontinuation. 36 Young people may be advised that COC use can

2019 Faculty of Sexual & Reproductive Healthcare

184. Management of Atopic Eczema

at 12 and 24 weeks. 59, level I Adverse events reported are mild (57%), moderate (37%) and severe (6%) at 1-year treatment. 57, level I Common adverse events are hypertension, gastrointestinal symptoms, hypertrichosis, fatigue, flu-like symptoms, headache, paraesthesia, haematological and biochemical abnormalities (increased creatinine level >30% from baseline). 53, level I Severe adverse events include infections, abdominal pain, acute cholecystitis and basal cell carcinoma. 53, level I; 57, level (...) %) Cream/Ointment Hydrocortisone Acetate 1% Cream/Ointment 1 - 2 times daily 1 - 2 times daily Worsening of untreated infection, contact dermatitis, perioral dermatitis, acne, depigmentation, dryness, hypertrichosis, secondary infection, skin atrophy, pruritus, tingling/stinging, rosacea, folliculitis, photosensitivity Moderate Betamethasone Valerate 1 in 2 dilution (0.05%) Cream/Ointment Betamethasone Valerate 1 in 4 dilution (0.025%) Cream/Ointment Clobetasone Butyrate 0.05% Cream/Ointment Untreated

2019 Ministry of Health, Malaysia

185. Infertility Workup for the Women’s Health Specialist

, delivery route, and associated complications) c previous methods of contraception c coital frequency and timing c sexual dysfunction c past surgery (procedures, indications, and out- comes) focused on abdominal and pelvic procedures c previous hospitalizations, serious illnesses, or injuries c gynecologic history (eg, pelvicinflammatory disease, sexually transmitted infections, endometriosis, leiomyomas) c sexual history c reviewoforgansystems,includinghistoryofthyroid disease, galactorrhea, hirsutism

2019 American College of Obstetricians and Gynecologists

186. Female Infertility

with and without PCOS [44]. In 2009, the Androgen Excess and PCOS Society proposed the following criteria for diagnosing PCOS: hyperandrogenism and ovarian dysfunction with the exclusion of other androgen excess or related disorders [42]. Hyperandrogenism typically presents as hirsutism, the presence of terminal hairs on the face and/or body in a female in a male-type pattern. Ovarian dysfunction can include ovulatory dysfunction or polycystic ovaries, as defined by ovarian volume greater than 10 cc or 12

2019 American College of Radiology

187. Screening and Management of the Hyperandrogenic Adolescent

symptoms are hirsutism and acne. Reports of hirsutism and acne should be taken seriously because of their possible association with medical disorders, their substantial effect on self-esteem and quality of life, and the potential for psychosocial morbidity. In patients with symptoms of androgen excess, the differential diagnosis should include physiologic hyperandrogenism of puberty, idiopathic hyperandrogenism, and polycystic ovary syndrome (PCOS). There is a great deal of overlap between the symptoms (...) of PCOS and those of normal puberty,whichmakesthediagnosisofPCOSintheadolescentdifficult.Treatmentofacneandhirsutismshould not be withheld during the ongoing longitudinal evaluation for possible PCOS. On physical examination, body mass index, blood pressure, and signs of hyperandrogenism, such as acne and hirsutism, should be evaluated. Although guidelines differ on recommended laboratory studies, most include measurement of total testoster- one, free testosterone, or both, and screening

2019 American College of Obstetricians and Gynecologists

190. Congenital adrenal hyperplasia

hydroxysteroid dehydrogenase deficiency. History and exam genetic predisposition weight loss failure to thrive vomiting hypotension ambiguous genitalia hyperpigmentation poor feeding irregular menses infertility male-pattern baldness (females) short stature precocious puberty polycystic ovaries hirsutism severe cystic acne genetic predisposition Diagnostic investigations serum 17-hydroxyprogesterone serum 11-deoxycortisol serum chemistry microfilter paper radioimmunoassay for 17-hydroxyprogesterone genetic

2017 BMJ Best Practice

191. Dysfunctional uterine bleeding

uterine bleeding use of hormone therapy menstrual irregularity anaemia premenstrual molimina hirsutism, acne, acanthosis nigricans age (years after puberty and before menopause) polycystic ovary syndrome (PCOS) other anovulatory disorders endocrine disorders obesity Diagnostic investigations pregnancy test FBC coagulation profile serum progesterone level serum prolactin level serum TSH level serum FSH and LH levels serum androgen levels serum 17-alpha-hydroxyprogesterone level ultrasound ultrasound

2017 BMJ Best Practice

193. Topical medication instillation techniques for glaucoma. Full Text available with Trip Pro

). The effect hypertrichosis (excessive hair growth) was uncertain between groups (RR 1.00, 95% CI 0.17 to 5.98; 10 participants; low-certainty evidence).Neither trial reported other outcomes specified for this review, including the proportion of participants with IOP less than 21 mmHg; participant-reported outcomes related to the ease, convenience, and comfort of instillation techniques; physiologic measurements of systemic absorption; escalation of therapy; mean change in visual fields; optic nerve

2017 Cochrane

194. Hormonal Contraceptives

Edema Oily skin and scalp Acne Hirsutism High androgen Lower androgenic activity (eg. 3 rd and 4 th generation COCs – see product chart) Adapted from RxFiles, 10th edition, Hormonal Contraception Chart B) Transdermal or intra-vaginal estrogen Same efficacy as oral contraceptives Main advantage of transdermal or intra-vaginal estrogen over oral contraceptives: daily action not required, may enhance compliance in some patients leading to better efficacy (however, real-world failure rates are similar

2018 medSask

195. Acne - Guidelines for Prescribing Topical Treatment

of hyperandrogenism are present such as: hirsutism, infertility, infrequent menses, insulin-resistant diabetes, middle-age onset in women. Sudden onset of acne associated with fever and arthralgias - possibly acne fulminans. Treatment for acne fulminans involves oral steroids and isotretinoin. Onset at age > 30 years. Possible rosacea. Excessive embarrassment, anxiety, low self-esteem, or feelings of shame. Unable to confirm patient's self-diagnosis of acne. Patient's condition requires further investigation

2018 medSask

199. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome

hyperandrogenismneedtobe considered. Historyofsymptomonsetandprogressionis criticalin assessing for neoplasia, however, some androgen-secreting neoplasms may only induce mild to moderate increases in biochemical hyperandrogenism. _ Clinicalhyperandrogenism CCR A comprehensive history and physical examination should be completed for symptoms and signs of clinical hyperandrogenism, including acne, alopecia, and hirsutism and, in adolescents, severe acne and hirsutism. **** CCR Health professionals should be aware (...) of the potential negative psychosocial impact of clinical hyperandrogenism.Reportedunwantedexcesshairgrowthand/oralopeciashouldbeconsidered important, regardless of apparent clinical severity. **** CCR Standardized visual scales are preferred when assessing hirsutism, such as the modi?ed Ferriman Gallwey score (mFG) with a levelR 4-6 indicating hirsutism, depending on ethnicity, acknowledging that self-treatment is common and can limit clinical assessment. (See recommendations on ethnic variation.) **** CCR

2018 Society for Assisted Reproductive Technology

200. Targeted Immunomodulators for the Treatment of Moderate-to-Severe Plaque Psoriasis: Effectiveness and Value

with psoralen and ultraviolet A radiation [PUVA]). Cyclosporine is also associated with nephrotoxicity, liver disease, hypertrichosis, gingival changes, GI symptoms, and neurologic symptoms. Drug interactions are common and there are many contraindications. Current US guidelines limit the continuous use of cyclosporine to one-year; European guidelines to two years. 54 Cyclosporine cannot be combined with other systemic treatments (other than phototherapy). ? Acitretin, a retinoid, vitamin A analogue

2018 California Technology Assessment Forum

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