The Mumbai Obstetric & Gynecological Society

The Mumbai Obstetric and Gynaecological Society www.mogsonline.org mogs

Adolescence

Websites

www.naspag.org

The website of the North American Society of Pediatric and Adolescent Gynecology offers useful clinical resources for common adolescent gynecological problems and links to other websites.


www.youngwomenshealth.org

A useful website that you can share with your net savvy teen patients.


Abstracts

Fibroadenomas in adolescence.

Jayasinghe Y, Simmons PS.

Curr Opin Obstet Gynecol. 2009 Jul 13.

A Division of Pediatric and Adolescent Gynecology, Mayo Clinic, Rochester, Minnesota, USA bDepartment of Gynecology, Royal Children's Hospital, Melbourne, Australia.

PURPOSE OF REVIEW: Fibroadenomas are the most common breast masses in adolescent women, therefore it is important that health providers understand their assessment and management. This review discusses an approach to investigation and management of fibroadenomas in adolescents.

RECENT FINDINGS: Fibroadenomas are benign tumors which commonly present in late adolescence. They are classified according to their histology and size. Simple fibroadenomas are the most common type and usually present as smooth mobile masses up to 3 cm in diameter. Giant fibroadenomas are more uncommon but typically present in adolescence. Fibroadenomas associated with other soft-tissue masses should raise the possibility of an inherited syndrome. Assessment of breast masses in this age group generally involves clinical assessment through history and physical examination and, when imaging is needed, ultrasonography. As the incidence of primary breast malignancy is very low in this age group, core biopsy is not routinely recommended. Large or rapidly growing tumors, or those associated with suspicious features, warrant surgical excision. New minimally invasive excision techniques are being introduced which are associated with high initial success rates. SUMMARY: Whereas the vast majority of fibroadenomas in teenagers may be monitored with surveillance alone, new minimally invasive techniques may play an important role in the management of selected patients.


Use of hormonal contraception in adolescents: skeletal health issues.

Tolaymat LL, Kaunitz AM.

Curr Opin Obstet Gynecol. 2009 May 30.

Department of Obstetrics and Gynecology, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA.

PURPOSE OF REVIEW: To summarize the current literature regarding the effects of hormonal contraceptives on adolescents' bone health.

RECENT FINDINGS: Use of progestin-only pills, implant and progestin-releasing intrauterine device is associated with low systemic progestin levels that do not appear to impact ovarian estradiol production or bone mineral density (BMD). In contrast, higher systemic progestin levels associated with the use of depot medroxyprogesterone acetate and combination oral contraceptives suppress ovarian estradiol production and reduce acquisition of BMD in teenagers and young adult women who use injectable and oral contraceptives. Although BMD is a predictor of the risk of fracture in postmenopausal women, the clinical implications of BMD changes in teenagers and young women are unknown. Following the hypoestrogenemia associated with the use of depot medroxyprogesterone acetate or lactation, BMD deficits have been found to completely reverse. Although BMD data following combination oral contraceptive use in adolescents is sparse, observations suggest that rapid and complete reversibility of BMD deficits is likely.

SUMMARY: Although more data on skeletal health outcomes following the use of oral and injectable contraceptives would be welcomed, theoretic concerns regarding the impact of depot medroxyprogesterone acetate and combination oral contraceptive use on adolescent and young women should not restrict the initiation or continuation of these important contraceptive methods.


Prognostic factors predicting recurrence in borderline ovarian tumors

Wu TI, Lee CL, Wu MY, Hsueh S, Huang KG, Yeh CJ, Lai CH.

Gynecol Oncol. 2009 Aug;114(2):237-41.

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 5 Fu-Shin St Kueishan, Taoyuan 333, Taiwan.

OBJECTIVE: We aimed to investigate outcome of borderline ovarian tumors (BOTs) with respect to methods and extent of surgical approach and to evaluate prognostic factors.

METHODS: A retrospective study included consecutive patients with BOT treated from 1984 to 2008. These cases were confirmed by histological review. The influence of clinico-pathological characteristics upon recurrence and death were analyzed by independent sample t test, Chi-square test, logistic regression model, and Cox proportional hazard model.

RESULTS: A total of 233 patients were enrolled, 214 in Stage I, 11 Stage II and 8 Stage III. There were 21 relapses, only 5 of which died of disease. 5-year and 10-year overall survival were 97.6% and 96.4%, and recurrence-free survival rates (RFS) were 92.7% and 88.2%, respectively. Median follow-up time for survivors was 81 (range, 0.5-295) months. Median time to recurrence was 31 (range, 5.5-181) months. In multivariate analysis, Stage II/III, cystectomy and higher pretreatment serum CA-125 level (>or=144 U/mL) were selected for a model predicting 5-year RFS, where risk factor=0, 1, and 2-3 had odds ratios of 1, 14.9, and 113.3, respectively (p<0.001). Replacing stage with peritoneal implants, the latter two factors along with invasive peritoneal implants were selected. Of the 5 cases died of disease, all had invasive recurrences. Initial laparoscopic or laparotomy approach had no influence on prognosis.

CONCLUSIONS: Although BOT has an excellent prognosis, they are not exempted from a risk of recurrence. Stage II/III (or invasive implants), cystectomy and higher pre-operative serum CA-125 were independent variables predicting recurrence.

 

Guideline

Management of Premenstrual Syndrome Green-top Guideline No. 48 - December 2007

 

Facebook   Twitter   Youtube   LinkedIn   Picasa

The Mumbai Obstetric & Gynecological Society

C-14, 1st Floor, Trade World, D-wing Entrance,
S. B. Marg, Kamala City, Lower Parel (W), Mumbai 400013.

Tel. : 022-24955324 / 24975035 • email: mogs2012@gmail.com

Today Visits
315

Month Visits
13351

Years Visits
144781