Gynecology Interview Preparation Guide

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Yes, it is not uncommon to notice some light spotting during the first 3 months after beginning Hormone Replacement Therapy. Heavy bleeding like your menstrual cycle is not normal and should be reported to the doctor immediately.

Fibroids, also known as leiomyomas, are benign smooth muscle tumors that occur in the uterus. They grow under the influence of estrogen and progesterone, and are thus seen in the reproductive years. By the age of 40, 40% of women have fibroids. African-American women may be prone to get symptomatic fibroids in their 20’s. With menopause and the decrease in hormones, fibroids also decrease in size. The most common symptom from fibroids is abnormal bleeding. When fibroids grow, it can also cause pressure symptoms on the bladder, rectum or pelvis. There may be a genetic predisposition to having fibroids and multiple fibroids.

Women should have a yearly physical exam by a physician which includes a pelvic exam and breast exam beginning in their late teens and early twenties. All women should have their cholesterol checked every 3 to 5 years. A yearly mammogram is essential after age 40. Women over 50 need a screening colonoscopy every 5 years. There are different opinions concerning whether women should have a pap smear every year after hysterectomy. You should discuss your individual medical history with your doctor before deciding whether you should continue to get a pap smear after hysterectomy

During a woman’s menstrual cycle, ovarian cyst formation is normal. These cysts are part of developing an egg to ovulate or to make hormones to support a potential early pregnancy, and are called functional cysts. These type of cysts should disappear with each cycle. I get worried that a cyst is abnormal if it persists for more than 2 cycles, if it is larger than 5 cm, or if it has unusual features such as a septum or solid elements. Sometimes a functional cyst can cause severe pain and internal bleeding if it should rupture internally. This is usually an emergent situation that requires immediate evaluation.

If you have not had a menstrual cycle in over 6 months you are probably in the menopause. The loss of your monthly period along with occasional hot flashes or night sweats usually indicate menopause. This begins for most women between the ages of 45 and 52. Any bleeding after the menopause is considered abnormal and requires evaluation by a doctor immediately.

To qualify as a screening test, the test has to be sensitive enough to pick up the disease in its early stages. It has to be specific, so other conditions do not trigger the test to be positive. It has to be cost efficient, so that trying to find the disease does not cost more than the treatment of the disease. Unfortunately, no such test is available for ovarian cancer currently. CA-125, an ovarian cancer antigen, was thought to be a possible screening tool. CA-125 is elevated in women with a known ovarian cancer, and is used to monitor progression or regression of the tumor. It is not sensitive enough to pick up ovarian cancer at Stage I disease, and can be positive in non-cancerous conditions like endometriosis, pelvic inflammatory disease, and fibroids.

Yes. It can take up to 3 months after switching to new a birth control pill before your menstrual period becomes regular. You should not discontinue your new pills for at least 3 months to see if they are going to begin working. Spotting between your cycle, nausea and occasional vomiting and headaches are all common when starting a new birth control method.

Polyps can form where there is glandular tissue, i.e. in the colon, nose or uterus. Endometrial polyps occur in the uterus and patients will have the symptom of heavy menstrual periods. These polyps can be resected with a simple procedure called hysteroscopy. With a small telescope inserted through the cervix and into the uterus, the polyp can be directly visualized and removed.

If you miss one pill, you should take it as soon as you remember and take the next one as usual.
If 2 pills are missed during the first 2 weeks of your cycle, then you should take 2 pills a day for the next 2 days and use a back-up method such as a condom for the next 7 days.
If 2 pills or more are missed in the 3rd week of the cycle then you should take 2 pills a day for the next 2 days and then complete the pack of pills. You should then begin your new pack on a Sunday. A back-up form of birth control should be used for the next 7 days such as a condom.

Dermoid cysts, also known as mature cystic teratomas, are the commonest ovarian tumor. They occur primarily in the reproductive years, but can also occur in children. The tumor has all three germ layers that are seen in the body - ectoderm, mesoderm and endoderm. As such, the tumor has fat, hair and teeth in it. Teratomas sometimes can be very organized and appear to form fetal-like tissues. Dermoids are bilateral 15-20 percent of the time. Treatment is surgical removal prior to torsion or rupture.