Uterine Fibroids: Diagnosis and Treatment.

Uterine fibroids are common benign neoplasms, with a higher prevalence in older women and in those of African descent. Many are discovered incidentally on clinical examination or imaging in asymptomatic women. Fibroids can cause abnormal uterine bleeding, pelvic pressure, bowel dysfunction, urinary frequency and urgency, urinary retention, low back pain, constipation, and dyspareunia.

Diagnosis and management of ectopic pregnancy.

Ectopic pregnancy affects 1% to 2% of all pregnancies and is responsible for 9% of pregnancy-related deaths in the United States. When a pregnant patient presents with first-trimester bleeding or abdominal pain, physicians should consider ectopic pregnancy as a possible cause. The patient history, physical examination, and imaging with transvaginal ultrasonography can usually confirm the diagnosis.

Adult vaccination.

Immunization has effectively decreased the burden of disease on society. Nevertheless, over 50,000 deaths occur annually in the United States from vaccine-preventable disease, and nearly all of these occur in adults. It is essential for primary care physicians to be knowledgeable about the unique immunization-related needs of adults and to be aware of the factors that determine the need for vaccination.

When to stop screening: a review of breast, gynecologic, and colorectal cancer screening in women over age 65.

Because age alone is not an indicator of health, there is no clear consensus among the various cancer screening guidelines on when to stop cancer screening. For breast, cervical, and colorectal cancer, there are recommended screening tests, while, for other gynecologic cancers, there are not. When discussing with older women patients when to stop cancer screening, we encourage practitioners to review the goals of the screening test, assess the health and functional status of the patient, and discuss her values and health goals.

Endometrial cancer.

Endometrial cancer is the leading cause of gynecologic cancer in the United States. Etiologically, endometrial carcinoma usually results from unopposed estrogen stimulation of the endometrium, although non-estrogen-related forms occur as well. The most common presentation of endometrial cancer is postmenopausal bleeding.

Screening and prevention: cervical cancer.

Cervical cancer is the leading cause of cancer death in women in developing countries and significant disparities in cervical cancer mortality rates persist in the United States. Improved recognition of the role of human papilloma virus (HPV) in cervical cancer pathogenesis has recently revolutionized screening and prevention strategies. Improved understanding and implementation of these advances will allow primary care physicians to significantly impact the cervical cancer mortality burden.

Urinary incontinence evaluation and the utility of pessaries in older women.

Urinary incontinence and pelvic organ prolapse are common conditions affecting the elderly. A careful evaluation of urinary incontinence, including history and physical examination, will often determine the etiology of this condition. Vaginal pessaries are a safe and efective treatment for both urinary incontinence and pelvic organ prolapse.