By Simon Kipersztok, Helen L. Ross, Joseph M. Novi
A basic and available reference that's excellent for the busy gynecologist or obstetrician in medical perform, Perimenopause provides a accomplished dialogue at the a number of matters affecting menopausal ladies. every one bankruptcy includes convenient quick-tab-tables to quickly find diagnoses and therapy methodologies.
Key issues within the textual content include:
- general overall healthiness screening
- bone health
- hormonal contraception
- obstetric problems
- nutritional concerns
- psychiatric issues similar to sexual dysfunction
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Extra resources for Perimenopause
The patient undergoes a combination of local anesthesia with conscious sedation and analgesia. A radiologist catheterizes one femoral artery and under fluoroscopic guidance manipulates the catheter in a retrograde fashion up the femoral, then through the external and internal iliac arteries and positions the tip in the uterine artery, where polyvinyl alcohol particles embolize the vessels. The patient may experience a significant amount of pain in the first 24 hours, therefore frequently requiring hospital admission for parenteral analgesia.
Numerous studies have shown that office endometrial biopsy using disposable or rigid catheters such as the Novak have been demonstrated equivalent to formal D&C (18, 19, 20; Level II evidence). Practitioners must remember that even D&C under general anesthesia may miss 2% to 6% of cases of cancer or hyperplasia (18–21). Current practice utilizes endometrial biopsies done with 3 to 4 mm sampling devices that usually do not require cervical dilation or anesthesia. A prospective randomized study comparing Pipelle endometrial sampling with the rigid Novak curette showed that Pipelle biopsy appears to be as effective as the Novak curette in obtaining an adequate specimen for histological analysis and is associated with less pain (22; Level I evidence).
19. Smith JJ, Schulman H. Current dilation and curettage practice: A need for revision. Am J Obstet Gynecol 1985; 65:516–518. 20. Stovall TG, Solomon SK, Ling FW. Endometrial sampling prior to hysterectomy. Obstet Gynecol 1989; 73:405–409. 21. MacKenzie IZ, Bibby JG. Critical assessment of dilatation and curettage in 1029 women. Lancet 1978; 2:566–568. 22. Stovall TG, Ling FW, Morgan PL. A prospective, randomized comparison of the pipelle endometrial sampling device with the Novak curette. Am J Obstet Gynecol 1991; 165:1287–1290.
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