Women's Health
Core concepts
Reproductive health spans contraception, screening, pregnancy, and menopause. Contraceptive counseling should match method to patient: LARC (IUD/implant) is most effective; estrogen-containing methods are contraindicated with migraine with aura, smoking age ≥35, hypertension, VTE history, and breastfeeding <3 weeks (per US MEC). Emergency contraception: copper IUD most effective, then ulipristal, then levonorgestrel.
Pregnancy care: folic acid 400 mcg (4 mg if prior neural tube defect), first-trimester dating ultrasound, aneuploidy screening, gestational diabetes screening at 24–28 weeks, group B strep at 36–37 weeks, and Tdap each pregnancy. Know preeclampsia (new HTN after 20 weeks + proteinuria or end-organ signs), its severe features, and magnesium sulfate for seizure prophylaxis. Ectopic pregnancy is a can't-miss in a reproductive-age patient with pain and bleeding.
Menopause: hormone therapy is the most effective treatment for vasomotor symptoms; use the lowest effective dose, generally within 10 years of menopause and under age 60, and avoid in breast cancer survivors. Screening: cervical, breast, and colorectal per USPSTF; osteoporosis in women 65+.
Traps
- Migraine with aura + estrogen - contraindicated.
- Missing ectopic when a pregnancy test is not ordered.
- Confusing physiologic leukorrhea with infection.
- Overlooking postpartum depression and intimate partner violence screening.
Rule of thumb
Any reproductive-age patient with abdominal pain, bleeding, or syncope gets a pregnancy test before anything else. Then risk-stratify for ectopic.