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Selectives - OB/GYN

Women's Midlife Health Selective

Selective Number: (Oasis - S52f) 1907

Rotation Supervisor: Dr. JoAnn Pinkerton

Available: TBA

Duration: 2 weeks

Report to: Dr. Pinkerton

Time to Report: 9:00 am

Place to Report: Northridge Midlife Health Clinic, suite 104

Typical Day: 9:00 am - 5:00 pm

Number of students per rotation: 1

Course Description: This two week course will occur entirely within the office setting. All patients will be seen at the Midlife Health Center at Northridge. The student will have the opportunity to work with all health care providers at the Midlife Clinic. The patients at Northridge Midlife are seeking a comprehensive approach to gynecological care during the years surrounding menopause (no obstetrical care provided). In addition to routine pelvic and breast exams, discussions with the patient can focus on nutrition, exercise, osteoporosis, stress/depression, sexuality, preventive cardiology, and breast health. The student's daily schedule will consist of "following" the practitioner throughout the clinic day. Students will be present in the room for history taking, pelvic exams, procedures and/or discussions. The educational value of this selective will be derived from observing the flow of a typical day in an office practice, and being exposed to the clinical decision making which is pertinent to this population of women. Students will be expected to become familiar with management of menopausal symptoms, abnormal Pap smears, fibroids, uterine polyps, ovarian enoplasms, dysfunctional bleeding, abnormal mammograms, and abnormal DEXA scans. Students will learn to be respectful of the "personal" issues that arise (sexuality, depression, family stress) in this population. Students will give a 15-20 minute didactic presentation on the topic of their choice in the second week of the rotation.


Rationale: Women spend as much as one-third of their lives in the postmenopausal years. Understanding the physical and emotional changes caused by estrogen depletion is important for all physcians who provide health care for women.

The student will be able to describe:

  • Physiologic changes in the hypothalamic-pituitary-ovarian axis
  • Symptoms and physical findings associated with hypoestrogenism
  • Long-term changes associated with hypoestrogenism
  • Management, including
    • Hormone therapy
    • Nutrition and exercise
    • Non-hormonal therapeutic options
  • Risks and Benefits of hormone replacement therapy

I. Population demographics

  • Older polulation aging - today, life expectancy for a woman = age 80 years
  • Older population growing - in 1990 > 30 million menopausal women

II. Menopause

  • Definition - cessation of spontaneous menses due to loss of ovarian function
  • Endocrinology
    • ovarian deficit leads to poor response to gonadotropins
    • leads to cessation of ovulation and decreased ovarian steroid production
  • Epidemiology/social concerns
  • Clinical Concerns
    • Symptoms (early)
      • hot flashes
      • insomnia
      • irritability
      • mood distrubances
    • Physical Changes (intermediate)
      • vaginal atrophy
      • urinary incontinence
      • skin atrophy
    • Diseases (late)
      • osteoporosis
      • cardiovascular disease
      • Alzheimer's Disease

III. Hormone Replacement Therapy (HRT)

  • What is it?
  • New terminology - ET and HT
  • Understanding the Women's Health Initiative (WHI)
    • vasomotor symptoms
    • cardiovascular - protection or risk?
    • osteoporosis - protection?
    • breast cancer
    • cognitive
  • Route of administration
  • "bio-identicals"
  • Alternative Therapies

IV. Osteoporosis

  • evaluation
  • treatment options

V. Primary Care Issues/Lifestyle Intervention

  • normalization of weight
  • dietary intervention
  • smoking cessation
  • regular exercise
  • control of other medical conditions
  • social stressors