Focusing on women’s health
Components and rationale of gynecological history
The gynecological health history emphasizes the subsequent physical examination and decides on the diagnostic testing and treatment planning. The first component of the gynecological history is the chief complaint. The chief complaint is essential in knowing the patient’s experience with any health problem, even if the patient is encountered for regular gynecological examination (Drosdzol-Cop et al.,2020). History of the presenting illness is the second component that has a rationale of making a chance for the patient to describe any symptoms in her own words and assist the gynecologist to additional information about the nature of the problem. The onset, location, duration, characteristics, aggregating and relieving factors are obtained here. The Menstrual history is the third component, and it is composed of inquiries about the age at menarche, last menstrual period, menstrual pattern, perimenopause, and menopause features. The rationale behind the menstrual history is to identify the abnormalities in the reproductive features and identify the risk factors for the menstrual problem. Contraception history is a component taken to know if the family planning methods the client is using are safe and if there is a need to introduce or change family planning methods. Cervical and vaginal cytology history is another component that provides information for screening to prevent reproductive abnormalities (Drosdzol-Cop et al.,2020). History of sexually transmitted infection is taken with a rationale that some disorders may interfere with the woman’s reproductive system and must be managed to minimize the complications. Sexual history, including history on sexual lifestyle, is taken to know any concerns about the sexual life.
Obstetric history and history of fertility are obtained to assist in understanding the pregnancy patterns and plan for future pregnancies. Past medical and surgical history, medication allergies are also taken to see the relationship between the management procedures and the presenting problems. Familial history, social history, and review of systems are the last components of gynecological history taken to know the risks and causes of the gynecological abnormalities.
GTPAL system
GTPAL is an acronym used to understand details about the woman’s obstetric history (Fein & Paladine, 2020). G means gravida, which is the number of times the woman has conceived, including the current pregnancy. T is for term births which is the number of times the woman has carried a pregnancy to at least thirty-six weeks gestation and delivered. P-preterm births are the number of births before thirty-six weeks but after the 20 weeks of gestation. A- stands for abortions which is the number of times the woman has lost pregnancy-living children and refers to the number of live births that the woman has experienced (Fein & Paladine, 2020).
G.R 66-year-old female with hysterectomy and fibroids history case study
USPSTF recommends against screening for cervical cancer in women with a history of hysterectomy with removal of the cervix and who do not have an account of a high-grade precancerous lesion (Curry et al.,2018). I will therefore recommend the 66-year-old woman against the cancer screening. The USPSTF recommends against screening for cervical cancer in women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer. I will screen against the same.USPSTF recommends screening for osteoporosis for women aged 65 and above and postmenopausal women below 65 years who are at a high risk of osteoporosis. Screening for HCV for those aged betwe18 to79 years is a recommendation that applies to the woman. Curry et al. (2018) state that biennial screening mammography by the USPSTF applies to those aged 50 to 74 years, and the same will apply to the 66-year-old woman.
Combined hormonal contraceptive case
The combined hormonal contraceptives have absolute and relative contraindications. The absolute contraindications are the life-threatening situations that contraceptive use can cause.
They include liver tumors that are benign or malignant, known or suspected pregnancy, breast carcinoma or another estrogen-dependent neoplasia, undiagnosed abnormal genital bleeding, coronary artery disease or cerebrovascular disease, and thromboembolic or thrombophlebitis disorders (Houvèssou, Farías-Antúnez & da Silveira,2020). I will assist the woman in knowing that the use of combined hormonal contraceptives with these conditions leads to life-threatening effects. The relative contraindications mean that caution should be taken when combined hormonal contraceptives are used, and the method is used when the benefits outweigh the risks. The absolute contraindications are hypertension, diabetes, gall bladder disease, gestational cholestasis, hyperlipidemia, impaired liver function, and smoking (Houvèssou, Farías-Antúnez & da Silveira,2020).
References
Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., … &
U.U.U.S. Preventive Services Task Force. (2018). Screening for cervical cancer:
U.U.U.S. Preventive Services Task Force recommendation statement. Jama, 320(7), 674- 686.
Drosdzol-Cop, A., Skrzypulec-Plinta, V., Guzik-Makaruk, E. M., Drozdowska, U., Huzarska, D., & Czech, I. J. (2020). Recommendations of the Group of Experts of the Polish Society of Gynecologists and Obstetricians regarding gynecological examination and treatment of a minor person (01.01. 2020). Ginekologia Polska, 91(11), 714-716.
Fein, A. W., & Paladine, H. L. (2020). Impact of a Student-Run Free Clinic’s Women’s Health Program on Perceived Readiness for Clinical Rotations. PRiMER: Peer-Review Reports in Medical Education Research, 4.
Houvèssou, G. M., Farías-Antúnez, S., & da Silveira, M. F. (2020). Combined hormonal contraceptives use among women with contraindications according to the who criteria: A systematic review. Sexual & Reproductive Healthcare, 100587.
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Question 
Focusing on women’s health:
- Name and describe the components and rationale of the gynecological health history.
Focusing on women’s health
- Define and describe each component of the GTPAL system used to document pregnancy history.
- Following the guidelines of the United States Preventive Service Taskforce (USPSTF) what screening recommendations would you do to G.R. a 66-year-old female patient who visits you at the office for the first time (last visit to her PCP 5 years ago) with only positive health history of hysterectomy 10 years ago due to fibroids.
- A 35-year-old women with a BMI of 40 comes in asking about combined hormonal contraception’s. You explain the contraindications for hormonal contraception include (name more than 4 contraindications).
- Include at least two references in your post.
- Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
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