Prenatal care

Establish gestational dating, baseline labs, BP risk, mental health, medication review, vaccine status, and follow-up cadence that matches pregnancy risk instead of using one template for everyone.

Contraception counseling

Choose methods by patient goals, medical eligibility, bleeding profile, postpartum status, migraine history, VTE risk, breast cancer history, hypertension, and medication interactions.

STI and cervical screening

Pair sexual history, pregnancy intention, symptom pattern, NAAT testing, HIV/syphilis/hepatitis risk, and preventive screening recommendations at the right intervals.

Pelvic pain and bleeding

Rule out pregnancy complications, torsion, ectopic pregnancy, infection, fibroids, ovarian cyst complications, malignancy warning signs, and anemia.

Vaginitis and cervicitis

Use symptom pattern, microscopy when available, NAAT, pregnancy status, and partner management planning to guide treatment.

Pregnancy hypertension and diabetes

Escalate quickly when severe BP, headache, RUQ pain, visual symptoms, edema with concerning context, or hyperglycemia suggest maternal-fetal risk.

Menopause and midlife care

Hot flashes, genitourinary syndrome, mood change, bone health, cardiovascular risk, sleep, and cancer screening all belong in the visit.

Ectopic pregnancy

Pathophysiology: A fertilized ovum implants outside the uterine cavity, most often in the fallopian tube, risking rupture and hemorrhage.

Diagnosis: Positive pregnancy test with pain or bleeding, serial quantitative hCG, and transvaginal ultrasound when the intrauterine pregnancy is not yet visualized or symptoms are concerning.

First-line treatment: Methotrexate (Rheumatrex/Trexall) for selected stable patients who meet criteria and can follow close monitoring.

Second-line treatment: Laparoscopic surgery or urgent surgery for rupture, hemodynamic instability, or methotrexate failure.

Preeclampsia

Pathophysiology: Abnormal placentation leads to endothelial dysfunction, vasospasm, proteinuria, and maternal end-organ injury after 20 weeks of gestation or postpartum.

Diagnosis: Hypertension after 20 weeks plus proteinuria or severe features such as thrombocytopenia, kidney/liver injury, pulmonary edema, headache, or visual symptoms.

First-line treatment: Labetalol (Trandate), nifedipine ER (Procardia XL/Adalat CC), or hydralazine (Apresoline) for blood pressure control when indicated.

Second-line treatment: Magnesium sulfate for seizure prophylaxis in severe disease, plus delivery planning and inpatient monitoring based on gestational age and maternal-fetal status.

Gestational diabetes

Pathophysiology: Placental hormones increase insulin resistance, and inadequate pancreatic compensation causes pregnancy hyperglycemia.

Diagnosis: Screening with glucose challenge/OGTT strategy per prenatal protocol, then fasting and postprandial glucose monitoring after diagnosis.

First-line treatment: Nutrition counseling, glucose monitoring, and insulin when targets are not met; insulin is the standard pharmacologic choice in pregnancy.

Second-line treatment: Metformin (Glucophage) may be used in selected cases when insulin is not feasible, but many patients still need insulin for control.

Hyperemesis gravidarum

Pathophysiology: Severe nausea and vomiting in pregnancy cause dehydration, electrolyte abnormalities, weight loss, and ketonuria.

Diagnosis: Clinical pregnancy-related vomiting with weight loss, dehydration, and exclusion of other causes; assess electrolytes, ketones, and thyroid testing when indicated.

First-line treatment: Pyridoxine (vitamin B6) plus doxylamine (Unisom) and oral/IV fluids.

Second-line treatment: Ondansetron (Zofran), metoclopramide (Reglan), or promethazine (Phenergan) when symptoms persist or oral intake fails.

Postpartum hemorrhage

Pathophysiology: Uterine atony, retained products, trauma, placental abnormalities, or coagulopathy cause excessive bleeding after delivery.

Diagnosis: Clinical blood loss with hypovolemia, uterine tone assessment, placental evaluation, and CBC/coagulation studies when severe.

First-line treatment: Uterine massage plus oxytocin (Pitocin); additional uterotonics include methylergonovine (Methergine) or carboprost (Hemabate) when not contraindicated.

Second-line treatment: Tranexamic acid (Cyklokapron) and escalation to balloon tamponade, blood products, or procedure-based control when bleeding continues.

Postpartum depression/anxiety

Pathophysiology: Rapid hormone shifts, sleep deprivation, psychosocial stress, prior mood disorder, and low support increase risk during the first year postpartum.

Diagnosis: EPDS or PHQ-9 screening, assessment for self-harm/psychosis, and differentiation from baby blues or thyroid disease.

First-line treatment: Sertraline (Zoloft) or escitalopram (Lexapro) plus psychotherapy and social support.

Second-line treatment: Zuranolone (Zurzuvae) for postpartum depression in selected patients, or psychiatry referral and urgent evaluation if psychosis or suicidality is present.

Abnormal uterine bleeding

Pathophysiology: Ovulatory dysfunction, fibroids, polyps, adenomyosis, infection, pregnancy complications, and endometrial pathology can all drive heavy or irregular bleeding.

Diagnosis: Pregnancy test, CBC, pelvic exam, and ultrasound; endometrial biopsy when age/risk profile or bleeding pattern suggests malignancy or hyperplasia risk.

First-line treatment: Combined hormonal contraception such as ethinyl estradiol/levonorgestrel (Nordette, Seasonale) or tranexamic acid (Lysteda) for heavy bleeding when appropriate.

Second-line treatment: Progestin therapy such as medroxyprogesterone (Provera) or levonorgestrel IUD (Mirena) and procedural options when medical therapy is inadequate.

Uterine fibroids

Pathophysiology: Benign smooth-muscle tumors of the uterus grow in response to estrogen and progesterone and can cause bleeding, pain, and bulk symptoms.

Diagnosis: Pelvic exam and pelvic ultrasound, with MRI or hysteroscopy when mapping is needed or diagnosis is uncertain.

First-line treatment: NSAIDs like ibuprofen (Advil/Motrin) for pain, or hormonal suppression with combined contraception or progestin therapy when bleeding is the main issue.

Second-line treatment: Tranexamic acid (Lysteda), leuprolide (Lupron Depot), or procedural therapy such as myomectomy/UAE depending on fertility goals.

Endometriosis

Pathophysiology: Endometrial-like tissue outside the uterus responds to ovarian hormones, causing inflammatory pain, adhesions, and infertility.

Diagnosis: Clinical history plus pelvic exam and ultrasound for endometriomas; laparoscopy can be diagnostic and therapeutic when symptoms persist.

First-line treatment: NSAIDs and hormonal suppression such as combined oral contraceptives or norethindrone (Aygestin).

Second-line treatment: GnRH agonists like leuprolide (Lupron Depot) with add-back therapy, or surgical excision for refractory disease.

PCOS

Pathophysiology: Hyperandrogenism, chronic anovulation, and insulin resistance drive irregular menses, infertility, acne, and hirsutism.

Diagnosis: Irregular ovulation, clinical or biochemical hyperandrogenism, and exclusion of mimics such as thyroid disease, hyperprolactinemia, and nonclassic CAH.

First-line treatment: Lifestyle change and combined oral contraception such as ethinyl estradiol/progestin products for cycle control and androgen suppression.

Second-line treatment: Metformin (Glucophage) for metabolic features, and spironolactone (Aldactone) for hirsutism when contraception is in place.

Ovarian cyst and torsion

Pathophysiology: Functional cysts are common and often resolve, but large or mobile cysts can torsion the ovary and threaten blood flow.

Diagnosis: Pelvic ultrasound identifies size, complexity, and blood flow; sudden unilateral pain with nausea/vomiting raises torsion concern.

First-line treatment: Watchful waiting for uncomplicated functional cysts and analgesia such as ibuprofen (Advil/Motrin).

Second-line treatment: Urgent gynecologic surgery for torsion, persistent complex cysts, or features concerning for malignancy.

Menorrhagia from adenomyosis

Pathophysiology: Endometrial tissue grows into the myometrium, causing heavy, painful, often progressive menses.

Diagnosis: History of heavy bleeding and dysmenorrhea plus ultrasound or MRI when needed; rule out pregnancy and endometrial pathology.

First-line treatment: NSAIDs and hormonal therapy such as combined contraception or progestin treatment.

Second-line treatment: Levonorgestrel IUD (Mirena) or hysterectomy for refractory symptoms when fertility is no longer desired.

Pelvic inflammatory disease

Pathophysiology: Ascending infection of the upper genital tract causes endometritis, salpingitis, tubo-ovarian abscess, and infertility risk.

Diagnosis: Low threshold for treatment when pelvic pain plus cervical motion, uterine, or adnexal tenderness is present; test for gonorrhea/chlamydia and assess pregnancy.

First-line treatment: Ceftriaxone (Rocephin) plus doxycycline (Vibramycin) with metronidazole (Flagyl) for outpatient therapy when appropriate.

Second-line treatment: Inpatient IV cefoxitin or cefotetan plus doxycycline, especially for abscess, pregnancy, severe illness, or failure of outpatient therapy.

Bacterial vaginosis

Pathophysiology: Loss of lactobacillus dominance and anaerobic overgrowth create a polymicrobial vaginal dysbiosis and thin discharge.

Diagnosis: Amsel criteria or Nugent score, with elevated vaginal pH and clue cells supporting the diagnosis.

First-line treatment: Metronidazole (Flagyl) oral or vaginal therapy.

Second-line treatment: Clindamycin (Cleocin) vaginal cream or oral therapy when metronidazole is not tolerated or not suitable.

Vulvovaginal candidiasis

Pathophysiology: Candida overgrowth causes vulvar pruritus, erythema, soreness, and thick curdy discharge.

Diagnosis: Wet mount with KOH showing budding yeast, hyphae, or pseudohyphae; culture when recurrent or complicated.

First-line treatment: Fluconazole (Diflucan) 150 mg once for uncomplicated nonpregnant infection, or topical azoles like clotrimazole (Gyne-Lotrimin/Canesten).

Second-line treatment: Longer azole courses or boric acid for recurrent/non-albicans disease; in pregnancy, topical azole therapy is preferred.

Trichomoniasis

Pathophysiology: Protozoal infection causes vaginitis, inflammation, and sexually transmitted reinfection risk.

Diagnosis: NAAT or wet mount when available, with evaluation for other STIs because coinfection is common.

First-line treatment: Metronidazole (Flagyl) or tinidazole (Tindamax) with partner treatment.

Second-line treatment: Repeat or extended nitroimidazole therapy for persistent infection or reinfection after adherence and exposure review.

Chlamydia and gonorrhea cervicitis

Pathophysiology: Cervical infection from C. trachomatis or N. gonorrhoeae can cause cervicitis, PID, infertility, and neonatal infection.

Diagnosis: NAAT from vaginal/cervical/urine specimen, with broader STI screening based on risk and symptoms.

First-line treatment: Doxycycline (Vibramycin) for chlamydia; ceftriaxone (Rocephin) for gonorrhea when indicated.

Second-line treatment: Azithromycin (Zithromax) or alternative regimens when adherence, pregnancy, or allergy changes the plan, plus partner treatment and retesting.

Contraception selection

Pathophysiology: Not a disease, but a core reproductive-health decision shaped by ovulation suppression, cervical mucus, endometrium, and patient risk profile.

Diagnosis: Apply the CDC U.S. MEC, pregnancy intention, postpartum status, migraine/VTE history, hypertension, breastfeeding, and medication interactions.

First-line treatment: Long-acting reversible contraception such as levonorgestrel IUD (Mirena/Kyleena/Liletta) or etonogestrel implant (Nexplanon) when desired and eligible.

Second-line treatment: Combined oral contraceptives like ethinyl estradiol/levonorgestrel (Aviane, Seasonale) or progestin-only pills such as norethindrone (Micronor) based on contraindications.

Infertility

Pathophysiology: Often multifactorial from ovulatory dysfunction, tubal disease, endometriosis, male factor, or diminished ovarian reserve.

Diagnosis: Cycle history, ovulation assessment, pelvic imaging, STI/tubal-risk review, and semen analysis are central starting tests.

First-line treatment: Lifestyle optimization and ovulation induction with letrozole (Femara) for anovulatory infertility such as PCOS.

Second-line treatment: Clomiphene (Clomid), gonadotropins, IUI, or IVF depending on cause and duration of infertility.

Menopause and genitourinary syndrome

Pathophysiology: Ovarian estrogen decline drives vasomotor symptoms, vulvovaginal atrophy, sleep disruption, and bone loss risk.

Diagnosis: Usually clinical after 12 months without menses; rule out pregnancy or pathology when bleeding is abnormal or menopause is early/atypical.

First-line treatment: Nonhormonal measures and, when appropriate, vaginal moisturizers plus local estrogen such as estradiol (Estrace/Vagifem) for GSM.

Second-line treatment: Systemic menopausal hormone therapy or nonhormonal agents such as venlafaxine (Effexor XR) for hot flashes when risk profile allows.

Bone health after menopause

Pathophysiology: Estrogen deficiency accelerates bone resorption, increasing osteopenia and fracture risk.

Diagnosis: DEXA based on age/risk factors, calcium/vitamin D review, and fracture-risk assessment.

First-line treatment: Calcium, vitamin D, weight-bearing exercise, and lifestyle risk reduction.

Second-line treatment: Bisphosphonates such as alendronate (Fosamax) or risedronate (Actonel) when fracture risk warrants pharmacotherapy.