This is for informational purposes only. For medical advice or diagnosis, consult a professional.

Components of a Gynecological Health History

A comprehensive gynecological health history is essential for providing appropriate and personalized care. Key components include:

• Menstrual History:
  • Age of menarche (onset of menstruation)
  • Cycle length (number of days between periods)
  • Duration of menstrual flow
  • Amount of menstrual flow (light, heavy, spotting)
  • Dysmenorrhea (menstrual cramps) – severity, location, duration, any associated symptoms
  • Intermenstrual bleeding (bleeding between periods)
  • Last menstrual period (LMP)
• Obstetric History:
  • Number of pregnancies (gravidity)
  • Number of live births (parity)
  • Number of miscarriages/abortions
  • Pregnancy complications (e.g., gestational diabetes, preeclampsia)
  • Delivery methods (vaginal, cesarean)
  • Postpartum complications
• Sexual History:
  • Number of sexual partners
  • Use of contraception (type and consistency)
  • History of sexually transmitted infections (STIs)
  • Sexual dysfunction
• Gynecologic History:
  • Previous gynecologic surgeries (e.g., hysterectomy, tubal ligation, D&C)
  • History of pelvic inflammatory disease (PID)
  • History of endometriosis
  • History of ovarian cysts
  • History of abnormal Pap smears or HPV infections
• Urogynecologic History:
  • Urinary incontinence (stress, urge, overflow)
  • Urinary tract infections (UTIs)
  • Pelvic organ prolapse
• Medications:
  • Current and past medications (including over-the-counter medications and herbal supplements)
• Family History:
  • Breast cancer
  • Ovarian cancer
  • Endometrial cancer
  • Cervical cancer

GTPAL System

The GTPAL system is used to document a woman’s obstetric history:

• G: Gravidity – Total number of pregnancies, including the current pregnancy.
• T: Term births – Number of pregnancies delivered at 37 weeks or more gestation.
• P: Preterm births – Number of pregnancies delivered between 20 and 36 weeks of gestation.
• A: Abortions/Miscarriages – Number of pregnancies that ended before 20 weeks of gestation (includes spontaneous and induced abortions).
• L: Living children – Number of living children.

USPSTF Screening Recommendations for G.R.

Given G.R. is 66 years old with a history of hysterectomy, the USPSTF recommends the following:

• No routine screening for cervical cancer: Hysterectomy eliminates the cervix, therefore, cervical cancer screening is not necessary.
• Mammography:
  • The USPSTF recommends biennial screening mammography for women aged 50-74 years.
  • For women aged 75 years and older, the decision to screen should be an individual one, considering the woman’s life expectancy, prior screening history, and preferences.
• Osteoporosis screening:
  • The USPSTF recommends screening for osteoporosis in women aged 65 years and older.
• Cardiovascular risk assessment:
  • Given her age and history of hysterectomy, a thorough cardiovascular risk assessment, including blood pressure, cholesterol levels, and other relevant risk factors, is recommended.

Contraindications to Combined Hormonal Contraception

• History of venous thromboembolism (VTE): Deep vein thrombosis (DVT) or pulmonary embolism.
• History of cerebrovascular accident (stroke) associated with estrogen use.
• Current or history of estrogen-dependent cancers: Breast cancer, endometrial cancer, or certain types of liver cancer.
• Undiagnosed abnormal vaginal bleeding.
• **Known or suspected pregnancy.
• Severe liver disease.
• Active or history of inflammatory bowel disease (e.g., Crohn’s disease, ulcerative colitis).
• Uncontrolled hypertension.
• Smoking (especially for women over 35 years old).