Abnormal Pap ACS-US-LSIL

Squamous cells make up the outer layer of the cervix and vagina (picture 1). Atypical squamous cells (ASC) is the name given to squamous cells on a Pap smear or cervical cytology that do not have a normal appearance but are not clearly precancerous. Low grade squamous intraepithelial lesions (LSIL, also called low grade cervical intraepithelial neoplasia) refers to cells that appear slightly abnormal.

Women who have ASC or LSIL require further testing because some women with these findings have a precancerous lesion of the cervix.

This topic review discusses the management of women with ASC and LSIL. The management of women with high grade squamous intraepithelial lesions (HSIL) and atypical glandular cells (AGC) are discussed in a separate topic review.

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Abnormal Pap HSIL

High grade cervical squamous intraepithelial lesion (HSIL, also called high grade cervical intraepithelial neoplasia) is the name given to moderately to severely abnormal-appearing cells on a Pap smear (also called a cervical cytology test). Any woman with HSIL requires further evaluation to determine if cancerous cells are present. While only about 2 percent of women with HSIL have invasive cancer, up to 20 percent of women with HSIL will eventually develop cancer if the abnormality is not treated.

Atypical glandular cells (AGC) is the name given to abnormal appearing glandular cells on a cervical cytology test. Glandular cells line the opening in the cervix (picture 1). AGC is a relatively uncommon result, although it always requires further evaluation. AGC can be caused by benign conditions, such as cervical polyps, or more serious conditions, such as cancer of the cervix, uterine lining (endometrium), ovary, or fallopian tube.

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Abnormal Uterine Bleeding

The inside of the uterus has two layers. The thin inner layer is called the endometrium. The thick outer layer is the myometrium (myo = muscle) (figure 1). In women who menstruate, the endometrium thickens every month in preparation for pregnancy. If the woman does not become pregnant, the endometrial lining is shed during the menstrual period. After menopause, the lining normally stops growing and shedding.

Under normal circumstances, a woman's uterus sheds a limited amount of blood during each menstrual period (less than 5 tablespoons or 80 mL). Bleeding that occurs between menstrual periods or excessive menstrual bleeding is considered to be abnormal uterine bleeding. Once a woman enters menopause and the menstrual cycles have ended, any bleeding, other than the small amount that may occur in women on hormone therapy, is considered abnormal.

Abnormal uterine bleeding can be caused by many different conditions. This topic review discusses the possible causes of abnormal bleeding, how it is evaluated, and various treatment strategies that may be recommended.

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Calcium Supplement Recommendations

Calcium, the most abundant mineral in the body, is found in some foods, added to others, available as a dietary supplement, and present in some medicines (such as antacids). Calcium is required for vascular contraction and vasodilation, muscle function, nerve transmission, intracellular signaling and hormonal secretion, though less than 1% of total body calcium is needed to support these critical metabolic functions. Serum calcium is very tightly regulated and does not fluctuate with changes in dietary intakes; the body uses bone tissue as a reservoir for, and source of calcium, to maintain constant concentrations of calcium in blood, muscle, and intercellular fluids.

The remaining 99% of the body's calcium supply is stored in the bones and teeth where it supports their structure and function. Bone itself undergoes continuous remodeling, with constant resorption and deposition of calcium into new bone. The balance between bone resorption and deposition changes with age. Bone formation exceeds resorption in periods of growth in children and adolescents, whereas in early and middle adulthood both processes are relatively equal. In aging adults, particularly among postmenopausal women, bone breakdown exceeds formation, resulting in bone loss that increases the risk of osteoporosis over time.

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Chlamydia

Chlamydia (pronounced klah-MID-dee-uh) is the most common sexually transmitted infection in the United States [1]. There are about four million cases of chlamydia in the United States every year.

Chlamydia and gonorrhea (another sexually transmitted infection) cause similar signs and symptoms, including discharge from the penis or vagina and pain with urination. However, chlamydia sometimes causes no symptoms. In addition, chlamydia can cause serious long-term complications in women who are not treated. Fortunately, chlamydia is curable with antibiotic treatment.

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Detecting & Treating Breast Problems

Breast problems, such as breast lumps, breast pain or tenderness, nipple discharge or inversion, and changes in the skin of the breast, are common in women of all ages, from adolescents to older women. While it can be frightening to discover a new breast problem, most breast problems are not caused by breast cancer.

This topic will review some of the most common breast problems, including those that you or your healthcare provider may find. This article will also review how common breast problems are evaluated and treated.

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Dysmenorrhea

Painful menstruation, also known as dysmenorrhea, is one of the most common gynecologic problems. Most women begin having dysmenorrhea during adolescence, usually within four to five years of the first menstrual period. Painful periods become less common as women age.

This topic review discusses the causes, symptoms diagnosis, and treatment of dysmenorrhea in women who do not have an underlying cause for their pain (eg, endometriosis, fibroids, bowel or bladder disease, etc). Separate topic reviews discuss the management of these problems.

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