All protocols

Cooling the body can help manage perspiration and blushing caused by anxiety before speaking; holding something cold in the palms is one method because the palms help thermoregulate the body.

Use challenging backward counting to force focus and become present-oriented before speaking.

Screen girls and young women early for endometriosis, especially when they have severe menstrual pain, missed school, fertility concerns, or other suggestive symptoms.

Screen all girls and young women for PCOS rather than assuming youth protects fertility.

Pelvic ultrasound should be included in a well-woman exam and requested for pelvic pain, suspected endometriosis, or evaluation of PCOS morphology, fibroids, septum, cysts, and possible endometrioma. If a doctor refuses to order it for pain, seek another doctor or another imaging site.

For PCOS, birth control can help symptoms by increasing sex hormone-binding globulin and improving acne, hair loss, and irregular periods. It is not a first-line treatment because many people with PCOS feel worse on it.

Progesterone-only birth control pill she tries for PCOS patients who want contraception and anti-androgen support.

She presents sex 3–4 times per week as the benchmark trying-to-conceive frequency, noting that in her example about 50% conceive within 6 months and 90% within 1 year.

For people with PCOS trying to get pregnant, ask a doctor about letrozole as a first-line treatment before Clomid.

For people with PCOS trying to get pregnant, ask a doctor about Clomid after letrozole.

Treat painful periods as a possible sign of endometriosis rather than normal menstrual discomfort, especially if the pain disrupts daily life or school.

Painful sex with deep penetration may be a sign of endometriosis.

Persistent bloating around and beyond periods may be a sign of endometriosis.

Painful bowel movements may be a sign of possible endometriosis and should be considered in evaluation.

If recurrent bladder symptoms are repeatedly treated with antibiotics despite negative cultures, consider endometriosis until proven otherwise.

Some cramps can be managed with a couple of Advil tablets, but this is different from abnormal endometriosis pain.

Laparoscopic excision/resection is the gold-standard diagnosis and treatment for endometriosis, especially when pain is severe or hormonal suppression fails.

Cut out lesions rather than burning them, since burning is only a temporary fix and the pain can return.

Use progesterone-only birth control pills to suppress endometriosis symptoms in suspected or confirmed cases. For patients with endometriosis, start progesterone-based birth control at six weeks postpartum.

Avoid estrogen-containing birth control for endometriosis, because estrogen can cause the implants to grow.

Progesterone IUD used to suppress endometriosis or adenomyosis; also serves as birth control and can last up to 8 years. Mentioned as the most common progesterone IUD used, including after surgery.

Smaller progesterone IUD preferred for young girls who have not had children; contrasted with Mirena as slightly smaller.

GnRH antagonists such as Orilissa and Myfembree can be used for endometriosis when stronger estrogen suppression is needed, especially for painful sex and painful periods, often after surgery or when progesterone suppression is insufficient. These medications carry a risk of bone loss and have duration limits.

Limit estrogen-suppressing pills to no more than 2 years because of the risk of bone loss.

After endometriosis surgery, she places a progesterone IUD before sending patients home.

For stage 3 or 4 endometriosis, she may add GnRH antagonists after surgery for 6 months up to 2 years, depending on stage and symptoms.

For patients with endometriosis after delivery, place a progesterone IUD at the postpartum visit, around 6 weeks postpartum, to help suppress recurrence.

Women should calculate their lifetime breast cancer risk using the Tyrer-Cuzick tool, and this should be known routinely. The result can guide decisions about earlier imaging.

If lifetime breast cancer risk is 20% or higher, start breast imaging at age 30 instead of waiting until age 40.

For women with dense breasts and a high risk of breast cancer, add breast ultrasound to mammography.