2026 Urogynecology for the Advanced Practice Provider-Case Studies Panel Discussion

Video Transcription

Video Summary

The discussion covered three cases. First was a 44-year-old with secondary amenorrhea and hypogonadotropic hypogonadism related to Langerhans cell histiocytosis affecting the pituitary. She developed persistent breakthrough bleeding on estrogen-progesterone replacement. The speakers reviewed causes of abnormal bleeding, when to adjust hormones, checking estradiol levels, and options like changing progestins, increasing estrogen, using drosperinone, or considering an IUD.  <br /><br />The second case involved a 38-year-old with recurrent “UTI” symptoms, mixed positive and negative cultures, bladder irritation, dyspareunia, atrophy, and pelvic floor hypertonicity. The group emphasized culture-based diagnosis, avoiding empiric treatment from urinalysis alone, considering ureaplasma/mycoplasma, vaginal estrogen, pelvic floor physical therapy, androgen-containing therapy, bladder instillations, and rescue options like phenazopyridine or hydroxyzine-type strategies.  <br /><br />The final case was a menopausal patient with severe hot flashes after neurosurgical treatment for meningioma. They discussed the risks of progesterone with meningiomas, whether estrogen is appropriate, and nonhormonal options such as fezolinetant, venlafaxine, and oxybutynin.

Asset Subtitle

Panelist:

Ian Fields, MD, MCR
Jenna Sarvaideo, DO

Keywords

secondary amenorrhea

hypogonadotropic hypogonadism

abnormal uterine bleeding

recurrent urinary symptoms

menopausal hot flashes

nonhormonal therapy