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1.
September 2017

Committee Opinion Number 714, September 2017

ABSTRACT: Rates of obesity among adolescents in the United States have increased at a dramatic rate along with the prevalence of weight-related diseases. Between the 1980s and 2014, the prevalence of obesity among adolescent females in the United States increased from approximately 10% to 21%. Although the steep increase in the prevalence of obesity in children (2–11 years) has slowed, the prevalence of obesity in adolescents (12–19 years) continues to increase. Because the obese female adolescent faces medical, psychologic, and reproductive health challenges, early intervention is imperative...


Committee Opinion Number 710, August 2017

ABSTRACT: Modern contraceptives are very effective when used correctly and, thus, effective counseling regarding contraceptive options and provision of resources to increase access are key components of adolescent health care. Regardless of a patient’s age or previous sexual activity, the obstetrician–gynecologist routinely should address her contraceptive needs, expectations, and concerns. Obstetrician–gynecologists should be aware of and be prepared to address the most common misperceptions about contraceptive methods in a way that is age appropriate and compatible with the patient’s health...


Committee Opinion Number 705, July 2017

ABSTRACT: Mental health disorders in adolescence are a significant problem, relatively common, and amenable to treatment or intervention. Obstetrician–gynecologists who see adolescent patients are highly likely to see adolescents and young women who have one or more mental health disorders. Some of these disorders may interfere with a patient’s ability to understand or articulate her health concerns and appropriately adhere to recommended treatment. Some disorders or their treatments will affect the hypothalamic–pituitary–gonadal axis, causing anovulatory cycles and various menstrual disturba...


Committee Opinion Number 704, June 2017

(Replaces Committee Opinion Number 641, September 2015)

ABSTRACT: Human papillomavirus (HPV) is associated with anogenital cancer (including cervical, vaginal, vulvar, penile, and anal), oropharyngeal cancer, and genital warts. The HPV vaccination significantly reduces the incidence of anogenital cancer and genital warts. Despite the benefits of HPV vaccines, only 41.9% of girls in the recommended age group, and only 28.1% of males in the recommended age group have received all recommended doses. Compared with many other countries, HPV vaccination rates in the United States are unacceptably low. The U.S. Food and Drug Administration has approved t...


5.
June 2017

Committee Opinion Number 702, June 2017

ABSTRACT: The female athlete triad is a medical condition observed in physically active females involving three components: 1) low energy availability with or without disordered eating, 2) menstrual dysfunction, and 3) low bone density. An individual does not need to show clinical manifestations of all three components of the female athlete triad simultaneously to be affected by the condition. Consequences of these clinical conditions may not be completely reversible, so prevention, early diagnosis, and intervention are critical. All athletes are at risk of the female athlete triad, regardles...


Committee Opinion Number 699, May 2017

ABSTRACT: In 2015, the birth rate among U.S. adolescents and young adults (aged 15–19 years) reached a historic low at 22.3 per 1,000 women. Despite positive trends, the United States continues to have the highest adolescent pregnancy rate among industrialized countries with data. Racial and ethnic disparities in adolescent pregnancy rates continue to exist, as do state-based differences in pregnancy, birth, and abortion rates. The American College of Obstetricians and Gynecologists supports access for adolescents to all contraceptive methods approved by the U.S. Food and Drug Administration....


Committee Opinion Number 698, May 2017

ABSTRACT: Primary ovarian insufficiency describes a spectrum of declining ovarian function and reduced fecundity due to a premature decrease in initial follicle number, an increase in follicle destruction, or poor follicular response to gonadotropins. The sequelae of primary ovarian insufficiency include vasomotor symptoms, urogenital atrophy, osteoporosis and fracture, cardiovascular disease, and increased all-cause mortality. In women with primary ovarian insufficiency, systemic hormone therapy (HT) is an effective approach to treat the symptoms of hypoestrogenism and mitigate long-term hea...


Committee Opinion Number 685, January 2017

ABSTRACT: Gender nonconforming youth are an underserved population who obstetrician–gynecologists are seeing increasingly in their practices. Currently, there are large gaps in training, knowledge, and comfort with transgender patients among obstetrician–gynecologists. The purpose of this document is to review current recommendations that apply to an obstetrician–gynecologist. It is important for obstetrician–gynecologists to be aware of the social and mental health risks for the transgender population. Consensus guidelines support initiating medical therapy after an adolescent has an establi...


Committee Opinion Number 678, November 2016

ABSTRACT: Current sexuality education programs vary widely in the accuracy of content, emphasis, and effectiveness. Data have shown that not all programs are equally effective for all ages, races and ethnicities, socioeconomic groups, and geographic areas. Studies have demonstrated that comprehensive sexuality education programs reduce the rates of sexual activity, sexual risk behaviors (eg, number of partners and unprotected intercourse), sexually transmitted infections, and adolescent pregnancy. One key component of an effective program is encouraging community-centered efforts. In addition...


Committee Opinion Number 668, August 2016

(Replaces Committee Opinion Number 448, December 2009)

ABSTRACT: For an adolescent with physical disabilities, intellectual disabilities, or both, and for her caregivers, menstruation can present significant challenges. If, after an evaluation, the adolescent, her family, and the obstetrician–gynecologist have decided that menstrual intervention is warranted, advantages and disadvantages of hormonal methods should be reviewed and individualized to each patient’s specific needs. Complete amenorrhea may be difficult to achieve, and realistic expectations should be addressed with the patient and her caregivers. The goal in menstrual manipulation sho...


Committee Opinion Number 653, February 2016

ABSTRACT: Although there are many positive aspects of social media for adolescents and young adults, there are also risks. Adolescence is a time of significant developmental changes, during which adolescents exhibit a limited capacity for self-regulation and an increased risk of susceptibility to peer pressure and experimentation. Social media can be harmful, and obstetrician–gynecologists may screen their adolescent and young adult patients for high-risk sexual behaviors, especially if sexualized text communication (sexting), exposure to pornography, online dating, or other risk-taking behav...


Committee Opinion Number 651, December 2015

(Replaces Committee Opinion 349, November 2006, Reaffirmed 2017)

ABSTRACT: Despite variations worldwide and within the U.S. population, median age at menarche has remained relatively stable—between 12 years and 13 years—across well-nourished populations in developed countries. Environmental factors, including socioeconomic conditions, nutrition, and access to preventive health care, may influence the timing and progression of puberty. A number of medical conditions can cause abnormal uterine bleeding, characterized by unpredictable timing and variable amount of flow. Clinicians should educate girls and their caretakers (eg, parents or guardians) about what...


Committee Opinion Number 626, March 2015

Reaffirmed 2017

ABSTRACT: Young women (aged 18–26 years) are a heterogeneous population transitioning from adolescence into adulthood who may present with unique issues and challenges, including a potential gap in health care after pediatric health care. Obstetrician–gynecologists should note that these patients may need assistance in transitioning from a pediatrician to a provider of adult health care (an internist, family practitioner, or obstetrician–gynecologist), especially in the absence of a parent. Preventive counseling is crucial for helping young women anticipate changes and stressors and for easin...


Committee Opinion Number 607, August 2014

Reaffirmed 2017

ABSTRACT: Advancements in radiation therapy, chemotherapy, surgery, and multimodal treatment have dramatically improved childhood cancer survival. However, cancer and its treatment may have immediate or delayed adverse effects on reproductive health. Gynecologists should be prepared to manage gynecologic concerns in young cancer patients and survivors before, during, and after their treatment. Gynecologists may be consulted regarding pubertal concerns; heavy menstrual bleeding and anemia; sexuality; contraception; ovarian function, including fertility preservation; and breast and cervical can...


Committee Opinion Number 606, August 2014

(Reaffirmed 2016)

ABSTRACT: Adolescents undergoing cancer treatment are at high risk of heavy menstrual bleeding, and gynecologists may be consulted either before the initiation of cancer treatment to request strategies for menstrual suppression or during an episode of severe heavy bleeding to stop the bleeding emergently. Therapy in both situations should be tailored to the patient, her cancer diagnosis and treatment plan, and her desires for contraception and fertility. Options for menstrual suppression include combined hormonal contraceptives, progestin-only therapy, and gonadotropin-releasing hormone agoni...


Committee Opinion Number 602, June 2014

(Replaces Committee Opinion Number 415, September 2008) (Reaffirmed 2016)

ABSTRACT: Depot medroxyprogesterone acetate (DMPA) is a highly effective injectable contraceptive that affords privacy and has a convenient dose schedule of four times per year, making it appealing to many users, especially adolescents. Although the use of DMPA is associated with loss of bone mineral density (BMD), current longitudinal and cross-sectional evidence suggests that recovery of BMD occurs after discontinuation of DMPA. No high-quality data answer the important clinical question of whether DMPA affects fracture risk in adolescents or adults later in life. The effect of DMPA on BMD ...


Committee Opinion Number 599, May 2014

(Reaffirmed 2016)

ABSTRACT: Confidentiality concerns are heightened during adolescence, and these concerns can be a critical barrier to adolescents in receiving appropriate health care. Health care providers caring for minors should be aware of federal and state laws that affect confidentiality. State statutes on the rights of minors to consent to health care services vary by state, and health care providers should be familiar with the regulations that apply to their practice. Parents and adolescents should be informed, both separately and together, that the information each of them shares with the health care...


Committee Opinion Number 598, May 2014

(Replaces Committee Opinion Number 460, July 2010, Reaffirmed 2016)

ABSTRACT: The initial visit for screening and the provision of reproductive preventive health care services and guidance should take place between the ages of 13 years and 15 years. The initial reproductive health visit provides an excellent opportunity for the obstetrician–gynecologist to start a patient–physician relationship, build trust, and counsel patients and parents regarding healthy behavior while dispelling myths and fears. The scope of the initial reproductive health visit will depend on the individual’s need, medical history, physical and emotional development, and the level of ca...


Committee Opinion Number 580, December 2013

(Replaces No. 451, December 2009, Reaffirmed 2015)

ABSTRACT: Von Willebrand disease, the most common inherited bleeding disorder among American women, is a common cause of heavy menstrual bleeding and other bleeding problems in women and adolescent girls. Von Willebrand disease and other inherited and acquired disorders of coagulation and hemostasis should be considered in the differential diagnosis of all patients being evaluated for heavy menstrual bleeding, regardless of age. There are many treatment options available for patients with von Willebrand disease and heavy menstrual bleeding, including hormonal and nonhormonal therapies. A mult...


Committee Opinion Number 562, May 2013

(Replaces No. 355, December 2006, Reaffirmed 2016)

ABSTRACT: Müllerian agenesis occurs in 1 out of every 4,000–10,000 females. The most common presentation of müllerian agenesis is congenital absence of the vagina, uterus, or both, which also is referred to as müllerian aplasia, Mayer–Rokitansky–Küster–Hauser syndrome, or vaginal agenesis. Satisfactory vaginal creation usually can be managed nonsurgically with successive vaginal dilation; however, there are a variety of surgical options for creation of a neovagina. Regardless of the treatment option selected, patients should be thoroughly counseled and prepared psychologically before the init...


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