Nichole Tyson, MD

View details for DOI 10.1016/j.jpag.2020.12.015

View details for PubMedID 33485521

View details for DOI 10.1016/j.jadohealth.2020.10.020

View details for PubMedID 33541602

Abstract

PURPOSE: There is growing advocacy for use of long-acting reversible contraception among sexually active adolescents. Our primary aims were to evaluate etonogestrel subdermal contraceptive implant (SCI) insertion trends among adolescents, as well as SCI retention at 1, 2 and 3 years, indications for removal, and to identify pregnancies occurring during SCI use.METHODS: A retrospective cohort study was conducted of adolescents aged 13-19 with SCI insertions in 2008-2014 within a large integrated healthcare system. Demographic and clinical characteristics included age, race/ethnicity, BMI, gravidity, parity, insertions, reinsertions, indications for removal, and pregnancy. Electronic medical record review was conducted on a randomized sample of 540 adolescents with insertions during 2008-2011 for the retention objective to validate electronically extracted variables. Analyses included descriptive statistics, survival analysis with Kaplan-Meier estimates for implant retention and Cochran-Armitage trend test for insertions by year during 2008-2014.RESULTS: Most adolescent SCI users were non-Hispanic White (43%), or Hispanic (34.2%) and 16 years or older (84.2%) at the time of insertion. Overall, 1-, 2- and 3-year retention rates were 78.6%, 59.4% and 26.2% respectively, with retention at 44.3% at 2 years 9 months (indicative of removal of method for near expiration of 3- year device). The insertion rate trend demonstrated statistically significant increases annually, from 0.14% in 2008 to 0.91% in 2014, p< 0.0001. No pregnancies were documented during implant use. The most common indication for SCI removal was device expiration.CONCLUSIONS: SCI insertions increased annually among adolescents, with more than a six-fold increase over the 6-year study period, and over half of the SCIs retained through 2 years of use.

View details for DOI 10.1016/j.jpag.2020.12.019

View details for PubMedID 33388444

Abstract

IMPORTANCE: Catamenial epilepsy (CE) is exacerbated by hormonal fluctuations during the menstrual cycle. Approximately 1.7 million women have epilepsy in the United States. CE affects more than 40% of women with epilepsy. There is a paucity of literature addressing this condition from a clinical standpoint, and the literature that does exist is limited to the neurological community. This article reviews the diagnosis and management of CE for the non-neurologist. Women with CE have early touch points in their care with numerous health care providers before ever consulting with a specialist, including OB/GYNs, pediatricians, emergency department physicians, and family medicine providers. In addition, women affected by CE have seizures that are more recalcitrant to traditional epilepsy treatment regimens. To optimize management in patients affected by CE, menstrual physiology must be understood, individualized hormonal contraception treatment considered, and adjustments and interactions with antiepileptic drugs addressed.OBSERVATIONS: CE is a unique subset of seizure disorders affected by menstrual fluctuations of progesterone and estrogen. The diagnosis of CE has been refined and clarified. There is an ever-increasing understanding of the importance and variety of options of hormonal contraception available to help manage CE. Furthermore, antiepileptic drugs and contraception can interact, so attention must be directed to optimizing both regimens to prevent uncontrolled seizures and pregnancy.CONCLUSION AND RELEVANCE: CE can be diagnosed with charting of menstrual cycles and seizure activity. Hormonal treatments that induce amenorrhea have been shown to reduce CE. Optimizing antiepileptic drug dosing and contraceptive methods also can minimize unplanned pregnancies in women affected by CE.

View details for DOI 10.7812/TPP/19.145

View details for PubMedID 33482944

Abstract

The current article explores some of the more complex subtopics concerning adolescents and long-acting reversible contraceptives (LARC).Recent research has highlighted ways in which LARC provision can be optimized in adolescents and has identified gaps in adolescent LARC access and utilization.Contraceptive counseling for adolescents should be patient-centered, not necessarily LARC-first, to avoid coercion. There are increasing applications for the noncontraceptive benefits of LARC for several unique patient populations and medical conditions.

View details for DOI 10.1097/GCO.0000000000000668

View details for PubMedID 33002953

Abstract

Contraception is paramount to the overall health and longevity of women. Most women in the United States use birth control in their reproductive lifetimes. All options should be available and easily accessible to permit individualization and optimization of chosen methods. Current contraceptive methods available in the United States are reviewed. Emergency contraception, contraception in the postpartum period, and strategies to tailor methods to those affected by partner violence are also addressed. Tables and flow charts help providers and patients compare various contraceptive methods, optimize the start of a method, and identify resources for addressing safety in those with underlying medical conditions.

View details for DOI 10.1016/j.ogc.2019.04.002

View details for PubMedID 31378285

Abstract

In North America, 30% of children are overweight or obese. Child obesity is a precursor to adult health risks. Diagnosis of childhood obesity is difficult. The best measurement is BMI percentile charts. Obesity in children and adolescents can be treated by diet and activity changes. Family involvement in healthy lifestyle changes is best for weight loss and prevention.

View details for DOI 10.1016/j.bpobgyn.2017.06.003

View details for PubMedID 28838829

View details for DOI 10.1016/j.jpag.2016.10.009

View details for PubMedID 27989918

Abstract

Long-acting reversible contraceptive methods are the most effective reversible contraceptives and have an excellent safety record. Although uncommon, possible long-acting reversible contraceptive complications should be included in the informed consent process. Obstetrician-gynecologists and other gynecologic care providers should understand the diagnosis and management of common clinical challenges. The American College of Obstetricians and Gynecologists recommends the algorithms included in this document for management of the most common clinical challenges.

View details for DOI 10.1097/AOG.0000000000001644

View details for PubMedID 27548557

Abstract

Although adnexal masses and ovarian torsion are common causes of acute pain in the female adolescent, fibroids are an uncommon etiology and little is reported in the literature. Because of the rarity of adolescent leiomyomas, the best surgical management is still unknown.To our knowledge, this is the first case report of a laparoscopic myomectomy in the adolescent population. The removed fibroid is one of the largest documented cases of uterine leiomyoma in adolescents.Degenerative fibroids, albeit less common, should be kept on the differential diagnosis, as a possible cause of pelvic mass and pain in the adolescent population. Fibroids in the adolescent patient, like the adult, can be managed with minimally invasive surgery with excellent clinical outcomes.

View details for DOI 10.1016/j.jpag.2016.05.007

View details for PubMedID 27262836

Abstract

Obstetrician-gynecologists are responsible for promoting healthy eating and physical activity in adolescents during annual screening examinations. Adolescents with a body mass index for age greater than or equal to the 95th percentile should undergo an in-depth health assessment to determine psychosocial morbidity and risk of cardiovascular disease. Further research is needed to determine the most efficacious approach to the prevention and treatment of obesity in adolescents. For now, it is best to extrapolate an approach from data pertaining to children and adults, while being cognizant of the special psychosocial and physical needs of adolescents.

View details for DOI 10.1097/GRF.0b013e31816d2282

View details for PubMedID 18463456