Women's Health

The NP integrates advanced pathophysiological knowledge of common gynecological conditions to guide diagnosis and management. Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-age women (6-12% prevalence), diagnosed using the Rotterdam criteria requiring 2 of 3: oligo/anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound (12+ follicles per ovary or ovarian volume greater than 10 mL). The pathophysiology involves hypothalamic GnRH pulse frequency dysregulation leading to increased LH:FSH ratio (typically greater than 2:1), which stimulates theca cell androgen production while insufficient FSH prevents follicular maturation, causing anovulation and cyst formation. Insulin resistance occurs in 50-70% of PCOS patients independent of BMI, amplifying ovarian androgen production through direct stimulation of theca cells and reduction of hepatic sex hormone-binding globulin (SHBG), increasing free testosterone. Endometriosis is characterized by the presence of endometrial-like tissue outside the uterus, most commonly on the ovaries, fallopian tubes, uterosacral ligaments, and pelvic peritoneum. Retrograde menstruation (Sampson theory) is the most accepted etiology: menstrual endometrial fragments reflux through the fallopian tubes and implant on pelvic structures, where they respond to cyclic hormonal stimulation,...