Paula Hillard

• MD
• Professor at Stanford University

Objectives To establish the frequency of torsion with multiple twists of the adnexa in girls 19 years old and younger surgically diagnosed with torsion. Study Design A retrospective chart review using an institutional tool to review charts of female patients 19 years old or younger who presented with acute abdominal pain leading to a surgical diagn...

Dimensions of human mood, behaviour and vital signs cycle over multiple timescales. However, it remains unclear which dimensions are most cyclical, and how daily, weekly, seasonal and menstrual cycles compare in magnitude. The menstrual cycle remains particularly understudied because, not being synchronized across the population, it will be average...

Polycystic Ovary Syndrome (PCOS) is the most common endocrine condition in reproductive age women, present in 8–13% of adult women. The prevalence in adolescents is not well established, but the signs and symptoms typically begin during adolescence. The diagnostic criteria for PCOS in adolescents include otherwise unexplained anovulation manifested...

For most women of reproductive age, assessing menstrual health and fertility typically involves regular visits to a gynecologist or another clinician. While these evaluations provide critical information on an individual’s reproductive health status, they typically rely on memory-based self-reports, and the results are rarely, if ever, assessed at...

Purpose of review: As politics continue to shape contraception and abortion care, providers have a responsibility to address the specific needs of the adolescent patient. Here we review the current literature on contraception and abortion in adolescents. Recent findings: Shared decision-making among patients, parents, and providers is the corner...

Female mood, behavior, and vital signs exhibit cycles which fundamentally affect health and happiness. However, it is unclear which dimensions of mood, behavior, and vital signs vary cyclically, how cycles at different timescales compare in magnitude, and how cycles vary across countries. Here we separate female mood, behavior, and vital signs into...

The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists have endorsed intrauterine devices as first-line contraceptive choices for nulliparous and parous adolescents. Practical concerns about intrauterine devices might be barriers to use for teens and clinicians; this review is devoted to “practical tips” for...

For most women of reproductive age, assessing menstrual health and fertility usually involves regular visits to a gynecologist or another clinician. While these exams provide critical information on an individual's reproductive health status, they typically rely on personal memory, and the results are rarely, if ever, assessed at the population lev...

Background: The differential diagnosis for pediatric prepubertal vaginal bleeding is wide. Rare etiologies include vascular malformations and tumors, such as infantile hemangiomas (IH), which validate the usefulness of exam under anesthesia, vaginoscopy, and tissue diagnosis. Case: We report a case of an infantile hemangioma in a 6 year-old girl...

Adolescent females frequently present to the ED with complaints that may be caused by a gynecologic emergency. Differentiating and excluding some of the common and most serious gynecologic emergencies reviewed in this article are critical. Timely and effective treatment of these conditions, once diagnosed, can result in better health outcomes.

Objective: To make scientifically sound and practical recommendations for daily sleep duration across the life span. Methods: The National Sleep Foundation convened a multidisciplinary expert panel (Panel) with broad representation from leading stakeholder organizations. The Panel evaluated the latest scientific evidence and participated in a fo...

There are a series of endocrine disorders that can affect adolescents, some of which are related to growth and development and others that can occur at any age but may have specific implication for the adolescent age group. This issue provides a comprehensive update of endocrine issues seen in adolescents, with a focus on recent advances in diagnos...

Because 83% of adolescent pregnancies among teens 15 to 19 years old are unintended and because adolescents with chronic medical conditions are as likely to be sexually involved as are healthy teens, preventing unintended pregnancies among teens with chronic endocrine conditions, including diabetes mellitus (both types 1 and 2), PCOS, and thyroid d...

Background Primary ovarian insufficiency (POI) is characterized by 4 to 6 months of amenorrhea and elevated serum FSH and LH in females less than 40 years. Ovarian insufficiency is uncommon in pediatrics and typically results from a chromosomal abnormality or treatment for malignancy. Idiopathic POI in which no apparent precipitant is identified is...

Objective: The objective was to conduct a scientifically rigorous update to the National Sleep Foundation's sleep duration recommendations. Methods: The National Sleep Foundation convened an 18-member multidisciplinary expert panel, representing 12 stakeholder organizations, to evaluate scientific literature concerning sleep duration recommendat...

The menstrual cycle has been recognized as a vital sign that gives information about the overall health of an adolescent or young adult female. Significant deviations from monthly cycles can signal disease or dysfunction. This review highlights the evidence based parameters for normal puberty, menarche, cyclicity, and amount of bleeding. The review...

Medical students experience significant stress and have high rates of depression and anxiety. Medical schools should have systems in place to identify these students and should have adequate resources available to support these students in obtaining professional assistance. One approach in promoting medical student Wellness is to train faculty who...

Purpose of review: The purpose of this review is to highlight the recent literature and emerging data describing clinical situations in which menstrual suppression may improve symptoms and quality of life for adolescents. A variety of conditions occurring frequently in adolescents and young adults, including heavy menstrual bleeding, and dysmenorr...

Menstrual suppression to provide relief of menstrual-related symptoms or to manage medical conditions associated with menstrual morbidity or menstrual exacerbation has been used clinically since the development of steroid hormonal therapies. Options range from the extended or continuous use of combined hormonal oral contraceptives, to the use of co...

Background: Serum markers are used before pelvic imaging to improve specificity and positive predictive value (PPV) of ovarian cancer multimodal screening strategies. Methods: We conducted a randomized controlled pilot trial to estimate surgical PPV of a "2 of 3 tests positive" screening rule, and to compare use of HE4 as a first-line (Arm 1) ve...

The gynecologic examination allows an assessment of common medical concerns that present to a primary clinician. These concerns include questions about pubertal growth, menstrual disorders (periods that are too frequent, too infrequent, too heavy, or painful), pelvic and abdominal pain, vulvar rashes and itching, vaginal discharge, contraception, a...

The structure of an initial outpatient office visit with an adolescent who presents for clinical care may vary, depending on whether the visit is with a primary clinician to establish ongoing primary care, or for a consultation regarding a specific problem with a gynecologist or specialist in adolescent medicine. This chapter will describe one mode...

In 2010, the National Physicians Alliance (NPA) with the support of the American Board of Internal Medicine Foundation convened the Good Stewardship Working Group, consisting of a representative sample of practicing primary care physicians selected from a variety of practice settings as well as geographic locations around the United States. Their g...

The American Congress of Obstetricians and Gynecologists (ACOG) has endorsed intrauterine devices (IUDs) as first-line contraceptive choices for both nulliparous and parous adolescents. The committee opinion did address some of the practical elements of IUD use in adolescents, but because these practical concerns may be barriers to use for both tee...

The levonorgestrel intrauterine system (LNG-IUS) is an underused contraceptive method in adolescent populations. In addition to being a highly effective, reversible, long-acting contraception, the LNG-IUS has many noncontraceptive health benefits including reduced menstrual bleeding, decreased dysmenorrhea and pelvic pain related to endometriosis,...

Study objective: Although men may influence women's reproductive choices, little is known about men's knowledge regarding gynecologic matters (eg, sex, anatomy, and contraception). This study aimed to evaluate the level of gynecologic knowledge among college students, particularly to investigate the differences in knowledge between men and women....

Background: Patients with müllerian agenesis may be at an increased risk of ovarian torsion due to the absence of the utero-ovarian ligament and the fact that the ovary is not tethered to a fixed and relatively non-mobile structure, the uterus. Case: We report a case of a 14-year-old female with abdominal pain who had a physical examination sugg...

We examined California pediatric residents' knowledge, practices, and comfort of providing expedited partner therapy (EPT) for sexually transmitted infections, by postgraduate year of training and presence of an adolescent medicine fellowship. We hypothesized that few residents are aware of EPT, and fewer are comfortable providing it; knowledge, pr...

To describe the experiences of 21 girls with developmental delay accompanied by multiple other medical problems, seen over a 3-year interval, who underwent insertion of the levonorgestrel intrauterine system (LNG-IUS) for menstrual suppression. Retrospective chart review. A referral pediatric and adolescent gynecology clinic within a tertiary care...

Receiving the diagnosis of Primary Ovarian Insufficiency (POI) can be emotionally difficult and confusing for young girls and their families. Parents need assistance in knowing how to help their daughters understand and live with the diagnosis in a way that allows for healthy growth and development. This paper provides a starting point for parents...

Most pregnancies in adolescents are unintended and preventable if contraception were utilized. IUDs provide an under-utilized highly effective form of contraception. IUDs are appropriate for nulliparous women, including adolescents. IUDs do not increase: the incidence of Pelvic Inflammatory Disease after the 1st month of insertion, the odds of infe...

Alkaline batteries are known to cause caustic burns to the esophagus when ingested. We report a case of alkaline burns to the vagina. A 13-year-old female presented to the Emergency Department with abdominal pain. She was admitted for necrotic vaginal burns after batteries were removed from her vagina. Examination under anesthesia revealed multiple...