Oral Contraceptives During Breastfeeding, Hyperprolactinemia, Tonsillectomy, Anal Cancer, Postinflammatory Hyperpigmentation
Am Fam Physician. 2023;107(5):461
What is the preferred oral contraceptive during breastfeeding?
Progestin-only contraceptives are preferred to combination oral contraceptives during breastfeeding. The estrogen in oral contraceptives does not affect the composition of breast milk or infant growth and development but may decrease milk production. Combination oral contraceptives should be avoided for at least three weeks postpartum because of the increased thrombotic risk.
What is the preferred treatment for hyperprolactinemia due to a prolactinoma?
Dopamine agonists are first-line therapy for hyperprolactinemia. Cabergoline is preferred because it has been shown to more effectively lower prolactin levels and decrease tumor size. Dopamine agonist therapy should be continued for at least two years, after which tapered discontinuation may be attempted if prolactin levels have normalized and tumor size is significantly reduced.
When should tonsillectomy be considered for those with recurrent tonsillitis?
Watchful waiting is typically preferred over tonsillectomy for recurrent tonsillitis if there have been less than seven episodes in the past year, less than five episodes per year in the past two years, or less than three episodes per year in the past three years.
Does early treatment of screen-detected anal high-grade squamous intraepithelial lesions in patients with HIV reduce risk of progression to invasive anal cancer?
In a large randomized controlled trial, immediate treatment of screen-detected anal high-grade squamous intraepithelial lesions reduced the likelihood of progression to invasive anal cancer compared with active surveillance (number needed to treat = 111 over 26 months). The study was not powered to detect a reduction in mortality.
What is the preferred initial treatment for postinflammatory hyperpigmentation?
First-line topical therapies for postinflammatory hyperpigmentation include hydroquinone 4% and triple combination therapy with fluocinolone 0.01%/hydroquinone 4%/tretinoin 0.05% (Tri-Luma). This triple combination therapy is more effective but more costly than hydroquinone alone.
Additional Online Only AFP Clinical Answers
Is pharmacotherapy effective for reducing symptoms of posttraumatic stress disorder in adults?
Selective serotonin reuptake inhibitors improve symptoms of posttraumatic stress disorder and are considered first-line pharmacologic agents, based on consistent, good-quality, patient-oriented evidence. Mirtazapine and amitriptyline also improve posttraumatic stress disorder symptoms, based on inconsistent or limited-quality, patient-oriented evidence.
What are effective strategies for reducing emergency department use and hospitalizations in people experiencing homelessness?
Housing First initiatives reduce emergency department use and hospitalizations. Over the past decade, emphasis has been placed on Housing First initiatives, which aim to expedite placement of people experiencing homelessness into permanent housing vs. Housing Ready programs, which first require individuals to be in mental health or substance use treatment programs. The American Academy of Family Physicians supports Housing First programs and encourages physicians to be involved in the health care of people experiencing homelessness.
What initial pharmacotherapy can be considered for patients with temporomandibular joint disorders?
Naproxen should be recommended for initial pharmacotherapy of temporomandibular disorders. The addition of cyclobenzaprine is recommended if there is clinical evidence of muscle spasm.
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