Appendix 3. reVITALize Gynecology Data Definitions (Version 1.0)

TERM DEFINITION NOTES

ADOLESCENT AND BENIGN GYNECOLOGY DEFINITIONS Rotation of the ovary and/or that ADNEXAL TORSION results in partial or complete vascular occlusion. A non-infectious condition associated with For classic vaginal or hypoestrogenic states, including prepubertal and genitourinary symptoms postmenopausal. Patients may present with signs associated with menopause, ATROPHIC or symptoms such as: tissue changes, itching, the term genitourinary burning, irritation, discharge, dryness, or syndrome of menopause is inflammation. preferred. A condition where the normal balance of bacteria A diagnosis may be in the is disrupted and replaced by an confirmed through overgrowth of certain bacteria. It is sometimes laboratory testing or clinical accompanied by discharge, fishy odor, pain, itching criteria. and/or burning. Childhood Asymmetric Labia Majus Enlargement is a common normal anatomic variant of the vulva CALME typically presenting without pain that mimics a neoplasm A fungal infection caused by a symptomatic CANDIDA VAGINITIS/ overgrowth of Candida species. It may be

VULVOVAGINITIS characterized by vaginal or vulvar itching, burning, irritation, erythema or thick, white discharge. Normally occurring fluid filled sac originating from Some functional cysts may FUNCTIONAL OVARIAN ovarian follicles and created by cyclic ovarian become symptomatic and CYST function. This is not a neoplasm and results from chronic and may require the accumulation of intrafollicular fluid. treatment or intervention. An organ (i.e. normally a testis or ovary) that may GONAD produce gametes. 1. May require surgical intervention to relieve A congenital anomaly of a partially developed obstruction. HEMIVAGINA vagina that typically presents without outflow tract 2. Does not include obstruction. transverse vaginal septum. 3. Frequently occurs with renal anomalies.

Sharp HT, Johnson JV, Lemieux LA, Currigan SM. Executive summary of the reVITALize initiative: standardizing gynecologic data definitions. Obstet Gynecol 2017;129.

The authors provided this information as a supplement to their article.

©2017 American College of Obstetricians and Gynecologists. Page 1 of 13 An inflammatory disorder of the genital mucosa. The classic presentation is that of white, reticulate, lacy, fern-like striae. In erosive lichen planus, deep LICHEN PLANUS erythematous erosions appear and often extend to the labia minora, resulting in resorption of the labial architecture. Chronic inflammatory condition, typically of the anogenital region, often characterized by pruritis, If biopsied, there is a LICHEN SCLEROSUS pigmentation changes, atrophy, and fissures that definitive histological may result in scarring and/or loss of normal appearance. architecture of the vulva. Occurs when the urogenital sinus fails to contribute LOWER VAGINAL to the inferior portion of the vagina, resulting in ATRESIA outflow tract obstruction. PELVIC An infection of the upper female genital tract INFLAMMATORY including , , , tubo- DISEASE ovarian abscess and/or pelvic peritonitis. Recurrent candida RECURRENT CANDIDA Four or more episodes of candida vaginitis/vulvovaginitis VAGINITIS/ vaginitis/vulvovaginitis in one year. should be confirmed by VULVOVAGINITIS testing. A sexually transmitted infection caused by the protozoan Trichomonas vaginalis. Patients may or TRICHOMONAS may not be symptomatic. Signs and symptoms may VAGINITIS include malodorous discharge, irritation and/or erythema. The enlargement of the vagina to address VAGINAL DILATION congenital or acquired vaginal narrowing. The use of fluid to rinse the vaginal canal of VAGINAL IRRIGATION discharge or to dislodge a foreign object. A reconstructive operation that provides an VAGINAL PULL outflow tract for the upper vagina in the presence THROUGH of lower vaginal atresia. The spectrum of conditions that cause vaginal signs VAGINITIS or symptoms, such as itching, burning, irritation, dryness, inflammation, and/or discharge. Endoscopic inspection of the vaginal cavity with VAGINOSCOPY access through the vaginal opening. The spectrum of conditions that cause vulvovaginal VULVOVAGINITIS signs or symptoms, such as itching, burning, irritation, dryness, inflammation, and/or discharge. It differs from problem- Comprehensive age- and interval- appropriate care WELL-WOMAN CARE oriented health care. to maintain and/or improve the health of a female.

Sharp HT, Johnson JV, Lemieux LA, Currigan SM. Executive summary of the reVITALize initiative: standardizing gynecologic data definitions. Obstet Gynecol 2017;129.

The authors provided this information as a supplement to their article.

©2017 American College of Obstetricians and Gynecologists. Page 2 of 13 BREAST AND CERVICAL ISSUES DEFINITIONS BREAST ISSUE DEFINITIONS A dense breast has more The relative proportion of fibroglandular tissue to BREAST DENSITY glandular and connective fat in the breast as it appears on a mammogram. tissue than fat. A range of non-specific benign changes in the ducts FIBROCYSTIC BREAST and stroma of the breasts that may result in

CHANGES palpable changes in the breast tissue and/or pain. This is also known as diffuse cystic mastopathy. Malignant lesions that originate from breast tissue. INVASIVE BREAST The most common types are invasive (or CANCERS infiltrating) ductal and lobular carcinoma. Pain in one or both breasts exclusive of MASTODYNIA/ inflammation or evidence of structural changes, MASTALGIA may be cyclic or non-cyclic. CERVICAL ISSUE DEFINITIONS

Atypical lower anogenital tract cells classified by the Bethesda System, as follows:

Squamous Cell: . ASC-US (atypical squamous cells of undetermined significance) . ASC-H (atypical squamous cells, cannot exclude 1. Replaces the term high-grade squamous intraepithelial lesion) “Abnormal Papanicolaou . LSIL (low-grade squamous intraepithelial lesion) (PAP) Test”. ABNORMAL LOWER . HSIL (high-grade squamous intraepithelial 2. This categorization does GENITAL TRACT lesion) not include any other result CYTOLOGY - With features suspicious for invasion preceded by the “negative - Squamous cell carcinoma for intraepithelial lesion or malignancy” interpretation. Glandular Cell: . AGC (atypical glandular cells, including qualifiers if listed) . Endocervical adenocarcinoma in-situ . Adenocarcinoma (including qualifiers if listed)

ATYPICAL A proliferation of endometrial glands relative to ENDOMETRIAL stroma with cytologic/nuclear atypia as classified HYPERPLASIA by the World Health Organization (1994) system. Inflammation of the cervical epithelium and stroma due to infectious or non-infectious etiologies.

Sharp HT, Johnson JV, Lemieux LA, Currigan SM. Executive summary of the reVITALize initiative: standardizing gynecologic data definitions. Obstet Gynecol 2017;129.

The authors provided this information as a supplement to their article.

©2017 American College of Obstetricians and Gynecologists. Page 3 of 13 A physiologic appearance of the when the CERVICAL This entity should not be endocervical columnar epithelium extends beyond EVERSION/ECTROPION designated as an erosion. the external os onto the ectocervix. (S) Hyperplastic projection of endocervical epithelium. A benign proliferation of endometrial glands relative to stroma. These lesions include simple and complex hyperplasia without atypia as defined by ENDOMETRIAL the World Health Organization (1994) classification HYPERPLASIA system and benign hyperplasia as defined by Endometrial Intraepithelial Neoplasia classification system. A premalignant lesion of the ENDOMETRIAL categorized according to quantitative pathologic INTRAEPITHELIAL criteria, including size of the lesion, gland-to- NEOPLASIA stroma ratio and cytology. A nonspecific finding of lesions that appear white on visual inspection of the lower genital tract prior

to the application of acetic acid. It may arise Biopsy is necessary to secondary to trauma, keratosis, human papilloma establish the exact diagnosis.

virus infection or even invasive keratinizing squamous carcinoma. HIGH-RISK HUMAN Testing biologic material for the presence of PAPILLOMAVIRUS oncogenic human papillomavirus (HPV) genomic or (HPV) TESTING proteomic products. HUMAN Detection of genomic human papillomavirus (HPV) PAPILLOMAVIRUS nucleic acids for the presence of specific HPV types, (HPV) GENOTYPING such as 16 or 16/18. Human papillomavirus (HPV) may cause transient or persistent infection of genital tract epithelium, HUMAN and can be oncogenic or non-oncogenic. Infection PAPILLOMAVIRUS can be subclinical, detected by molecular methods (HPV) INFECTION or cytology, or clinically manifested as condyloma and/or neoplasia. Abnormal proliferation of squamous intraepithelial cells categorized as low-grade or high-grade intraepithelial lesions (-IL), and applies to lesions of LOWER GENITAL TRACT the cervix, vagina, and vulva. The -IL nomenclature INTRAEPITHELIAL may be further qualified with appropriate LESION intraepithelial neoplasia (-IN) terminology, which (INTRAEPITHELIAL may also include the specific location, such as CIN 3 NEOPLASIA) (high-grade lesion of the cervix) or VaIN 3 (high- grade lesion of the vagina).

Sharp HT, Johnson JV, Lemieux LA, Currigan SM. Executive summary of the reVITALize initiative: standardizing gynecologic data definitions. Obstet Gynecol 2017;129.

The authors provided this information as a supplement to their article.

©2017 American College of Obstetricians and Gynecologists. Page 4 of 13 DEFINITIONS The absence of menstruation in women of reproductive age.

. Primary is defined as no AMENORRHEA menstruation by age 15. . Secondary amenorrhea is defined as the absence of menses for six or more months or the length of three cycles after the establishment of regular menstrual cycles. ASSISTED Treatments or procedures that include handling REPRODUCTIVE both oocytes and sperm and/or embryos for the TECHNOLOGY purpose of establishing a pregnancy. CONTROLLED OVARIAN The administration of medications to induce single

STIMULATION or multiple follicular development. Decreased ovarian responsiveness to exogenous DIMINISHED OVARIAN stimulation in women of reproductive age RESERVE compared to women of similar age. The growth of endometrial tissue in the body outside of the . Female factors may include ovulatory disturbances, diminished ovarian reserve, Infertility stemming from a female partner. pelvic abnormalities affecting the reproductive tract, or other abnormalities of the reproductive system. FERTILITY The capacity to reproduce. Therapies intended to maintain reproductive FERTILITY potential through protecting or preserving PRESERVATION gametes, zygotes, embryos, or gonadal tissue. A disease characterized by the absence of a successful pregnancy after one year of either unprotected intercourse or insemination. Diagnosis INFERTILITY may be considered in less than one year based on medical history, age, physical findings, or diagnostic testing.

INTRACYTOPLASMIC A procedure in which a single spermatozoon is

SPERM INJECTION injected into the oocyte cytoplasm.

Sharp HT, Johnson JV, Lemieux LA, Currigan SM. Executive summary of the reVITALize initiative: standardizing gynecologic data definitions. Obstet Gynecol 2017;129.

The authors provided this information as a supplement to their article.

©2017 American College of Obstetricians and Gynecologists. Page 5 of 13 Male factors include abnormal semen parameters, MALE INFERTILITY Infertility stemming from a male partner. abnormal sperm function, or inability to have coitus. OVARIAN Pathological condition characterized by ovarian HYPERSTIMULATION enlargement and ascites that may occur after SYNDROME ovarian stimulation. An indication of the number of oocytes in the OVARIAN RESERVE ovaries. OVULATION Ovarian stimulation in oligoovulatory or

INDUCTION anovulatory women. A heterogeneous endocrine condition in reproductive aged women commonly associated with ovulatory dysfunction, physical or biochemical POLYCYSTIC OVARIAN evidence of androgen excess, and an increased SYNDROME number of antral (immature) follicles in the ovaries. This diagnosis can only be made after excluding other pathologic conditions. 1. Also known as premature PRIMARY OVARIAN A condition characterized by hypergonadotropic ovarian failure. INSUFFICIENCY hypogonadism in women younger than age 40. 2. Includes women with premature menopause. UNEXPLAINED Infertility due to an unidentified cause. INFERTILITY STAGES OF DEVELOPMENT DEFINITIONS The stage of preimplantation embryo development that occurs around day 4-5 after fertilization. BLASTOCYST Contains a fluid filled cavity, an outer layer of cells (trophectoderm), and the inner cell mass. Placement of the embryo(s) in to the uterus at the BLASTOCYST TRANSFER blastocyst stage, typically on day 5-6 post oocyte retrieval, as part of in-vitro fertilization. The result of the division of the zygote up to 10 EMBRYO weeks’ gestational age (8 completed weeks after fertilization). A multi-step process that results in the formation of FERTILIZATION a zygote by the union of sperm and ovum. The result of the continued development of the FETUS embryo (beyond 8 completed weeks after fertilization) until the end of pregnancy.

A single cell resulting from fertilization of an oocyte ZYGOTE by spermatozoa.

Sharp HT, Johnson JV, Lemieux LA, Currigan SM. Executive summary of the reVITALize initiative: standardizing gynecologic data definitions. Obstet Gynecol 2017;129.

The authors provided this information as a supplement to their article.

©2017 American College of Obstetricians and Gynecologists. Page 6 of 13 PAIN AND BLEEDING ISSUES DEFINITIONS PAIN DEFINITIONS An unpleasant sensation (e.g. pain, pressure, discomfort) perceived to be related to the urinary BLADDER PAIN bladder, associated with lower urinary tract SYNDROME / symptoms, such as increased frequency or urgency INTERSTITIAL CYSTITIS of more than six weeks’ duration, in the absence of infection or other identifiable causes. Consists of pain symptoms perceived to originate from pelvic organs/structures typically lasting more Cyclical is than 6 months. It is often associated with negative considered a form of chronic CHRONIC PELVIC PAIN cognitive, behavioral, sexual and emotional pelvic pain if it has significant IN WOMEN consequences as well as with symptoms suggestive cognitive, behavioral, sexual, of lower urinary tract, sexual, bowel, , and emotional consequences myofascial, or gynecological dysfunction. Characterized by persistent or recurrent vulvar VULVAR PAIN discomfort in the absence of infectious or local SYNDROME / obvious causes (e.g., acute trauma, dermatologic conditions). A type of vulvar pain syndrome which is Previous terms have included characterized by discomfort that cannot be GENERALIZED VULVAR “dysesthetic vulvodynia” and persistently and precisely localized by point- PAIN SYNDROME “essential vulvodynia” but pressure “mapping” via probing with a cotton- are no longer recommended. tipped applicator or similar instrument. A type of vulvar pain syndrome which is Mapping can be performed LOCALIZED VULVAR characterized by discomfort that can be using a cotton-tipped PAIN SYNDROME consistently and precisely localized by point- applicator. pressure “mapping” on physical examination.

A type of localized vulvar pain syndrome CLITORAL PAIN characterized by discomfort that can be localized SYNDROME by point-pressure mapping to the .

Previous terms have included “vulvar vestibulitis”, A type of localized vulvar pain syndrome which is VULVAR VESTIBULAR “vestibulodynia”, and characterized by discomfort that is localized by PAIN SYNDROME “localized and focal ”, point-pressure “mapping” to the vulvar vestibule. but are no longer recommended.

Sharp HT, Johnson JV, Lemieux LA, Currigan SM. Executive summary of the reVITALize initiative: standardizing gynecologic data definitions. Obstet Gynecol 2017;129.

The authors provided this information as a supplement to their article.

©2017 American College of Obstetricians and Gynecologists. Page 7 of 13 BLEEDING DEFINITIONS Bleeding from the uterus which differs in frequency, regularity, duration or volume from normal uterine bleeding, in the absence of pregnancy.

ABNORMAL UTERINE AUB as a symptom should be further classified in BLEEDING (AUB) etiology as follows: PALM-COEIN: Polyp; ; Leiomyoma; Malignancy and hyperplasia; Coagulopathy; Ovulatory dysfunction; Endometrial; Iatrogenic; and Not otherwise classified. A type of abnormal uterine bleeding characterized by excessive cyclic blood loss which differs from HEAVY MENSTRUAL Replaces the term normal uterine bleeding and interferes with a BLEEDING “menorrhagia”. woman’s physical, social, emotional, and/or material quality of life. The difference between the longest and shortest cycles A type of abnormal uterine bleeding characterized over a one-year period varies by unpredictable bleeding where the longest and by age. If very short (<18 IRREGULAR UTERINE shortest interval between bleeding episodes within day) and very long (>43 day) BLEEDING a one-year timeframe typically differs by more than cycles are excluded, variation 20 days. typically is less than or equal to 7-9 days, depending on age. A type of abnormal uterine bleeding that represents the symptom of excessive uterine blood IRREGULAR AND HEAVY loss (in terms of volume or duration) which occurs Replaces the term UTERINE BLEEDING unpredictably and interferes with a woman’s “”. physical, social, emotional, and/or material quality of life. A type of abnormal uterine bleeding characterized INTERMENSTRUAL by bleeding episodes in between regular episodes BLEEDING of cyclic uterine bleeding.

Sharp HT, Johnson JV, Lemieux LA, Currigan SM. Executive summary of the reVITALize initiative: standardizing gynecologic data definitions. Obstet Gynecol 2017;129.

The authors provided this information as a supplement to their article.

©2017 American College of Obstetricians and Gynecologists. Page 8 of 13 The 20-day difference is based on a general population of women including women with very short (<18 day) and with very long cycles (>43 day). When Cyclic bleeding that occurs from the uterine corpus these women with very short between menarche and menopause. The bleeding and very long cycles are generally lasts up to 8 days and occurs every 24-38 excluded variation is age- days. The cycle should occur at regular predictable dependent and is typically intervals and the difference between the longest less. and shortest cycle over a one-year period should be

NORMAL UTERINE no more than 20 days. The resulting breakdown by BLEEDING age (between 18 to 45 years) Normal volume may be defined quantitatively as up of is depicted in the chart to 80 mL per cycle and/or qualitatively as volume below: that does not excessively interfere with a woman’s physical, social, emotional, and/or material quality Difference of life. between Age longest and shortest cycles 18-25 years ≤9 days 26-41 years ≤7 days 43-45 years ≤9 days

PREPUBERTAL VAGINAL Any prior to puberty. BLEEDING REPRODUCTIVE PLANNING DEFINITIONS A substance intended to cause termination of a ABORTIFACIENT pregnancy so that it does not result in live birth. Pregnancy loss based on low and decreasing human BIOCHEMICAL chorionic gonadotropin (hCG) levels or transient PREGNANCY LOSS hCG detection only. CONTRACEPTION Action taken to prevent pregnancy. Devices and/or medications used to prevent CONTRACEPTIVES pregnancy. A procedure that can be used after 12 weeks of DILATION AND pregnancy that includes cervical dilation followed

EVACUATION by removal of uterine contents using a combination of vacuum aspiration and instruments. Pregnancy outside of the endometrial cavity, ECTOPIC PREGNANCY diagnosed by ultrasound, surgical visualization, or histopathology.

Sharp HT, Johnson JV, Lemieux LA, Currigan SM. Executive summary of the reVITALize initiative: standardizing gynecologic data definitions. Obstet Gynecol 2017;129.

The authors provided this information as a supplement to their article.

©2017 American College of Obstetricians and Gynecologists. Page 9 of 13 EMERGENCY Contraceptives intended to be used after sexual The term “morning after pill” (POST-COITAL) intercourse or rape. is misleading. CONTRACEPTIVES Concurrent pregnancy involving at least one HETEROTOPIC pregnancy implanted in the uterus and at least one PREGNANCY implanted outside of the uterine cavity. An intervention intended to terminate a pregnancy INDUCED ABORTION so that it does not result in a live birth. LONG-ACTING Reversible contraceptives that are highly effective These methods generally REVERSIBLE for at least one year following a single include intrauterine devices CONTRACEPTIVES administration without user action. and implants. (LARC) MEDICATION INDUCED The use of medication(s) intended to terminate a

ABORTION pregnancy so that it does not result in a live birth. Loss of a documented intrauterine pregnancy.

MISCARRIAGE / Early Miscarriage: Loss of a documented INTRAUTERINE intrauterine pregnancy prior to 10 weeks’ PREGNANCY LOSS gestational age.

Conception and pregnancy are not the same. Conception is a lay term that has no A physiologic state of a woman that follows scientific validity and is not PREGNANCY implantation of a blastocyst(s). generally used in the medical literature because of its variable definition and connotation. RECURRENT EARLY 2 or more intrauterine pregnancy losses prior to 10

PREGNANCY LOSS weeks' gestational age. RECURRENT 2 or more intrauterine pregnancy losses. PREGNANCY LOSS PREGNANCY OF Positive beta human chorionic gonadotropin (hCG)

UNKNOWN LOCATION with non-visualization of pregnancy by ultrasound. RESOLVED PREGNANCY Treated or expectantly managed pregnancy of OF UNKNOWN unknown location resulting in undetectable serum LOCATION human chorionic gonadotropin (hCG).

Evacuation of the uterine contents using a vacuum Replaces the term “suction VACUUM ASPIRATION aspirator. and vacuum curettage”.

Sharp HT, Johnson JV, Lemieux LA, Currigan SM. Executive summary of the reVITALize initiative: standardizing gynecologic data definitions. Obstet Gynecol 2017;129.

The authors provided this information as a supplement to their article.

©2017 American College of Obstetricians and Gynecologists. Page 10 of 13 AND MENOPAUSE DEFINITIONS UROGYNECOLOGY DEFINITIONS URINARY FREQUENCY AND INCONTINENCE DEFINITIONS “Accidental Bowel Leakage” is Involuntary loss of feces, mucus, or flatus through an acceptable alternative term ANAL INCONTINENCE the anus. for both anal incontinence and fecal incontinence. “Accidental Bowel Leakage” is an acceptable alternative term FECAL INCONTINENCE Involuntary loss of feces or mucus. for both anal incontinence and fecal incontinence.

Number of voids (micturitions) by day (wakeful DAYTIME URINARY hours including last void before sleep and first FREQUENCY void after waking and rising).

Complaint that voiding (micturition) occurs more INCREASED DAYTIME frequently during waking hours than previously URINARY FREQUENCY deemed normal by the woman. Symptom: Complaint of involuntary loss of urine associated with urgency and also with effort or physical exertion or on sneezing or coughing. MIXED URINARY A sign is not required for this (Combination of stress urinary incontinence and INCONTINENCE definition. urgency urinary incontinence). Sign: Observation of stress urinary incontinence and urgency urinary incontinence. NOCTURIA / Number of times sleep is interrupted by the need NOCTURNAL to void (micturate). Each void is preceded and FREQUENCY followed by sleep. Urinary urgency, usually accompanied by increased daytime frequency and nocturia, with OVERACTIVE BLADDER or without urgency urinary incontinence, in the SYNDROME absence of urinary tract infection (UTI) or other obvious pathology. Symptom: Complaint of involuntary loss of urine on effort or physical exertion, or on sneezing or coughing. N.B.: ‘‘activity related incontinence’’ STRESS URINARY might be preferred in some languages to avoid A sign is not required for this INCONTINENCE confusion with psychological stress. definition. Sign: Observation of involuntary leakage from the urethra synchronous with effort or physical exertion, or on sneezing or coughing. TWENTY-FOUR HOUR Total number of daytime voids and episodes of

URINARY FREQUENCY nocturia during a specified 24-hr period.

Sharp HT, Johnson JV, Lemieux LA, Currigan SM. Executive summary of the reVITALize initiative: standardizing gynecologic data definitions. Obstet Gynecol 2017;129.

The authors provided this information as a supplement to their article.

©2017 American College of Obstetricians and Gynecologists. Page 11 of 13

The number of voids (micturitions) over a defined URINARY FREQUENCY period of time.

Symptom: complaint of involuntary loss of urine. URINARY Sign: Observation of involuntary leakage on A sign is not required for this INCONTINENCE examination: this may be urethral or definition. extraurethral. Sudden, compelling desire to void (micturate) URINARY URGENCY which is difficult to defer. Symptom: complaint of involuntary loss of urine accompanied by or immediately preceded by urinary urgency URGENCY URINARY A sign is not required for this Sign: observation of involuntary leakage from the INCONTINENCE definition. urethra synchronous with the sensation of a sudden, compelling desire to void that is difficult to defer. PROLAPSE DEFINITIONS Most commonly involves ANTERIOR VAGINAL bladder descent () and WALL PROLAPSE Descent of the anterior vaginal wall. often includes apical vaginal (CYSTOCELE) descent. The presence of any such sign The descent of one or more pelvic structures: the should be correlated with cervix, uterus, vaginal apex, anterior vaginal wall relevant PELVIC ORGAN (usually with bladder, cystocele), posterior symptoms. More commonly, PROLAPSE vaginal wall (usually with rectum, ), or this correlation would occur at peritoneum of the cul-de-sac (usually with small the level of the hymen or intestine, enterocele). beyond.

Most commonly this involves POSTERIOR VAGINAL rectal protrusion into the WALL PROLAPSE Descent of the posterior vaginal wall. vagina (rectocele) and may (RECTOCELE) include apical vaginal descent.

UTERINE/CERVICAL Descent of the uterus or cervix. PROLAPSE

Descent of the vaginal apex (i.e. vaginal cuff) VAGINAL VAULT after a total hysterectomy. PROLAPSE

Sharp HT, Johnson JV, Lemieux LA, Currigan SM. Executive summary of the reVITALize initiative: standardizing gynecologic data definitions. Obstet Gynecol 2017;129.

The authors provided this information as a supplement to their article.

©2017 American College of Obstetricians and Gynecologists. Page 12 of 13 MENOPAUSE DEFINITIONS A collection of symptoms and signs associated with decreased estrogen and other sex steroids that can involve changes to labia majora/minora, vestibule/introitus, clitoris, vagina, urethra, and GENITOURINARY Symptomatic vulvovaginal bladder. Symptoms include, but are not limited SYNDROME OF atrophy is included within this to, dryness, pain with sex that may lead to MENOPAUSE definition. subsequent , bladder and urethral symptoms, frequent urinary tract infections, burning, itching, and irritation that are bothersome or distressing. For some women menstrual bleeding criteria cannot be The final menstrual period resulting from the used to define menopause and physiologic permanent decline in gonadal the diagnosis can be supported MENOPAUSE hormone levels confirmed by 12 months of with criteria including amenorrhea in women with a uterus. symptoms and/or serial measurement of endocrine markers. A time span that begins with the onset of inter- menstrual cycle irregularities (+/- 7 days) and/or PERIMENOPAUSE other menopause-related symptoms and extends through menopause (the final menstrual period) to 1 year after menopause. PREMATURE Menopause before age 40. MENOPAUSE POSTMENOPAUSAL Bleeding from female genital organs 12 or more

BLEEDING months after the final menstrual period.

POSTMENOPAUSE The time span after menopause.

Flushing with or without sweating resulting from VASOMOTOR vasodilation of blood vessels primarily affecting SYMPTOMS head, neck, and upper torso. “Symptomatic Vulvovaginal Tissue changes in the vulva or vagina typically VULVOVAGINAL Atrophy” is included in the associated with low estrogen levels that may or ATROPHY definition of “Genitourinary may not be symptomatic. Syndrome of Menopause”.

Sharp HT, Johnson JV, Lemieux LA, Currigan SM. Executive summary of the reVITALize initiative: standardizing gynecologic data definitions. Obstet Gynecol 2017;129.

The authors provided this information as a supplement to their article.

©2017 American College of Obstetricians and Gynecologists. Page 13 of 13