1- Women's Health Flashcards
What are the signs and symptoms of vulvovaginal candidiasis (VVC)?
-discharge: thick, white
-odor: no odor
-normal vaginal pH
-not sexually transmitted
-caused by candida
What other common vaginal infection must be referred and are not suitable for self-care?
bacterial vaginosis(BV) and trichomoniasis
What are the risk factors of VVC?
-pregnancy
-diabetes
-antibiotic use
-immunosuppressive agent
-HIV infection
-receptive oral sex
-vaginal sponge use
-use of combined oral contraceptives (COCs) and estrogen effect vaginal pH
What are the exclusions for self-care for VVC?
-age <12 years old
-pregnancy
-fever or pain in pelvic area/lower abdomen/back/shoulders
-use of corticosteroids, antineoplastics
-uncontrolled diabetes or HIV infection
-recurrent VVC (> 3 infections per year or 1 infection in the past 2 months
-first VVC episode
What are the goals of treatment?
-relief of symptoms
-eradication of infection
-reestablishment of normal vaginal flora
What are non-pharmacological treatment for VVC?
eating yogurt-containing live cultures and if possible, discontinue medication that may increase risk
What is the preferred pharmacological treatment for VVC?
intravaginal imidazole
What is the MOA of imidazole?
alter fungal cell membrane permeability
What are the strengths and duration of therapy of clotrimazole?
-1% cream: 1 applicatorful intravaginally at bedtime x7 days
-2% cream: 1 applicatorful intravaginally at bedtime x3 days
What products can be found in 1 day preperations?
-miconazole 1200 mg vaginal suppository
-tioconazole 6.5% ointment
What is the preferred duration of therapy recommended by the CDC?
for most patients short course therapy is preferred (1 or 3 days)
What are the side effects of imidazoles?
BURNING
When should patients seek medical attention for VVC?
if symptoms:
-continue beyond 1 week after treatment
-reoccur within 2 months
-symptoms occur more than 3x in 12 months
What should patients avoid while using imidazole treatment?
-douching
-tampons
-intercourse (may weaken integrity of latex condoms)
-other vaginal preparations
What can be used to treat vaginal itching?
-imidazole creams externally
-vagisil cream(benzocaine and resorcinol or hydrocortisone)
What are complementary treatment options for VVC?
-lactobacillus (probiotics, yogurt)
-sodium bicarbonate sitz bath
-tree tea oil (for resistant infections)
-gentian violet (for resistant candida infection)
-boric acid (for non-candida)
What is dysmenorrhea?
painful menstrations
What is the difference between primary and secondary dysmenorrhea?
-primary = pain at the time of menstruation
-secondary = typically associated with pelvic pathology
What are the exclusions for self-care for dysmenorrhea?
-severe dysmenorrhea and/or heavy bleeding
-symptoms inconsistent with primary dysmenorrhea (pain at other times than menses)
-history of pelvic inflammatory disease, infertility, irregular menstrual cycles, endometriosis, ovarian cysts
-use of IUD
-use of warfarin, heparin, lithium
-active GI disease
-bleeding disorder
What are the goals of treatment for dysmenorrhea?
-resolve/improve symptoms
-minimize disruption of usual activities
What are the non-pharmacological treatment options for dysmenorrhea?
-heat therapy
-sleep
-exercise
-smoking cessation
What is the preferred pharmacological treatment for dysmenorrhea?
NSAIDs (ibuprofen or naproxen)
What is the recommended dosage of NSAIDs for dysmenorrhea?
start at onset of menses or 1-2 days prior- SCHEDULED doses for first 48-72 hours of menses
-ibuprofen= 200-400 mg q4-6h (max= 1200mg/day)
-naproxen= 220-440 mg initially, then 220mg q8-12h
What are some dietary supplements and complementary therapy that can treat dysmenorrhea?
fish oil (diet or supplements) and vitamin D (600 IU/day) have the most robust evidence
Transcutaneous electrical nerve stimulation (TENS)
What are counseling points for dysmenorrhea?
- avoid aspirin in children/ adolescents
- avoid high dose aspirin in breast feeding women
- educated on dysmenorrhea
- not all patients respond to INITIAL treatment
- excessive blood loss needs evaluated
Define: Premenstrual Syndrome (PMS)
One physical or mood symptom during 5 days prior to menses, resolves around day 5 of cycle
What are “typical” premenstrual symptoms?
Mild physical or mood changes before menses that do not interfere with normal life functions
-breast tenderness
-bloating
-backache
-irritability
Define: Premenstrual Dysphoric Disorder (PMDD)
Five or more symptoms (physical/mood) during last week of cycle. One symptom will be depression, anxiety, affective lability, or anger. Interferes with work, school, social activities, relationships.
What are the exclusions for self-care for PMS or PMDD?
-severe symptoms
-uncertain pattern of symptoms
-onset of symptoms coincident with use of oral contraception or MHT
-contraindications to dietary supplements
What are the treatment goals for PMS?
-increase understanding premenstrual disorders
-improve or resolve symptoms (50%+ improvement)
What are the non-pharmacological treatment options for PMS?
-aerobic exercise
-complex carbohydrates
-cognitive behavioral therapy
-limit sodium
-avoid caffeine
-avoid alcohol
What are pharmacological treatment options for PMS?
-pyridoxine
-calcium and vitamin D
-magnesium
-vitamin E
-NSAIDs
-diuretics
What are patient counseling points for PMS?
-PMS does not occur after menopause
-avoid herbal products in breast feeding patients
-encourage tracking of symptoms and cycle
- begin management 7-14 days before menses
-it may take several cycles to see improvement
-monitor impact on daily life
What contraceptive barrier methods prevent pregnancy AND STI
Male/Female condom
What contraceptive barriers methods only prevent pregnancy?
Spermicide, sponge
Review Male Condoms
What are patient counseling points for female condom?
-breakage rate is lower than male condom but slippage may be higherDO NOT USE WITH MALE CONDOM
-may be inserted 2 hours before intercourse
-works immediately
What are patient counseling points for spermicide?
-nonoxynol-9, found in foams, gels, suppositories, film, sponge
-immediate onset of action (except suppositories and film= 10-15 mins)
-duration of action= 1 hour
-must be reapplied after every episode of sexual intercourse
-low effectiveness when used alone
What are patient counseling points for vaginal sponge?
-sponge with nonoxynol-9 (spermicide)
-may fit poorly in women with previous vaginal births
- may insert 24 hours before intercourse
-must remain in place for SIX HOURS AFTER intercourse
-do not use during menses
What are patient counseling point for a diaphragm?
-prescription only
-use spermicide
-most require a fitting by a clinician
-reusable
-insert up to 2 hours before intercourse
-MUST LEAVE INSERTED FOR AT LEAST 6 HOURS AFTER INTERCOURSE
What are patient counseling points of Cervical Caps?
-prescription only
-reusable for 1 year
-may be used up to 48 hours
-use with spermicide
-may be inserted 6 hours prior to intercourse
-must keep in place for 6 HOURS after intercourse
Describe the Calendar Method
uses the menstrual cycle length to calculate fertile window, takes 6-12 cycles to predict range, best for cycles 26-32 days
Describe the cervical mucus methods
detect changes in cervical mucus, cervical mucus becomes more prevalent, clear, “stretchy” and disappears with ovulation and thick or absent mucus will appear when ovulation is over
Describe Basal Body Temperature (BBT) monitoring
-charting body temperature upon waking, before getting out of bed
-BBT drops 12-24 hours before ovulation, then rises by at least 0.4F at time of ovulation
-app= Natural Cycles
