43: Nonhormonal and Preventative Health Flashcards
Reproductive Tract overview
Menstrual Cycle phases
-follicular (menses -> ovulation)
-luteal (ovulation –> menses)
Follicular phase
-menses to ovulation
luteal phase
ovulation to menses
ovulation mech
-drop in estrogen
-LH surge
-release of matured follicle
Preventative Health
-annual exam (vital, breast, pelvic screening)
breast exam for avg risk women
-self/clinical exam
-mammogram (start at 40-50 until 75 every 1-2 years)
breast exam for HIGH risk women
-BRCA1/2 mutations
-breast MRI and mammogram ANNUALLY (start at age 30)
Pelvic Exam screens for
-STI
-gyno cancers
-pelvic inflammatory disease
-ovarian cysts, polyps, fibroids
Pelvic exam components
-assess external genitalia
-internal speculum exam or recto vaginal exam
Pelvic exam recommendations
-not really for asymptomatic patients
-performed when indicated by medical history or symptoms
Cervical Screening (PAP smear)
-swab inserted into vagina to collect cells
Cervical Screening recommendations
What groups don’t really need cervical screening?
-under 21 years
-over 65 years w normal prior screenings
-hysterectomy w cervix removal
Cervical Screening recommendations age 21-29
-Pap smear every 3 years
Cervical screening recommendations for 30-65 years
-choose one:
-pap every 3 years
-HPV test every 3 years
-PAP and HPV every 5 years
big takeaway of cervical screenings
-age 21-29 start
-every 3 years
most common STI in US
-HPV
HPV (human papillomavirus)
->150 viruses
-42.5% of adults 18-59
-warts (papilloma) but also asymptomatic
HPV genital warts may lead to
-inc risk of multiple cancers
HPV transmission
-skin-to-skin contaact
-vaginal, anal, oral sex
HPV-associated cancers in women
-Cervix (most)
-Vagina
-Vulva
-Anus (most)
-Oropharynx
HPV-associated cancers in men
-penis
-anus (most)
-oropharynx
HPV prevention
-barrier protection
-mutual monogamy
-male circumcision
-HPV screening
-vax
HPV screening for pts w cervix
-follow recommended cervical screening guidelines
HPV screening for pts w penis
-no recommended routine screening
-high risk pt may benefit from anal PAP smear
patients w penis at higher risk of HPV include
-men who have sex w men
-HIV+ men
HPV vax
-Gardasil 9
-Cervarix and Gardasil discontinued
Gardasil 9 indication
-HPV vax against 9 strains
-males and females age 9-45
-recommended to start. 9-11 years old
Gardasil 9 admin schedule
-if UNDER 15: 2 doses
-if OVER 15: 3 doses
Gardasil 9 admin in <15yo
-2 doses
-0 months
-6-12 months
Gardasil 9 admin in >15yo
-3 doses
-0 month
-2 month
-6 month
Gardasil 9 vax efficacy in ages 19-26
-98-100% prevention of HPV-cancers in females
~75% in males
Gardasil 9 vax efficacy in ages 27-45
-88-95%
-slightly less effective
-provides less benefit after exposure!
Gardasil 9 side effects
-injection site reactions
-dizzy/fatigue
-headache
-syncope
-vomitting
-myalgia
Patient Case:
-19 y/o F
-only received one dose of Gardasil at age 16
How many additional doses should she receive to complete series
-2 more doses
-3 dose series bc she started after age 15
Role of provider
-educate about HPV risk
-give recs
-utilize standing orders
-process and monitor for follow up
Non-hormonal contraception
-
Stats of contraception
-65% of women aged 15-49 are on contraception
Reasons for non-hormonal contraception
-back up hormonal method
-side effects/contraindications
-no need for ongoing contraceptives
-no alteration to body’s natural cycle
Behavioral Contraceptive methods
-Coitus interuptus (withdrawal)
-Lactation Amenorrhea Method (LAM)
-Fertility Awareness Methods (FAM)
-Natural Family Planning (NFP)
FAM + NFP methods
-Basal Body Temp (BBT)
-Billings Ovulation Method
-Calander/Rhythym method
-standard days method
-two-day method
Basal Body Temp (BBT)
-predict ovulation
-regular cycles
-take temp every morning
-record in chart
BBT change that signifies ovulation
-slight drop in temp followed by large inc in temp (1 degree)
Billing Ovulation method
-monitor cervical mucus
-clearer,thinner mucus is fertile
-irregular cycles
cervical mucus during fertility
-clearer
-thinner
Calander/rhythym method
-based on past cycles
-Fertile days = shortest cycle -18 days and longest cycle - 11 days
Standard days method
-26-32 day cycle
-move rubber band around colored beads like a calander
2-day method
-cervical secretions
-pregnancy UNLIKELY if no secretions for 2 days
FAM + NFP monitoring
-sympothermal
-electronic (detect LH)
-marquette
Natural Cycles App
-first app approved by FDA for contraception
-based on BBT and cycle data
-App will prompt use to use protection on fertility days
-1-7% failure rate
Advantages to FAM and NFP
-no effect on hormones/cycle
-no side effects
-inexpensive/free
-culturally acceptable
Disadvantages to FAM +NFP
-no STI protection
-hard for irregular cycles
-consistent montioring
-requires abstinence/back up contraception
Barrier methods
-prevent sperm from entering uterus
-fewer side effects but less efficacy
Barrier devices
-condoms
-vaginal sponge
-diaphragm
-cervical cap
-gel/spermicide
Long-term non-hormonal birth control
-Copper IUD
-sterilization
Copper IUD
-up to 10 years
-can be used as emergency
-inserted and removed by HCP
-copper is spermicide
-no STI prevention
IUD side effects
-heavy bleeding
-spotting
Sterilization
-male vasectomy
-tubal ligation
Contraception efficacy
- implant, IUD, sterilization
- injection, pill, patch, ring, diaphragm
- condom, sponge
- FAM and spermicide
pt case
wants to try effective non-hormonal but wants children later
-copper IUD
