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Women's Health > AUB > Flashcards

AUB Flashcards

1
Q

Which hysterectomy route is least invasive and ends with a vaginal cuff?

A

Transvaginal Hysterectomy

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2
Q

1 & #2 MC contraceptive used in women 15-49

A

1 Female Sterilization

#2 Combination Oral Contraceptives (COCs)

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3
Q

Before starting a woman with unexplained AUB on contraceptives, you must ____

A

do a complete WU bc contraceptives can mask/alter symptoms

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4
Q

Pt with irregular periods wants to go off of hormonal birth control and try the rhythm method aka Natural Family Planning. Wdyd?

A

Explain that cycles must be regular with persistent charting and to not have sex during her fertile window

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5
Q

What does your mucus look like when you’re ovulating? When do you know its safe to have sex?

A

wet & clear or thick egg white mucus = ovulating. Safe to have 4 days after this MAX MUCOUS (after ovulation), when the mucous becomes dry and sticky again

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6
Q

When is it safe to have sex based on measuring your basal body temperature?

A

Have sex 3 days after your temp rises

temp rises just AFTER ovulation with rise of progesterone (0.5-1.0F)

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7
Q

What hormone is responsible for raising your basal body temp right after ovulation?

A

progesterone

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8
Q

Lactational amenorrhea can only be used reliably for ____ mo after birth

A

6

must breast feed q 4-6 hrs
No menses

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9
Q

How does breastfeeding stop your period?

A

Breastfeeding increases Prolactin -> Decr GnRH -> Decr FSH/LH -> Anovulation -> Amenorrhea

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10
Q

Do male or female condoms have a higher failure rate?

A

female

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11
Q

diaphragm, cervical cap, and cervical sponges must be kept in place ____ hours after intercourse

A

6

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12
Q

Do diaphragm, cervical cap, and cervical sponge protect against STIs?

A

Some mild protection against gonorrhea and chlamydia

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13
Q

MOA: diaphragm, cervical cap, and cervical sponge

A

maintains reservoir of contraceptive gel “spermicide” against the cervix (has some barrier function as well)

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14
Q

What is OTC Nonoxynol-9?

A

Spermicide
MOA: Non-ionic surfactant damages cell membrane of sperm

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15
Q

Does the depo shot have estrogen, progesterone, or both?

A

Progestin only
HOWEVER, it has HIGHER systemic concentrations than the progestin only mini pill and therefore causes LARGER supression of GnRH axis -> Decreased ovulation and production of estrogen

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16
Q

Does the NuvaRing have estrogen, progesterone, or both?

A

BOTH E+P

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17
Q

COCs are made up of one synthetic estrogen component (________) + 1 of 12 synthetic progesterone combinations

A

ethinyl estradiol

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18
Q

Which COC is FDA approved for PMDD and acne

A

Yazmin

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19
Q

Main MOA of COCs

A

PREVENT OVULATION

Exogenous estrogen and progesterone -> negative feedback to hypothalamus -> decr GnRH -> decr FSH/LH
Low FSH = follicle dont mature
Low LH = interferes with LH surge

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20
Q

Cyclic vs Extended vs Continous COC formulations

A

Cyclic - period q month (24/4 is better than 21/7)
Extended - period q 3mo
Continous - does not get period

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21
Q

Benefits to shorter or less frequent hormone free time periods?

A
  1. less hormone withdrawal symp (PMS)
  2. More effective (less amnt of time without HPO axis suppression means less likely the endometrium will proliferate or follicles will start to mature during withdrawal bleed)
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22
Q

Are monophasic or multiphasic COC formulations MC?

A

Monophasic (same dose of E+P in each pill)

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23
Q

How can you change the dose of Ethinyl Estradiol if pt has unscheduled bleeding problems?

A

Increase doe up to 35mcg
If low estrogen and high progestin -> super fragile and thin -> breakthrough bleeding. Increasing estrogen dose will thicken it a little to make it less fragile

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24
Q

Which 2 COC should you AVOID if pt has acne problems?

A

Norgestrel or Levenorgestrel (HIGH Adreogenic effect bc derived from Testosterone)

Drospirenone (Yaz) is better choice

25
Q

Absolute contraindications to E+P Contraceptives

A

ASCVD, Clots
Breast cancer
Liver

26
Q

Relative contraindications to COCs

A

Smoker >35 and <15cig/day Superficial venous thrombosis
GI

27
Q

38yo F smokes 20 cig per day (1 ppd). Is this a relative or absolute contraindication to COCs?

A

ABSOLUTE

Absolute = > 35yo + > 15 cig/day
Relative = > 35yo + < 15 cig/day

28
Q

Pros and Cons to COCs

A
29
Q

Indications to start COCs

A
  • Contraception
  • Menstrual Pain Disorders: dysmenorrhea, chronic pelvic pain, endometriosis
  • Various Abnormal Uterine Bleeding Disorders: Fibroids, PCOS
  • Adjunctive in PMS and PMDD
  • Ovarian Cysts: reduce development of new cysts
30
Q

What is the best time/day to start your 1st dose of birth control

A

1st SUNDARY after PERIOD BEGINS

  • If > 5 days from onset of menses, backup contraception x 7 days
  • Typically prescribe full year of medication to improve compliance and continuation
31
Q

What vital is most important when initiating COCs?

A

BP

32
Q

WDYD if you pt forgets to take one pill? 2+ pills?

A

1 pill -> take ASAP
2+ pills -> take remaining pills at usual time and use Plan B

33
Q

What meds decrease the efficacy of COCs?

A

ABX - Rifampin
Anti-Sz meds

34
Q

Take pt off COCs once they hit normal menopausal age ~_____ yo

A

50-51

35
Q

after giving birth or breastfeeding, wait at least ____ wks before starting COCs again due to ____

A

4 wks
incr risk VTE

36
Q

obese pts are at incr risk for _____ if they take COCs, especially if they are older

A

VTE

37
Q

Diabetics can only COCs if they’re ____

A

< 20 yrs from onset of Dx and are well-controlled

38
Q

It will usually take _____mo to be fertile again

A

1-3mo

39
Q

Is the estrogen in the patch higher or lower than COC pills

A

HIGHER

40
Q

Pts with BMI ____+ cannot use the patch bc it wont work as well and they will have increased risk of VTE

A

30+

41
Q

Can the NuvaRing be used if you’re obese?

A

YES

42
Q

Which progesterone is in the mini pill (POP)

A

Norethindrone/NET (Camila, Errin) continuous 28 day pack active pills

Drospirenone (Slynd): 24/4 formulation

43
Q

Mini pill main MOA

A

thick cervical mucus
thin endometrium

POP’s have short duration of action AND MUST BE TAKEN AT THE SAME TIME EACH DAY …IF PATIENT MISSES A DOSE BY >3 HOURS, should use backup contraception x 48 hours after last dose

44
Q

Unline COCs, the only main absolute contraindication to the mini pill is ____

A

Known breast cancer (may be hormone receptive)

relative CI
- Liver - benign/malignant liver tumors, liver disease & cirrhosis
- Malabsorptive bariatric surgeries (GI systemic absorption)
- Anti-epileptic drugs (GI systemic absorption)

45
Q

Pt wants an oral contraceptive but has ASCVD risk factors and just gave birth and is breastfeeding. What should you prescribe?

A

Mini pill

46
Q

MC SE for nexplanon rod

A

spotting/unscheduled bleeding

47
Q

is low estrogen good or bad for the bones?

A

BAD
Low estrogen -> incr bone breakdown (bone resorption) -> decr bone mineral density

48
Q

is bone mineral density loss from depo shot permanent?

A

No, usu reverses after stopping shots

  1. Advise adequate intake of calcium and vitamin D, regular exercise
  2. Clinical judgement for use in those with increased risk for OP
  3. Otherwise, for those with “normal risk” of OP – data suggests that DMPA does NOT increase risk of OP fracture in later life and there is no reason to limit the duration of use; may be used safely for decades.
49
Q

Depo SE

A
  • bleeding changes (spotting, amenorrhea)
  • wt gain
  • Diabetes

poss incr risk for CVD and VTE

50
Q

What makes the depo shot progesterone unique from other progesterones?

A

depo shot progesterone has increased risk for CVD

51
Q

After stopping depo shots, it can take up to ____ to become fertile again

A

18 mo (1.5yrs)

52
Q

After a vasectomy, use back up contraceptives for ___ mo

A

3

53
Q

Most female sterilizations are done when ____

A

postpartum (already in the stirrups afer birth)

54
Q

Salpingectomy is becoming MC d/t decreased risk of ___________

A

ovarian CA

55
Q

wait ____ days after taking plan B to take your normal birth control again

A

5

56
Q

Can IUDs be used as emergency contraception?

A

YES (paragaurd or mirena)

57
Q

Does plan B work if you’ve already ovulated?

A

NO

58
Q

How does emergency contraceptive PO Ulipristal acetate (UPA) “Ella” work to prevent pregnancy even if you’ve already ovulated?

A

postpones or inhibits oocyte release from follicle by ~ 5 days

Women's Health (6 decks)

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