Common Reproductive Health Flashcards
Family Planning
Prevention of unintended pregnancy
45% of all pregnancies are unintended
Cervical cancer screening
Ages 21 - 29: every 3 years pap , hpv test not recommended
Ages 30 -65 : A pap and cervical her test every 5 years or pap alone every 3
Older than 65 - who have had 3 consecutive negative pap-no screening
Do not apply to high risk women
IUD
Highly effective greater then 99%
Side effect : copper- heavy bleeding, estrogen iud-amenorrhea, l increased expulsion rate higher after childbirth
Contraindications - pregnancy, distorted uterus, pelvic tb, cervical or pelvic cancer, PID, post septic abortion, post party sepsis, purulent cervicitis
Etonogestrel implant
4 cm single rod inserted subdermaly in the arm progestin only
Back up used if insertion is 5 days after menses
Contraindications - cirrhosis, liver tumors, lupus, unexplained vaginal bleeding I breast cancer
Oral contraceptives
Combined estrogen and progestin or progestin only
Most popular are the 4 week cycle combo
Failure rate. 3%. When taken correctly however most is 8%
Supress ovulation
Ethinyl estradiol- most popular estrogen used in us
All progestin offer excellent cycle control and minimal metabolic changes
Contraindications - breast cancer, less than al days postpartum, cirrhosis, but, Major surgery with prolonged immobilization, vascular disease, Diabetes more than 20 years, diabetic retinopathy, migraine with aura
Instructions for use of oral BC
Started with onset of menses or on First Sunday of the week in which menses starts
With sunday-start use back up for 7 days
Taken same hour everyday
Missed doses
One dose late or missed - take when remembered and then next dose at normal time-no backup
Two or more. Take missed dose ASAP, discard any other missed pills continue taking remaining pills at regular time I back up until pills have been taken for 7 consecutive days
If last week pills missed, omit placebos, start new pack, if unable to start new pack use back up until 7 days of pills taken
Special consideration
Do not start until 4 to 6 weeks after delivery and non-nursing mothers
Combination not recommended for lactating women -can only use progesterone ocp only
Start immediately or within 7 days after abortion or miscarriage - first trimester
Mid- trimester- same as postpartum
Adverse effects of oral birthcontrol
Bloat, weight gain l nausea, leg pain, cramps, blood clots, ammenorhea,?
Stop bc if having surgery I month before
Increased risk in smoking women
Can alter lipids
Decrease glucose tolerance
Increased risk of hypertension
Higher-dose estrogen= increased risk of mi
Increased risk ofcerrvical dysplasia and cancer in those with HPV
Breast swelling and tenderness
Increased risk of vaginal infections such as candidiasis
Increased risk of pigmentation
Vaginal contraceptive ring
Combined birth control
Same benefits as oral Bo
Left in place for 3 rings
Absorbed vaginally
Same contraindications as oral
Insert ring on First day of menses
Back up used if not inserted in first S days of menses
If it falls out, rinse, reinsert within 3 hours
First two weeks reinsert ASAP, back up 7 days
If in 3rd week start new ring or wait 7 days, use back up
Progestin only pill
Mini pill
In thins ovulation inconsistently and thickens cervical mucosa
Safe durnylactation
Higher risk of failure
Contraindications pregnancy, breastcancer cirrhosis, diabetes more than 20 years, diabetic retinopathy nephropathy, neuropathy vascular or cardiovascular disease, history of strokes vaginal bleeding unexplained
Depo Medroxyprogesterone acetate
’ I’m every 3 months
Initially given on day 5 of menses or anytime
If after 7 days use back up
Increase alight and body fat
Black box because it can cause bone mineral loss
Breast Mass
Jump in the breast
Benign breast disorders are referred to fibrocystic changes
May fluctuate size
Management- avoid trauma, firmer, eliminate chocolate and caffeine, and tacky vitamin E
Danazol-androgen derivative helps with sever pain
Abnormal uterine bleeding
Change in the pattern or volume of menstrual bleeding
Acute is an episode in non pregnant women and requires immediate intervention to prevent more blood loss
Chronic-present for the past 6 months
Determination of abnormal bleeding recognizing is variations in frequency, regularity, duration and volume of flow
Normal is 24-36 days, duration 45 to 8 days, 5 ml to 80ml of blood loss
Causes- PALM-COEIN
Polyps adenomyosis, leionyoma, malignancy and hyperplasia, coagulopathy, ounlatory asyfunction, endometrial,
Itrogenic, not yet classified
Management- control bleeding and prevent reoccurrence
Teenagers → birth control
Women → birth control depo
Ee helps Controlacute bleeding
Sever bleeding but bp stable → conjugated estrogen
Dyspareunia
Painful sexual intercourse that can occur as a result of either introduction of the penis or cheep penile penetration
Can also can be fingers and toys
Can be caused by vaginal inflammation, structural abnormalities, vaginal atrophy, insufficient lubrication, pelvic pathology, and psychological
management
Depends on symptoms and etiology
Estrogens, lubrication, treat STI, muscle awareness exercises such as kegals, psychotherapist
Nocturne in men
Waking at night one or more times to void and then by followed sleep
Men older than 50-sign of bph
May be due to diminished bladder capacity, overflow inconitrence or habit
Spincal cord disease, incontinence, tumors, trauma, MS
Medications such as methylodopa, phenotniazines, diazepam, excessive bit D and diuretics
Management
Rule out UTI
PSA to rule out BPH
Digital rectal exam
