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531 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

ovarian cycle consists of

A

follicular phase, ovulation, luteal phase

dev/release of oocyte in ovary and follicular maturation

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2
Q

uterine/endometrial cycle consists of

A

menstrual phase
proliferative phase
secretory phase

preps the endometrium for implantation of fertilized ovum and shedding of lining when implementation does not occur

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3
Q

follicular phase

A

Day 1-7
starts last few days of last period until release of mature follicle; produce ovum in prep for fertilization

ESTROGEN DOMINANCE

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4
Q

ovulatory phase

A

Day 14
LH surge, ovulation happens 10-12 hrs afterwards

progesterone lvls increase = suppress new follicles

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5
Q

luteal phase

A

Day 15-28
if no conception = follicle luteinization; corpus lute forms then regresses and levels rapidly fall, allowing FSH/LH rise again for new cycle

PROGESTERONE DOMINANCE

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6
Q

menstrual phase

A

Day 1-5
Menses

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7
Q

proliferative phase

A

Day 6-14
rising lvls of estrogen & endometrial tissue develops

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8
Q

secretory phase

A

Day 14-28
rising progesterone shifts to secretory tissue
gland tortuous, thicker,
Day 21-27 prep uterus to accept fertilized ovum

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9
Q

estrogen function

A

proliferates and thickens endometrium which stimulates progesterone receptors & increases blood flow to endometrium

causes + feedback to make LH surge and FSH

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10
Q

progesterone function

A

causes endometrium to differentiate and secrete proteins that aid in survival and implantation of early embryo

decreases proliferative effects of estrogen on endometrium

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11
Q

what happens to endometrium when estrogen and progesterone w/drawal

A

sloughing / menstrual cycle

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12
Q

estrogen side effects

A

gall bladder dz
bone growth / density
reduced vascular tone
blood clot

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13
Q

progesterone benefits

A

protects fibrocystic breasts, prevent breast cancer, maintain secretory phase of endometrium / prevent cancer

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14
Q

abnormal uterine bleeding

A

Issue of timing, amount, or volume of bleeding

Variations of bleeding is from higher or lower lvls of prog or estrogen in body

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15
Q

Single variations in bleeding can be __ and due to ___

A

normal
exercise, activity, travel, time zones, emo stress, unknown
Reassurance!

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16
Q

frequent cycle days

A

occurs < 24 days between cycles

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17
Q

normal cycle days

A

24-38 days

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18
Q

hallmark of luteal phase is shift from

A

estrogen dominant in follicular phase to progesterone dominance in luteal phase

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19
Q

once corpus lute regresses from no pregnancy, these hormones decline

A

estrogen and progesterone

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20
Q

In menstrual phase, there is a phase called

A

ischemic phase which is destruction of functional zone
uterus sheds lining = drop in estrogen and progesterone

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21
Q

in mid to late follicular phase, estradiol levels increases causing the cervical mucus to become

A

clear, thin, profuse
cervix swells, softens, os dilates

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22
Q

after ovulation, progesterone causes the cervix to become

A

firm, os closes, mucus scant and thick

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23
Q

infrequent cycle

A

> 38 days

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24
Q

prolonged bleeding in days

A

> 8 days

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25
Q

typical bleeding in days

A

4.5 - 8 days

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26
Q

shortened bleeding in days

A

< 4.5 days

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27
Q

women of reproductive age with amenorrhea or AUB is…

A

pregnant until proven otherwise!!

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28
Q

post menopausal women (no period for 1 year) that bleeds is..

A

NEVER NORMAL!
think endometrial hyperplasia or endometrial cancer until proven otherwise

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29
Q

menorrhagia

A

heavy prolonged menstrual flow
aka heavy menstrual bleeding

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30
Q

oligomenorrhea, hypomenorrhea

A 
oligo = infrequent cycles 
hypo = light/scant flow
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31
Q

polymenorrhea, hypermenorrhea

A

frequent cycles or profuse or prolonged bleeding

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32
Q

metrorrhagia

A

metro = irregular

irregular bleeding

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33
Q

metromenorrhagia

A

irregular, heavy bleeding

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34
Q

IMB/intermenstrual bleeding

A

intermenstrual bleeding
bleeding in between periods

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35
Q

post coital bleeding

A

bleeding after intercourse

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36
Q

PALM-COEIN is abbreviation for evaluating what?
PALM is for what etiologies?
COEIN is for what etiologies?

A

abnormal bleeding

palm is for anatomical/structural etiologies

coein is for hormonal / functional abnormalities of AUB

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37
Q

P (PALM-COEIN)

A

polyps - overgrowth of endometrial glandular tissue

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38
Q

endocervical polyps

A

Fleshy, pedunculated lesion, often on a stalk
red/purplish in color (vascular)
Pear shaped
Seen in speculum exam
May cause post-coital
if > 3cm/ irregular shape = bx

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39
Q

endometrial polyps

A

Overgrowth of endometrial tissue

Benign

Smaller polyps, resolve spontaneously

seen only on US

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40
Q

A (PALM)

A

Adenomyosis

Endometrial tissue from uterus burrows deep in uterine muscle in wall

knifelike stabbing pain, dysparunia

from multiple pregnancies, spontanous abortions, uterine surgery, c section, or DNC

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41
Q

L (PALM)

A

Leiomyoma or uterine fibroids

Fibro-muscular tumors that are benign

Arise from smooth muscle in uterine wall

Estrogen and Progesterone promote growth

After menopause = degenerate and resolves

Leading indicator of hysterectomy

“pelvic fullness”

firm, nontender and irregular on bimanual exam

can contribute to: infertility, preterm labor, spontaneous abortion, abn labor, rectal pressure

dx with US

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42
Q

M (PALM)

A

Malignancy and hyperplasia

Overgrowth of endometrial glands = precancerous atypical adenomatous hyperplasia and into endometrial cancer

> 50 yrs, average dx is 61

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43
Q

C (COEIN)

A

coagulopathy

Any family hx of bleeding sx’s

Clotting disorders that explain abnormal bleeding, r/t clotting deficiencies (thrombocytopenia, liver dz, platelet deficiencies)

Von Willebrand disease

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44
Q

Von Willebrand disease

A

congenital acquired clotting factor def

Always r/o if young women with heavy bleeding w/ cycles since they began period/menarche

a/s with easy bruising, prolonged bleeding after dental procedures, surgery, PP hemorrhage

Work-up: PT, PTT, platelet count

Treatment: anticoagulation therapy may also be considered in abnormal uterine bleeding

Diagnosis: hematologic testing; referral to hematology

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45
Q

3 things seen with von willebrand dz

A
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46
Q

O (COEIN)

A

Ovulatory dysfunction

age (peri - menopause; amenorrhea)

dx after r/o everything else

causes: endocrine, luteal defects, adrenal hyperplasia, renal/liver dz, PCOS, excessive exercise, acute stress

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47
Q

E (COEIN)

A

endometrial

increasingly longer and heavier menses in predictive cyclical patterns

Pelvic inflamm dz and PP bleeding

a/s with placental fragments after delivery or endometritis or post abortal issues

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48
Q

I (COEIN)

A

Iatrogenic Conditions

medications (anticonvulsants, dilantin, digoxin, progestin in contraceptives), IUD, PID, complications with IUD (perforation and expulsions), chronic steroid use, opiates

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49
Q

N (COEIN)

A

Not classified

Other chronic conditions that are not infectious

Do not fit in any other categories

For ex, AV malformations

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50
Q

hwo do you evaluate AUB?

A

first R/O pregnancy

determine where bleedig is coming from: cervix, uterus, vagina, sore, rectum?

anovulatory?

regular/irreg? other sx’s?

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51
Q

AUB: physical exam

A

BMI >30

Skin: acne, hirsutism, acanthosis nigricans, bruising

Breast: galactorrhea (nipple discharge)

Abdomen: abdominal pain, masses

Pelvic/speculum exam: lesions, S/S infection, foreign body

Can determine if uterine blood by looking at blood exiting thru cervical os into vaginal

Source of bleeding: cervical, vaginal, anal?

Bimanual exam: uterine ovarian enlargement, masses

Can be perianal bleeding

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52
Q

AUB: labs

A

Urine HCG (r/o preg)

CBC to check H&H and platelet count

TSH and prolactin if amenorrhea or any anovulatory bleeding is suspected

PT, PTT fibrinogen if coagulopathy is suspected

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53
Q

endometrial biopsy only tells us

A

if it’s uterine hyperplasia or endometrial cancer

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54
Q

when is endometrial biopsy warranted

A

in premenopausal women with prolonged irregular bleeding, unexplained post-coital bleeding, or intermenstrual bleeding, or those with endometrial cells noted on pap smear, premenopausal with anovulatory abnormal bleeding or glandular cells on their pap smear

required for post-menop with abnormal uterine bleeding and those on hormone therapy with abnormal bleeding

Any unscheduled bleeding on hormone therapy that lasts > 3 months after starting combined OC or with endometrial stripe that > 5mL on US

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55
Q

when to do a pelvic ultrasound

A

anovulatory and no response to tx

or any anatomic defect suspected (saline infusion sonogram, helps identify polyps and fibroids)

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56
Q

when is amenorrhea abnormal

A

PCOS, anatomic, abnormalities in HPO axis/hormones

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57
Q

primary amenorrhea

A

no menses by 14 yrs + no secondary sex characteristics ( pubic)

OR

no menses by 16 regardless of characteristics

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58
Q

secondary amenorrhea

A

No menses in previously normal menstruating for at least 3 cycles or 6 months after being normal

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59
Q

ashmeran syndrome

A

disorder of genital outflow tract

development of scar tissue from surgical instrumentation (c section) of uterus, vagina, or cervix

No pain, no buildup

Uterine lining obliterated bc of scar tissue, no endometrial buildup, no bleeding

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60
Q

cervical stenosis

A

disorder of genital outflow tract

scar tissue that develops in cervix and plugs = no bleeding allowed to drain

Scar tissue from cone bx of cervix, LEEP procedure, cryotherapy of cervix, dilation and curettage, congenital absence of uterus/vagina

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61
Q

Amenorrhea: disorder of ovary

A

autoimmune: thyroid, addisons, diabetes, lupus, RA
other: ovarian, chemo, tubo-ovarian abscess, surgery

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62
Q

4 causes of amenorrhea

A

disorders of:

genital outflow tract

ovary

anterior pituitary

hypothalamus or CNS

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63
Q

sheehan syndrome

A

significant postpartum hemorrhage causes vascular infarction and deprives pitutary gland

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64
Q

anovulatory amenorrhea

A

alteration in menses; irregularity; unpredictable

NO mittelschmerz or PMS

caused by: PCOS

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65
Q

common cause of infertility

A

chronic anovulation

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66
Q

amenorrhea: disorder of hypothalamic/CNS

causes

A

lifestyle!

excessive exercise, issues a/s with excess exercise (catechol estrogens are produced and endorphins, which inhibit GnRH, LH, FSH)

Dramatic life events

Grieving process = amenorrhea

Anorexia

Hypothalamic lesions, tuberculosis, sarcoid, and encephalitis = dec secretion of GNRH and reduced levels of FSH and estrogen

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67
Q

what meds / conditions can cause amenorrhea

A

meds that affect prolactin levels: antihypertensives, psychotropics, H2 blockers, oral contraceptives

chronic dz: diabetes, crohns, CF, celiac dz

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68
Q

amenorrhea: disorders of anterior pituitary

causes

A

from hyperprolactinema; a prolactinoma (secretes prolactin) tumor! most common cause

hypothyroidism can lead to hyperprolactinemia

increasing dopamine from hypothalamus inhibits GnRH = inhibits steroidogenesis

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69
Q

amenorrhea work up

A
  1. Rule out pregnancy and peri-menopause
  2. overall health: malnutrition, Exercise, recent weight changes, disorders of eating (anorexia, crash dieting, rapid weight loss), Obesity

Meds, herbs, Emotional state, chronic illness

  1. Physical exam, BMI, Gynecological and breast examination (galactorrhea)
  2. Assess TSH and prolactin levels (hyperprolactinemia common with anovulation)
  3. Administer provera challenge test
  4. Assess FSH & LH levels

ovarian failure dx if FSH high and low estrogen

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70
Q

provera challenge test

A

7-10 day course of provera making high levels of progestin then stop taking that to create withdrawal bleeding

Positive if get period = it’s not due to obstruction & has estrogen but not ovulating/anovulation

Negative if no period = adhesions/ashermans or not enough estrogen making endometrium not thick enough

If fails, give exogenous estrogen to determine if that’s part of problem

If responds, we know its limited endogenous estrogen or inadequate estrogen

Draw gonadotropin levels

71
Q

ovarian amenorrhea most common cause

A

ovarian fxn abnormalitiies

ovary resistant to FSH or LH stimulation (PCSO) or lacks egg to ovulate

72
Q

hypothalamic or pituitary amenorrhea r/t to

A

deficiency of FSH and LH

73
Q

assess what for heavy menstrual bleeding

A

duration, color, presence of clots, character of bleeding

look for anemia

74
Q

heavy bleeding assessment

A
  1. r/o pregnancy
  2. Manual exam
  3. Pelvic exam

Masses (ovarian, uterine) = pap smear

CBC, TSH, liver fxn, coagulation

r/o infections with cervical cultures, endometrial bx if indicated

  1. Pelvic sonogram = assess fibroids, polyps, measure endometrial stripe

During follicular phase, endometrial thickness is 1-2mm

During preovulation, layer 3-5 mm

Endometrial stripe > 5 mm = suspicious! Eval

75
Q

heavy bleeding tx

single epsidoe vs chronic/cyclic

A

single is prob due to pregnancy or infection

chronic/cyclic: manage with IUD, monophasic OCP, patch/ring, Progestin (limits growth), depo, GnRH agonist (Lupron), NSAIDs, Danocrine (Danazol) but weight gain

non pharm: acupuncture, chinese med, herbs, aromatherapy

76
Q

acute vaginal bleeding tx

A

estrogen and progestern 3x the dose but NAUSEAAAAA

77
Q

metrorrhagia etiology

A

Possibly of preg

Threatened spontaneous abortion

Ectopic pregnancy

Gestational trophoblastic neoplasm

Mid-cycle spotting might signal ovulatory bleeding with heavy bleeding.

An STI can be a source of the problem, including cervicitis, vaginitis, or pelvic inflammatory disease.

Trauma related to sexual activity or abuse

Need sexual history and extensive assessment regarding interpartner violence or assault.

78
Q

metrorrhagia tx

A

if from OC = change/review dosing, change

if not OC = stop OC to allow healthy buildup

progesterone therapy

Nuvaring, patch, progesterone IUD

79
Q

primary dysmenorrhea

A

begins 6-12 months after menses (menarche)

d/t increased prostaglandin production = uterine contraction (use NSAID)

ischemic pain

recurrent sx’s with each cycle and stops after end of period

NOT from hx of anxiety/depression/psychosomatic dz

80
Q

secondary dysmenorrhea causes

A

1 cause: endometriosis

adenomyosis (2nd common)

fibroids, polyps, cysts, cancer, PIDS: STI’s, pelvic floor weakness,

non GYN issues: IBS, interstitial cystitis or UTI

81
Q

secondary dysmenorrhea assessment

A

GYN, obstretic, sexual hx

physical exam

US - pelvic pathology

r/o STI

if sus endometrial cancer, collect bx

if from IUD = remove and alt methods

82
Q

when can secondary dysmenorrhea happen? is it related to prostaglandins?

A

before, during, or after period

NOT caused by prostaglandins

83
Q

Primary dysmenorrhea Management:

Pharmacological vs Non Pharm

A

pharm: first line is NSAIDS (start 2-3d before menses + 2-3 d ibuprofen 400-800 mg q 6 hrs or naproxen 500 mg onset)

combined hormonal contraceptives

progestin only contraceptives (LNG IUD, Nexplanon), Depo BUT not immediate results (takes 3-12 mo)

non pharm: heat, no smoking/sugar, soda, exercise, belladonnna/camilla (herbal), acupuncture/relaxation aromatherapy

84
Q

premenstrual disorder (PMD) sx’s appear ONLY during what phase

A

luteal phase (7 days or less before menses and RESOLVES with menses) day 4-13

moderate sx’s = PMS

severe sx’s = PMDD

85
Q

PMDD sx’s in majority of cycles and have at least 1 of these sx’s:

A

1 or more: emotional lability, anger, feelings of hopelessness, anxious

1 or +, total 5 or +: poor concentration , appetite changes, decreased interest in activities, fatigue, overwhelmed, breast tenderness, bloating , weight gain, aching joints, insomnia or hypersomnia

86
Q

how is PMDD thought to happen

A

neurologic hypersensitivity to normal hormone fluctations

NOT depression, NOT hormonoe changes

87
Q

best tx for PMDD

A

stabilize hormones

suppressing ovulation with hormonal contraceptives, especially drospirenone, or Yasmine and Angeliq.

or SSRI antidepressants

88
Q

PMDD management

pharm & nonpharm

A

stabilize hormones; suppress ovulation = COC drospirenone

SSRI #1 if sx is mostly emotional/PMS and taken only during luteal phase/day 14 [fluxoetine, sertraline, paroxetine]

anxiolytic last resort (Buspar, Ativan, lorazepam)

nonpharm:

healthy, exercise, stress, smoking, sleep

herbal: vitex agnus castus, curcumin (tumeric), Calcium supplements 500 mg, acupuncture, acupressure

89
Q

what can worsen PMD symptoms

A

oral contraceptives

90
Q

symptoms of toxic shock syndrome

A

fever, hypotension, sunburn rash

chills, malaise, h/a, sore throat, vomiting, diarrhea, desquamation of fingers/palms/feet (late)

91
Q

TSS involves what organs

A

GI, MSK, mucus membranes, hepatic, hematologic, CNS

92
Q

TSS Dx and tx

DO NOT WHAT

A

SEND TO ER!

culture, IV hydration, infectious dz, broad spectrum antibiotics, corticosteroids, immune globulin, supportive therapy

DO NOT RESUME TAMPON USE/MENSTRUAL CUP/BARRIER CONTRACEPTIVES LIKE DIAPHRAGM/CAP/SPONGE

93
Q

what is the most common org for TSS

A

staph aureus

94
Q

what is the leading cause of infertility

A

PCOS

95
Q

PCOS patho

A

ovaries make excess male hormone, either excess LH or excess insulin = stimulate androgen production in ovaries

androgen precursor to estrogen = hyperplasia risk

‘string of pearls’ bc no LH surge

insulin resistance could be leading cause

96
Q

PCOS risks

A

anovulation/infertility

obesity

hirsutism

CVD

endometrial cancer

DM 2

97
Q

diagnosis criteria for PCOS

A

according to PCOS consensus group:

need 2 of 3: oligo/anovulation, clinical/biochemical signs of hyperandrogenism, polycystic ovaries

according to androgen excess and PCOS society:

hyperandrogenism, ovarian dysfxn (anovulation and/or cysts), exclusion of aother androgen excess

98
Q

PCOS diagnosis

A

PE: BMI, trunical obesity, virilization, moon face, buffalo hump, alopecia, amenorrhea, hirt, acan nigri

thyroid exam

breast: galactorrhea
pelvic: bimanual exam

screen for depreesion

99
Q

screen PCOS for

A

if have menstrual dyxfunction + hyperandrogenisms, screen:

Pregnancy—urine hCG

Hypothyroidism—TSH

Hyperprolactinemia—prolactin level

Glucose intolerance—OGTT

Dyslipidemia—lipid profile

100
Q

R/O other causes of hyperandrogenism with PCOS such as

A

Androgen-secreting tumor

Adrenal gland tumor

Adult-onset non-classical congenital adrenal hyperplasia CAH

Cushing’s syndrome

101
Q

PCOS management

A

determine if wanna get preggos, life style mods (diet, sat fat, fiber), exercise

COC! suppress enlarged ovaries and inhibit LH/androgen secretion = helps normalize ovary function, protect endometrium, raises sex hrmone binding globuin = binds to testosterone (helps with hirtsusism)

Progesterone, Levonorgestrel (LNg) - Mirena

progestin only pills

DMPA (depo provera) or implant (DONT give if want preg soon)

if no contraception, medroxyprogesterone acetate QD x 14 days

102
Q

PCOS tx for hirsutism

A

antiandrogens:

spironolactone (Aldactone)

finasteride (Propecia, Proscar)

103
Q

PCOS managing metabolic abnormalities

A

metformin and oral antihyperglycemics

inhibits glucose production, decrease androgen lvls with PCOS (no weight loss)

dec insulin, BP, LDL cholesterol

regulate menses, induce ovulation with clomiphene

104
Q

PCOS f/u

A

tx diabetes, dyslipidemia, and hypertension

Smoking cessation

Repeat lipid profiles every two years

HgA1c screening for diabetes annually

105
Q

birth control

A

limitation of children conceived or via specific methods of contraceptives

106
Q

contraception

A

preventing pregnancy via contraceptive methods

107
Q

efficacy

A

likelihood conception occurs when evaluating birth control methods

“true method failure” from “perfect use”

108
Q

effectiveness

A

measuring success of method preventing pregnancy when used

user error; what’s really happening

109
Q

open adoption

A

birth mother + adoptive family know each other

110
Q

closed adoption

A

birth records closed/sealed, all identities concealed

111
Q

semi open adoption

A

identifying info is shared b/t parties

communicaiton occurs at a pre-arranged intervals via agency or attorney

112
Q

medication abortion most often used up to?

surgical?

A

10 weeks

mifepristone + misoprostol or methotrexate

products of conception passes 2-4 hrs after misoprostol or 24 hrs later

surgerical: aspiration/manual vacuum < 14 weeks, D&C after 14 wks, D&Evacuation after 14-15 wks+

113
Q

Mifepristone

indication and MOA

A

Mifepristone

blocks progesterone receptor sites (require for normal implantation) & prevents fertilization

can be used up to 10 weeks/70 days

prostaglandin analog

used with misoprostol

95-98% effective

114
Q

methotrexate MOA / indic

A

inhibits enzymes required for DNA synthesis and stops normal mitosis of rapidly dividing cells

60-84% effective

takes up to 2 wks for expuslion (undesirable)

115
Q

coitus interruptus

A

withdrawal method

12/100 get pregnant; no STI protection

pre-ejac fluid may have sperm

116
Q

lactational amenorrhea (LAM)

criteria

A

using beginning of postpartum period as contraception

high levels of prolactin from BF inhibits gonadotropin releasinghormone = sets off HPO axis = prevents ovulatin

criteria: exclusive/near exc BF (4 hrs max b/t feedings, and 6 hrs max at night), amenorrhea, infant < 6 months

PUMPING reduce effectiveness

117
Q

Fertility Awareness Based on Methods

A

Identify the fertile period during the menstrual cycle + abstinence and/or a barrier method to prevent conception during the time when the risk of pregnancy is at its highest

fertile period: 5 days before ovulation until 1 day after ovulation = need back up method during this time

least effective contraception

118
Q

contranindications to FABM

A

anything that interrupts cycles, birth, menarche, BF, intermenstrual bleeding, infxns

119
Q

calendar method

A

count/record 6-12 months to find longest and shortest cycle. Then find the 1st and last fertile days expected in her routine or menstrual cycle.

subtract 18 from shortest cycle and 11 from longest cycle

119
Q

Calendar Method: Standard Days Method

A

MUST have cycles of 26-32 day cycle

barrier contr days 8 - 19

circle beads (32 beads)

120
Q

Calendar Method: Billings Ovulation Method

A

changes in cervical mucus to determine the fertile window.

Pt observes the sensation of moisture around the vulva and the presence of mucus throughout the day and records observations daily.

Abstinence first cycle to record!

fertile window: when observe vulva wetness slick, slippery up to 4 days

estrogen causes spinnbarkeit (mucus increases, clear, stretchy egg white) before ovulation

121
Q

Calendar method: Two-day method

A

Did I note secretions today? And did I note secretions yesterday?

If yes, NO SEX

Typically, this results in 10 to 14 days of abstinence during her menstrual cycle.

check daily for secretions

122
Q

Basal body temperature (BBT) Method

A

Measures basal body temperature daily BEFORE GETTING OUT OF BED

progesterone (corpus luteum) causes rise in temp = ovulation

rise of 0.4F or more = ovulation

fertile days: sharp temp rise and continue for 3 days until 5 day progressive increase

123
Q

symptothermal method

A

BBtemp AND cervical mucus/observations

self-examines the cervix, os is dilated slightly and cervix is higher in the vagina and softer. After ovulation, the cervix becomes more firm and lower in the vaginal canal and closed.

124
Q

pros and cons to FAB

A

Pros:

Min cost

User control

Culture acceptance

Cons:

Abstinence or barrier BC needed (10-12 days monthly if not longer)

Complicated

No protection from STI

125
Q

male condoms

A

Natural rubber latex

Made of polyurethane = synthetic material for latex allergy.

Prevent STIs

Latex condoms are effective in preventing HIV and STI transmission (Non latex = not as effective)

18% will have unintended pregnancy.

condom failures = breakage or slippage during intercourse or while removing the condom.

126
Q

female condom

A

2 flexible rings; larger ring remains outside of the vagina and covers the introitus.

1 size only

Can use lubricants and spermicides

In for up to 8 hours before sex but must be in place before the penis enters the vagina

Effectiveness: 79% during the 1st year of typical use.

127
Q

Spermicidal agents with condoms

agent? don’t what?

A

chemical agents that are available as creams, aerosol, foam, supposed, gels, and tablets, vaginal film and sponges = kill sperm.

Agent: nonoxynol-9 (N-9): surfactant that destroys the sperm cell membrane. The inert basin which the spermicide is compounded acts as a physical barrier to the cervical os.

Don’t use for HIV protection !!! actually causes irritation and can cause HIV

Don’t put in rectum = micro tears

Don’t lube condom with N-9

128
Q

using spermacide alone is

A

MOST ineffective contraceptive methods, with failure rates as high as 28%.

129
Q

Sponge

A

Polyurethane with spermicide

When moistened, releases 125-150 mg N-9 over 24 hrs

Leaves in at least 6 hours after sex

Irritation more common than diaphragm bc higher amt of N-9

130
Q

toxic shock syndrome a/s with what BC and sx’s of TSS

A

sponge

an immunological, potentially fatal septic reaction to toxins from Staph aureus and Strep pyogenes.

involves recent childbirth, leaving the device in place longer than 24 hours, or difficulty removing or fragmenting the sponge.

presents as 2-3 day syndrome of mild symptoms including low backache or body aches, chills, and malaise.

Sx worsen and rapidly progress to include fever higher than 101.4 or 38C.

diffuse macular erythematous rash and hypotension occurs.

teach to remove the device within 24 hours of its insertion to avoid the risk of TSS

131
Q

diaphragm and cervical cap both need what

A

spermacide to maximize eff!

132
Q

diaphragm

A

Used with spermicidal gel or cream that’s spread around the rim and inside the dome for maximum effectiveness.

needs fitting/various sizes

Inserted for up to 6 hours before intercourse and should remain in place in the vagina at least 6 hours after intercourse, but no longer than 24 hours because TSS

If have sex again w/in the 6 hr window, add more gel, DON’T take the diaphragm out

if PP, wait 6 weeks

133
Q

diaphragm SE’s

A

UTI due to pressure on the bladder or change in vaginal flora related to spermicide.

Local irritation from an improperly fitting diaphragm may result in abrasions of the vaginal wall.

potential for latex allergy.

TSS if leave in > 24 hrs

Need to be refitted if the woman experiences weight gain, more than 15 pounds, or has had a 2nd trimester abortion or a vaginal birth within the past 6 weeks.

134
Q

cervical cap

A

Dome-shaped cervical silicone cap that has suctionUsed with spermicide applied inside the dome and around the brim.

FemCap

3 sizes: 22 mm for a nulligravida, 26 mm for a nullipara, and 30 millimeters for full term vaginal delivery

Inserted up to 42-48 hours prior to intercourse and in place for at least 6 hours after intercourse

77% eff

135
Q

what are some serious side effects with CHC

A

ACHES

abdominal pain (hepatic mass/tenderness)

chest pain (cough, SOB)

headache (migraines)

eye problems (visual changes/loss of vision/speech)

severe leg pain (DVT, hot leg/edema leg)

136
Q

other side effects CHC

A

Breast Tenderness

Nausea

h/a

Altered bleeding pattern – spotting, breakthrough bleeding (not taking pill same day / time), increase/decrease bleeding, amenorrhea

Mood Alteration – Mood swings and depression

Libido changes

Skin Changes and acne

Acne gets worse before it gets better

137
Q

health benefits of CHC; reduces risk of:

A

Reduce risk of:

Endometrial cancer

Ovarian Cancer

Colon cancer

Reduce anemia and blood loss with menses

May reduce PMS/PMDD

Reduce PID

Fewer ectopic pregnancies

Reduce benign breast conditions /Fibrocystic breast

May reduce ovarian cysts

Less dysmenorrhea

Some improve acne and hirsutism

Improve BMD

138
Q

Long-Acting Reversible Contraceptives, or LARCs

A

IUDs, implant

139
Q

Short-acting reversible contraceptives

A

Rings, patches, contraceptive pills, injectable agents, transdermal patches, and intravaginal rings contain estrogen and progesterone or only progestin.

140
Q

cautions/contraindications to hormonal methods

A

contrain: Active breast cancer or pregnancy, history of cardiovascular disease or coagulopathies.

Caution tx for tuberculosis, seizure disorders, clotting disorder, HIV, or depression, including use of rifampin, Tegretol, Dilantin, antifungal agents, particularly Griseofulvin, St. John’s Wort, and over-the-counter antacids such as Maalox or Mylanta can decrease effectiveness due to impaired absorption.

141
Q

management for hormonal contraceptives

A

1st: r/o preg (no recent unprotected sex for past 2 wks)

if started within first 5 days of period = protected; no need for back up

if start any other time = back up for 7 days

make sure no contraindications and know how to use correctly

142
Q

if have photophobia, loss of vision, flashing nights, slurred speech, dizziness from CHC

A

STOP! til eval

could b ecerebrovascular accident = med emerg!

143
Q

quick start method / same day

A

can start BC today and use backup method x 1 week

144
Q

monophasic pill COC

A

same dose combo hormone eveery day

steady state

24 active pills + 4 placebo

145
Q

multiphasic coc

A

vary in estrogen and/prog weekly

4-7 day of placebo pills

biphasic or triphasic

146
Q

extended cycle coc

A

Seasonale

daily 3 months

84 active pills, 7 placebo

147
Q

pseudomenstruation

A

from combined OC

endometrium doesn’t grow as thick

148
Q

Transdermal Contraceptive (Patch) placements and contranindications

A

Xulane

exogenous estrogen transdermally with progestin

inhibit ovulation by suppressing gonadotroins in HPO axis and changes cervical mucus and endometrial lining

1 patch x 7 days over 3 weeks, 4th week patch free

sites: but, upper outer arm, abdomen, upper torso

NO: breast or legs

91% effective

149
Q

Patch management

A

>198 pounds = decreased effectiveness

Discuss satisfaction and side effects

Use only if untouched and unstuck

If more than 9 days elapsed, NOT protected

150
Q

Intravaginal Contraceptives

the Ring

A

flexible, vinyl ring about 4 mm thick and 54 mm in diameter

Body heat activated ; NOT A BARRIER METHOD

Not systematically absorbed

inhibits ovulation through suppressing the gonadotropins in the HPO access.

alters cervical mucus, and the endometrial lining

91% effective

keep in fridge x 4 months

last 21 days and then, it’s removed for seven days, to induce a withdrawal bleed.

if out > 3 hours= decrease in effectiveness

151
Q

Progestin only pill (mini pill)

A

for those that are contraindicated using estrogen or lactating pts

only thickens cervical mucus which happens 2-4 hrs after taking pill and lasts 22 hrs

if 3 hrs late taking pill, use back up BC x 2 days (strict schedule)

152
Q

Depomedroxyprogesterone DMPA

MOA

A

derivative of progesterone

inhibit HPO axis; thickens cervical mucus, endometrial atrophy = less likely implantation

shot every 13 weeks; suppresses ovulation q 14 weeks

shot anytime as long as not preg

don’t massage site!!!! dec efff

153
Q

side effects of depo

A

menstrual changes

migraine with aura = STOP

report h/a’s

weight gain common

vag dryness

delayed feritity

BBW: bone density loss (take Ca + Vit D suppls)

154
Q

DMPA benefits and pt education

A

Benefits:

Reduces seizures

Not affected by most meds

Reduction in sickle cell risks

Less menorrhagia and dysmenorrhea

Decrease in eptopci preg, PID and endometriosis

Educate:

BMD loss, changes in bleeding pattern then amennorhea after 12 months

Need ca vit D and weight bearing exercises

DO NOT ORDER DEXA / BMD testing in young women

if d/c, ovulation comes back 15-49 weeks after last injection

weight management (weight gain)

155
Q

MEC for DMPA

A

3

BBW density d/t supp gonadotropin secretion suppressing ovarian estradiol production but reversible

156
Q

Nexplanon Implant

A

MOST effective contraception

progesin analog x 7 yrs

start after 6 wks PP or during first 7 days of period or termination

barium sulfate = see on xray

once take out, return to fertilty 6 weeks

157
Q

implant SE

A

1 unscheduled bleeding

mood changes

Weight gain

Acne

Breast tenderness

Bruising /irritation at insertion site

Small ovarian cysts

Migration

Infection at insertion site

Difficult removal

Damage to nerves and/or blood vessels

Scarring

158
Q

IUD

A

Liletta, Mirena, Skyla, Kyleena

continuous release of levonorgesterl = absorbed locally by endometrium = changing mucus viscosity & diminished dev of endometrium

NOT systmically absorbed

insert any day but prefer during period (os more openand blood as lube)

can be placed after birth but caution of explusion, up to 4-8 wks PP (give nonsteroids 30 mins prior), misoprostol (cervical ripening) if cramping

159
Q

do IUD’s cause ectopic pregnancy

A

NO. but if ferti with IUD, greater risk of ectopic implantation but risk of this still lower than no IUD and ectopic

160
Q

if can’t feel IUD strings on speculum…

A

1: r/o pregnancy

uterus perforation

strings thru uterine wall

spontaneous expulsion

strings cut short andmigrate up cervix (can retract string and pull back out)

161
Q

pains reported to provided using IUD

A

P.A.I.N.S.

period - irregular, late or spotting

Abdominal pain or dyspareunia

Infection or abn vag discharge

Not feeling well, flu, chills

strings missing

162
Q

Copper IUD Paraguard MOA

A

NONhormonal; copper ions paralyze sperm and decrease motility

Foreign body effect toxic to sperm and ova

Local inflammatory response: creates spermicidal environment

barium = x ray = shows

163
Q

Copper IUD not good for

A

heavy menstrual bleeding (better using levonorgestrel IUD) or copper allergy

worsens anemia, inc dysmenorrhea, and blood loss

164
Q

Yuzpe method

A

Take 4-5 pills x 2, 12 hours apart

high doses of estrogen and progestin, combined oral contraceptive pills in a single dose = inhibit ovulation

Preg rate 2% to 3%

LOTS of nausea and vomiting, headache, breast tenderness, irregular bleeding, or spotting = unfav

165
Q

Copper IUD/Paraguard as EC

A

insert w/in 120 hrs/5 days after unprotected sex

most effective EC AND in obese women and ongoing contraception (0.1%)

alters tubal transport. It’s toxic to the ovum and incapacitates sperm so that fertilization is prevented.

inhospitable uterine environment, preventing implantation.

166
Q

which IUD NOT effective for emergency contraception?

A

The levonorgestrel-releasing IUDs, like the Mirena, the LILETTA, the Skyla, and the Kyleena are NOT effective for emergency contraception.

167
Q

female sterilization/ tubal ligation

A

done after vaginal delivery, C-section, uncomplicated first-trimester abortion, or independent of pregnancy, or whenever

The fallopian tubes are surgically cut and ligated with or without a section of the tube being removed = salpingectomy

May be mechanically blocked using clips or rings or coagulated electronically.

blocked by a reaction induced by chemicals or micro-inserts.

>99% effective in preventing pregnancy. failure rate is about 0.5% in the first 12 months.

168
Q

tubal ligation pros and cons

A

pros: decrease ovarian cancer and PID
cons: high risk of ectopic preg

won’t rec if unsure of future, unlikely to get preventative health services, not wear condoms -> STI, regrets

169
Q

female transcervical sterilization

A

Essure

insert into fallopian tubes

new growth of tissue into a surrounding insert = forms scar tissue and occludes the tube.

Need follow-up hysterosalpingogram, or HSG, to ensure occlusion has occurred about 3 months following the procedure.

**Taken off market in 2018

NO allergy nickels

170
Q

male sterilization

A

vasecetomy

The procedure involves cutting or occluding both of the vas deferens so that sperm can no longer traverse into the seminal fluid.

uses ligation, cautery, or excision of a segment, and then application of clips.

171
Q

no-scalpel technique

A

where the scrotum is pierced, and the vas deferens are then exposed and occluded through this small opening.

no stitches and results in less bleeding, quicker recovery time, less issues with hematomas, infection, and pain.

no difference in effectiveness between the no-scalpel technique and traditional conventional vasectomy.

172
Q

Male sterilization counseling

A

NOT immediately effective.

Sperm continually is produced and transported, so some sperm will continue to be present distal to the site of the procedure.

Take between 15 and 20 ejaculations to clear all the sperm; wait 3 months.

The failure rate is < 1%, similar to the female sterilization; some post-operative discomfort; infection; scrotal hematomas are possible.

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