female health Flashcards
what is cystitis?
- Bladder infection usually caused by bacteria from the GI tract.
– Escherichia coli (70-95%)
what are the risk factors for UTI?
– Female (15-34 years)
– Pregnancy
– Sexual intercourse
– Hx or FHx of UTI
– Catheterization
– Immunosuppression
what are the symptoms of a UTI?
- Pain on urination (dysuria)
- Frequency
- Urgency
- Feeling of incomplete voiding of the bladder
- Nocturia
- Foul- smelling/ cloudy urine
- Suprapubic tenderness/ discomfort
- Delirium/ reduced functional ability
- All in the absence of discharge
how do you treat UTI?
- Acute uncomplicated UTI usually resolves within a few days.
– Should start to feel better within 3 days - Antibiotics can speed up recovery by approx. 24 hours
- Self care (first line)
– Drink plenty of fluids
– Paracetamol and/ or NSAID for symptomatic relief
– Hygiene- wipe front to back
– Avoid caffeine, alcohol and acidic drinks
– Do not resist urge to urinate
who are cystopurin contraindicated in?
– Male, children
* Cautions:
– Hypertension, pregnancy, CKD, CVD
when do you refer UTIs?
– No improvement in symptoms in 3 days
– Systemic symptoms: Fever, Chills, nausea, vomiting
– Severe pain in the loins
– Pregnant
– Children under 16 years
– Elderly patients in an acute confused state
– Failed treatment
– Patients presenting with haematuria
– Male patients
– Structural abnormality of genitourinary tract
– Immunosuppressed
– Uncontrolled diabetes
what causes thrush?
– Caused by Candida Albicans
what are the risk factors for thrush?
– Broad spectrum antibiotics- can you think of examples?
– Cushing’s disease
– Uncontrolled diabetes
– Medication: SGLT2 inhibitors, corticosteroids
– Immunosuppression (HIV, chemotherapy)
– Increase in endogenous and exogenous oestrogen: Pregnancy, COC
pill, HRT
– Local factors e.g. heat, moisture, maceration, topical corticosteroids,
local irritants
– Female
what are the symptoms of thrush?
- Vulval or vaginal itching (often the defining
symptom). - Vulval/ vaginal or penile soreness redness, burning
and irritation. - Vaginal/ penile discharge
– usually white, ‘cheese-like’, and non-malodorous. - Superficial dyspareunia.
- Dysuria (pain or discomfort during urination).
how do you treat thrush?
- Oral fluconazole 150mg capsule STAT dose
– CI in pregnant and breastfeeding female
– Usual azole interactions relevant
– Clotrimazole 2% external cream
* 16-60 years
* Applied bd to tds until symptoms improved
* >7 days see GP
what counselling advice should you give about thrush?
- Avoid tight fitting clothes especially synthetic materials
- Wear loose fitting, natural fibre underwear
- Avoid using perfumed products/soaps around genital area.
- Clotrimazole can damage condoms/diaphragms
- Should clear up within 7 to 14 days of starting treatment.
- You do not need to treat partner(s) unless they have symptoms
when should you refer thrush?
- First presentation
- Under 16 and over 60
- Diabetic
- Pregnant or breastfeeding
- 2 episodes in 6 months
- Patient/ partner with history of STI
- Abnormal menstrual bleeding/ lower abdominal pain
- Systemic symptoms: fever, chills, lower back pain
- Foul smelling discharge- bacterial vaginosis?
- No improvement in 7 days
- Vulval or vaginal sores, ulcers or blisters
what causes bacterial vaginosis?
– Overgrowth of anaerobic organisms and a loss of lactobacilli. The vagina loses its normal acidity, and pH increases to greater than 4.5.
– Most common cause of abnormal vaginal discharge
what are the risk factors for BV?
– Exact trigger is unknown
* Sexually active (but not an STI)
* Douches, deodorant, and vaginal washes
* Menstruation
* CuIUD
* Smoking
what are the symptoms of BV?
- Approximately 50% of women with BV are
asymptomatic - Fishy-smelling vaginal discharge
- Grey/white watery discharge
- Not usually associated with soreness, itching,
or irritation.
how do you treat BV?
- Refer to GP-cannot manage OTC
- Non-pregnant women with asymptomatic BV
do not usually require treatment - For symptomatic
– Oral metronidazole (1st line) or gel, clindamycin
cream
what counselling should you give for BV?
- Avoid: Douches, deodorant, and vaginal
washes
– Use water and plain soap to wash your genital
area
– Avoid perfumed soaps/ shower gel
– Do not put antiseptic liquids in the bath
what is dysmenorrhoea?
- Painful cramping, usually in the lower abdomen, which occurs shortly
before or during menstruation, or both - Thought to be caused by the production of uterine prostaglandins during
menstruation, which causes uterine contractions and pain.
what is the difference between primary and secondary dysmenorrhoea?
- Primary:
– Young females, pain begins with onset of period and lasts 24- 72 hours
– Starts 6-12 months after the menarche - Secondary: (refer)
– Associated with pelvic pathology e.g. fibroids, endometriosis, PID, IUD insertion
– Often starts after several years of painless cycles. Pain may continue after
menstruation stops. Irregular bleeding, chronic pain rather than cramping
what are the risk factors for dysmenorrhoea?
– Earlier age at menarche, heavy menstrual flow, nulliparity, family history of
dysmenorrhea, and stress
what are the symptoms of dysmenorrhea?
- Pain, usually cramping in the abdomen, spreading to the
lower back and inner thigh - Can start before menstruation and continue for up to 72
hours - Cyclical mastalgia (breast pain)
- Nausea and vomiting
- Do not confuse with menorrhagia
what treatment is there for dysmenorhoea?
- Feminax Ultra (P)
– 15- 50 years
– Naproxen 250mg tablets (P) pack of 9
– Provides relief from period pain and menstrual cramps
– First day: 2 tabs when pain starts, then take another 1 after
6-8hrs if needed
– Second and third day: 1 tablet every 6-8hrs
– Maximum 3 days treatment - Paracetamol, ibuprofen
what general counselling should you give for dysmenorrhoea?
- Heat: warmth to the abdomen e.g. hot water
bottles, heat packs - Warm bath
- Tea e.g. regular, camomile or mint
- TENS machines
what are the red flags for dysmenorrhoea?
- Severe abdominal pain
- Pregnant
- Persistent intermenstrual or postcoital bleeding
- Symptoms of secondary dysmenhorrea
– Irregular bleeding, chronic pain rather than cramping - Naproxen specific:
– <15y, >50y, Hx of peptic ulceration or active GI bleed,
asthma (if worsens symptoms)
what is menorrhagia?
- Heavy menstrual blood loss
- Can interfere with physical, emotional, social, and material quality of life.
what are the causes of menorrhagia?
– In almost 50% of people with menorrhagia, no underlying cause is
found.
– Uterine and ovarian pathologies, such as uterine fibroids, endometriosis, and pelvic inflammatory disease. Systemic diseases
and disorders, such as coagulation disorders, hypothyroidism, diabetes mellitus, and liver or kidney disease. Anticoagulant treatment or
chemotherapy
how do you treat menorrhagia?
- Tranexamic acid 500mg tablet (P)
– 18-45 years with regular 21–35-day cycles
– Once bleeding starts 2x 500mg tablets tds - If still heavy can increase to max 8 tablets/day
– Maximum 4 consecutive days
or NSAID/ paracetamol
when do you refer menorrhagia?
- No reduction in bleeding after 3 cycles.
- Irregular bleed, Hx thrombotic disease, anticoagulants, oral contraceptive,
tamoxifen, pregnancy, breastfeeding, PCOS, Hx endometrial cancer in 1st
degree relative. Obese, diabeti
what POM treatments are avaialble for menorrhagia?
COC, norethisterone, LNG-IUS, LA progesterone inj, surgery
what are the red flags for menorrhagia?
- Unusual vaginal discharge
- Fever (systemic infection?)
- Female over 45 developing heavy periods
- Irregular periods
- Persistent intermenstrual or postcoital bleeding
- Pregnant
- Hx endometrial cancer in 1st degree relative
what is amenorrhoea?
The absence of menstruation
what is the difference between primary and secondary amenorrhoea?
- Primary Amenorrhoea (refer)
– Failure to start periods - By 15y with normal 2’ sexual characteristics
- By 13y with no 2’ sexual characteristics
- Secondary Amenorrhoea (refer)
– Absence of periods for 6 months
– Many possible underlying causes: - pregnancy, exercise, menopause, stress, birth control, thyroid
disorders, tumours, PCOS
what is chlamydia?
- Infection of the urogenital tract typically causes inflammation of the urethra in men and inflammation of the cervix and/or urethra in women
what are the symptoms of chlamydia?
– Asymptomatic in at least 70% of female and 50% of male.
– Post-coital or intermenstrual bleeding, increased or purulent vaginal
discharge, mucopurulent cervical discharge, deep dyspareunia, dysuria, pelvic
pain and tenderness, an inflamed or friable cervix.
– In men: dysuria, urethral discharge, urethral discomfort, epididymo-orchitis or
reactive arthritis.
what are the complications with chlamydia?
PID, pregnancy complications, epididymo-orchitis
how often should one get tested for chlamydia?
The National Chlamydia Screening Programme recommends annual
screening for all sexually active people younger than 25 years of age, or
more frequently if they change their partner
what is the treatment for chlamydia?
- Prompt treatment and referral to GUM
- Clamelle (azithromycin 500mg) OTC
– >16yrs, who have tested positive but no symptoms, or
sexual partner has chlamydia with no symptoms.
– If symptoms present – refer to GP - Doxycycline 100mg bd is now considered first line treatment
what is PID?
Pelvic inflammatory disease
* Not an STI but commonly caused by STIs
– Untreated Chlamydia and Gonorrhoea (90%)
what are the risk factors for PID?
– Multiple sexual partners
– Unprotected sex
– Interruption of cervical barrier
* Insertion of IUD
* Giving Birth
* Surgery
what are the symptoms of PID?
– Lower abdominal pain (usually bilateral)
– Vaginal discharge
– Abnormal bleeding
– Nausea and/or vomiting
– Pain during sex/on urinating
– Refer any suspected case of PID for diagnosis and treatment
what are the two different types of EHC and when do you take them?
Levonorgestrel and Ulipristal Acetate
* To be taken ASAP after unprotected sex
* Levonorgestrel effective up to 72hrs
* Ulipristal effective up to 120hrs (caution with OCs)
* Ulipristal P since 2015, Levonorgestrel POM and P
(levonelle one step)
* Both available on some PGDs
what should be done when selling OTC ehc?
- Requires consultation with pharmacist before sale
- Can only be sold to the woman who needs it
- Effective up to 72hrs after unprotected sex
- Precise mode of action unknown
- Right to refuse to sell but MUST refer
what interactions are there with EHC?
reduced efficacy with enzyme inducers:
carbamazepine, griseofulvin, phenytoin,
barbiturates including primidone, rifabutin,
rifampicin, ritonavir, St.John’s wort
what is the prefrred option with EHC when breast feeding?
- Levonorgestrel is secreted into breast milk.
– Therefore breastfeeding should take place immediately before taking
the tablet and women should avoid nursing for at least 8 hours - Ulipristal acetate is excreted in breast milk.
– Breastfeeding is not recommended for one week. During this time
express and discard the breast milk in order to stimulate lactation.
how long can EHC delay your menstruation?
– Can be delayed…take a pregnancy test if >5 days late for
levonorgestrel or >7 days for ulipristal
what counselling should you give around EHC?
- Take as soon as possible
- If vomit or have diarrhoea
- Ulipristal acetate: within 3hrs repeat
- Levonorgestrel: within 2hrs repeat
- Next period may be early or late
- If next period >7 days late or unusual take pregnancy test
- Does not protect against STDs
- Advise on long-term contraception if necessary
- Levonorgestrel can be used while breast-feeding
when should you be mindful with EHC presentations?
- sudden severe chest pain
- sudden breathlessness
- unexplained swelling or severe pain in calf of one leg
- severe stomach pain
- unusual severe, prolonged headache
- sudden partial or complete loss of vision
- sudden disturbance of hearing
how can a pharmacist help prepare for pregnancy?
- Healthy eating
- Plenty of fluids but avoid caffeine and alcohol
- Stop smoking
- Medication prescribed or OTC?
- Take Folic Acid 400mcg daily
- Take Vitamin D10 mcg daily
- Avoid Vitamin A
what support can you give in pregnancy for minor ailments?
Pain/Headache/Flu
* Analgesic= paracetamol.
* Refer severe pain and persistent or severe
headache.
Nausea and vomiting
* Morning sickness usually 1st trimester.
* Ginger.
* Sea-bands.
* Refer constant and severe vomiting.
Indigestion/ heartburn
* Around half of women get heartburn.
* Increased intra-abdominal pressure and hormonal
effects on sphincter.
* SodiumAlginate (Gaviscon).
Constipation
* Estimated one in three suffer.
* Increase fluids and fibre.
* Avoid stimulant laxatives.
* Bulk laxatives preferred (ispaghula husk)
