GYN Flashcards
estrogen amount in COCs is _______ than the amount of estrogen in menopausal HRT
HIGHER
If a woman is having infrequent periods, she is not ovulating frequently.
If she’s not ovulating, she’s not making a corpus luteum.
If there’s no corpus luteum, there’s no progesterone.
Know This!!
PMS occurs during the late _________ phase, cycle days ___-___
luteal, cycle days 21-28ish
structural causes of AUB
fibroids
adenomyosis
polyps
only hormonal causes of AUB cause change in:
length of the cycle
structural causes of AUB cause the period to be:
heavier and/or breakthrough bleeding b/t periods
basal body temperature increases after ovulation in response to __________ secreted by the __________
progesterone secreted by the corpus luteum
hormone that stimulates follicular growth in the ovaries and stimulates estrogen secretion (from developing follicles)
FSH
hormone that surges to cause ovulation resulting in the formation of the corpus luteum
LH
hormone that thickens the uterine lining, inhibits FSH and LH for most of the cycle, and stimulates FSH and LH release pre-ovulation
estrogen
hormone that thickens the uterine lining and inhibits FSH and LH
progesterone
FSH is secreted by the:
anterior pituitary
LH is secreted by the:
anterior pituitary
estrogen and progesterone are secreted by the:
ovaries
Endometrial Cycle includes these menstrual cycle phases:
Proliferative
Secretory
Menstrual
Ovarian Cycle includes these menstrual cycle phases:
Follicular
Ovulatory
Luteal
basal body temp increases due to increase in:
progesterone
first day of bleeding is menstrual cycle day #:
1
The ___________ phase is always 14 days long
luteal
high estrogen levels after dominant follicle has been established increase:
FSH and LH secretion
prolactin is secreted by the:
anterior pituitary
when estrogen is the dominant hormone, the endometrium:
proliferates
when progesterone is the dominant hormone, the endometrium:
thickens to prepare for implantation
leave diaphragms and cervical caps in for at least ___ hours
6
remove diaphragm by ___ hours
24
remove cervical cap by ___ hours
48
MOA of ___________:
- Supresses ovulation
- Thickens cervical mucus
- Thins asynchronous endometrial lining: decreases chance of implantation
- Slows tubal motility
COCs, Ring, Patch
MOA of ___________:
- Thickens cervical mucus for 2-4 hrs after ingestion, lasting for 22 hrs
- Inhibits ovulation (**40% ovulate normally)
POPs
MOA of ___________:
- Inhibits LH and FSH surge: suppresses ovulation, thickens cervical mucus
- Slows tubal and endometrial mobility
- Thins endometrium
Depo
MOA of \_\_\_\_\_\_\_\_\_\_\_: -Thickens cervical mucus -Inhibits ovulation x 2 yrs -Atrophies endometrium (**may rarely ovulate after 2 yrs)
etonogestrel implant (Nexplanon)
Contraindications for \_\_\_\_\_\_\_\_\_\_\_\_:
-Active gallbladder or liver disease
-Multiple CVD risk factors
HTN >/= 160/100
Current DVT or PE
Hx of thrombogenic mutations (Factor V leiden)
-Current breast cancer
-Migraines w/ aura at any age
-Migraines w/o aura if age > 35
-Hx of stroke
-Diabetes > 20 yrs w/retinopathy, nephropathy, neuropathy or other complications
-Major surgery w/prolonged immobilization
-Prior to 21 days postpartumCOCs, ring, patch
Contraindications for \_\_\_\_\_\_\_\_\_\_\_\_:
-Active liver disease
-Multiple CVD risk factors
HTN >/= 160/100
Current DVT or PE
Hx of thrombogenic mutations (Factor V leiden)
-Current or recent breast cancerPOPs, Depo, Nexplanon
most effective EC
copper IUD
most effective PO method of EC
UPA
UPA EC effectiveness: ___ pregnancies in 1000 uses
10 (1.8% chance of pregnancy after 1 act)
POPs/LNG IUDs EC effectiveness: ____ pregnancies in 1000 uses
12 (2.6% chance of pregnancy after 1 act)
COCs EC effectiveness: ____ pregnancies in 1000 uses
20-32
failure rate of copper IUD EC
under 1 in 1000 (99.9% effective)
SE of \_\_\_\_\_\_\_\_\_\_\_\_\_ (EC): Increased bleeding during periods Increased dysmenorrhea Infection during first 20 days Uterine perforation Expulsion Vasovagal or fainting w/ insertion
copper IUD
SE of \_\_\_\_\_\_\_\_\_\_\_\_\_ (EC): N+V (**most common) HA Abdominal pain Breast tenderness Fatigue Dizziness
UPA, POPs/LNG, COCs
nausea + vomiting is less severe with ______ as EC than _______ as EC
POPs/LNG less severe than COCs
POPs/LNG methods of EC
Plan B
Plan B timeframe for use
72 hours but may work up to 120 hours
ella (UPA) EC is available by __________ only
prescription
EC that is less effective in women with BMI >30
ella (UPA)
EC that delays ovulation even when LH is rising
ella (UPA)
ella (UPA) timeframe for use
120 hours
copper IUD can be inserted up to ___ days after ovulation (up to 5 days after unprotected sex that occurs mid-cycle or earlier) to prevent pregnancy
5
EC methods that delay ovulation
COCs, POPs/LNG, UPA
EC methods that have spermicidal activity
copper IUD only
EC methods that prevent implantation via uterine line effects
copper IUD
possibly UPA
type of IUD that is associated with irregular bleeding after 3 months of use
Mirena
co-test for HPV with pap for women over age:
30
start pap smears at age:
21
paps are q___ year until age 30
3
Reasons for more frequent pap smears
HIV positive
immunocompromised
DES exposure
after treatment for CIN2/3 cervical cancer
paps are q___ years after age:
30
paps are not recommended after age:
65
ASC-US
Atypical Squamous Cell of Undetermined Significance
lowest clinical concern result of pap
ASC-US
LSIL
Low-grade Squamous Intraepithelial Lesion
pap result that includes mild hyperplasia, cervical intraepithelial neoplasia (CIN) 1– probably HPV but with a high likelihood of resolution especially among young women
LSIL
pap result that includes moderate to severe dysplasia, carcinoma in situ, CIN 2 and 3– almost 100% HPV and not as likely to spontaneously resolve
HSIL
HSIL
High-grade Squamous Intraepithelial Lesion
for women > age 25 with ASC-US or LSIL pap result, order:
reflex testing for High Risk HPV
for women younger than age 25 with ASC-US or LSIL pap result:
repeat pap in 1 year
if High Risk HPV is present on reflex testing, next step is:
colposcopy
for HSIL result at any age, woman will need:
colposcopy + biopsy
___-___% of ASC-H is already cancer
5-10%
If HPV 16 or 18 is detected, even if pap is normal, woman will need:
colposcopy
negative pap with positive HPV management
repeat pap in 1 year, if same result- refer for colposcopy
if HPV is high-risk but not types 16 or 18, when should pap be repeated?
1 year
for unsatisfactory pap result on 3 month repeat pap, midwife should:
refer for colposcopy
woman < age 25 with negative pap but insufficient sampling of transformation zone, midwife should:
advise screening at regular interval
LSIL result, repeat pap in:
1 year
Type of Nipple Discharge: Lesion in duct Spontaneous (without stimulation) UNIDUCTAL UNILATERAL Bloody nipple discharge
Intraductal papilloma
