GYN Flashcards
Estrogen
responsible for secondary sex characteristics, predominant in follicular phase of cycle; produced by ovarian follicles, adrenal cortex, and corpus lute
Estradiol
most potent, derived from dominant follicle, primary estrogen of reproductive age
Estrone
estrogen of menopause
Estriol
least potent, estrogen of pregnancy
Progesterone
predominant in luteal phase of cycle; thickens cervical mucus; level of 3ng/mL or greater indicates ovulation
Gonadotropin releasing hormone
Produced by the hypothalamus and stimulates anterior pituitary to release FSH/LH
FSH
released in response to GnRH; stimulates follicular growth in ovaries; works by positive and negative feedback mechanisms
LH
released in response to GnRH; promotes final growth of Graafian follicle; promotes follicular atresia in non dominant follicles; induces steroidogenesis
Prolactin
large amounts in pregnancy; stimulates synthesis of milk proteins in mammary tissue and epithelial growth in breasts during pregnancy
Androgens
precursor to estrogens; DHA is converted to testosterone in peripheral tissues
Follicular phase
First half of menstrual cycle; increased estradiol that peaks before ovulation; FSH is increased but then decreases before LH surge; LH surge occurs right before ovulation(10-12hrs before); thin cervical mucus
Ovulation
Rupture of follicle; Occurs 32-44 hrs after LH surge begins; thin/stretchy cervical mucus; peak sexual desire; increase in BBT of 0.2-0.5 degrees F
Luteal phase
Last half of menstrual cycle; begins after ovulation occurs; CL formed and secretes progesterone; thickened cervical mucus; increase in BBT maintained; if no pregnancy- CL regresses and progesterone decreases; ends with onset of menses
Uterine cycle
defined by endometrial changes during menstruation; proliferative phase, secretory phase, and menstruation
Proliferative phase of uterine cycle
estrogen influence; endometrium grows and thickens; lasts around 10 days from end of menses to ovulation- during follicular phase
Secretory phase of uterine cycle
progesterone influence; endometrial hypertrophy; lasts around 12-16 days, from ovulation to menses- during luteal phase; increased vascularity that is favorable for implantation
Menstruation phase of uterine cycle
around 3-6 days, declining progesterone from CL; endometrium undergoes involution, necrosis, and sloughing
Well Woman Visit: 13-20yrs old
no pelvic/breast exam unless indicated; screen for GC/CZ and HIV if sexually active; review safe sex practices and expected body changes in puberty; HPV vaccine
Well Woman Visit: 21-29yrs old
menstrual/sexual hx; CBE per ACOG, not recommended per USPSTF/ACS for average risk women; pelvic/Pap exam; GC/CZ if 25 or younger or risk factors; HIV screen; family planning
Well Woman Visit: 30-49yrs old
mentrual/sex/gyn hx;CBE per ACOG, not recommended per USPSTF/ACS for average risk women; pelvic/Pap exam; mammogram at 40 per ACOG, 45 per ACS, biennial screening from 50-74 for average risk; perimenopause expected changes
BRCA 1 and BRCA 2
Lifetime risk of breast cancer with BRCA1 mutation on average is 55% to 65% but may be as high as 80%; risk with BRCA2 mutation is around 45%; lifetime risk without mutation is 13%
Pap Test
instruct pt to avoid douching, intercourse, and use of vaginal creams 48hr before; entire squamocolumnar junction sampled to avoid false negative; endocervical sampling with broom/cytobrush
Wet mount
obtain from posterior fornix and lateral vaginal walls; one sample with saline; one sample with KOH to facilitate visualization of yeast buds and pseudohyphae as well as for a whiff test
Warning signs with COC use
ACHES: abdominal pain, chest pain, headache, eye problems, severe leg pain
Cervical Cap
Can be used for 1-2 years; Wait until 6 weeks postpartum to fit; insert at least 30min prior to sex; fill 1/3 cap with spermicide; leave in place for 6 hours but no more than 48hrs; do not use during any vaginal bleeding
Diaphragm
more effective than cervical cap; can use for 1-2years; increased risk for VB and UTI; wait 6 weeks postpartum to fit; insert just prior to or up to 6hrs before sex; 1tbs of spermicide; if repeated intercourse do not have to remove just add more spermicide; leave in place for at least 6hrs after sex but no longer than 24hours….same for the sponge except sponge has spermicide in it
What 4 bones make up the pelvis?
two innominate bones (hip bones), sacrum and coccyx
What is the definition of infertility if woman is <35 years old and >35 years old?
1 year of unprotected sex if <35 years old
6 months of unprotected sex if >35 years old
How to manage/treat ovulatory dysfunction as cause of infertility?
Ovulation induction therapy with clomiphene citrate (clomid) or letrozole (femara)
How to manage/treat luteal phase defect as cause of infertility?
vaginal or IM progesterone
How to manage/treat tubal occlusion/obstruction as cause of infertility?
surgery
When is intrauterine insemination appropriate?
If male has oligospermia but female has normal evaluation, can separate motile sperm and combine with ovarian stimulation
Can also be used in woman who does not have a sperm-producing partner
What are 3 examples of assisted reproductive technology (ART)?
In vitro fertilization (IVF), gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer.
GIFT has the highest success rate at 25%
How does copper releasing IUC (paragard) prevent pregnancy?
Copper inhibits sperm capacitation. Alters tubal/uterine transport of ovum
How does the LNG-IUS (mirena, skyla, liletta, kyleena) prevent pregnancy?
thickens cervical mucus, inhibits sperm motility and function, produces atrophic endometrium and slows ovum transport through tube
Warning signs of issues with IUDs? PAINS?
Period late/missed, abnormal spotting/bleeding Abdominal pain Infection- vaginal discharge Not feeling well- fever, aches, chills String missing, shorter or longer
How does progestin only implant (Nexplanon) work?
By suppressing LH and therefore ovulation, producing atrophic endometrium and thickened cervical mucus
Warning signs of issue with Nexplanon?
Abdominal pain (severe) Arm pain or signs of infection Heavy vaginal bleeding Missed menses after period regularity Onset of severe headaches
How does estrogen in a COC work? and what is the most common one used?
Inhibits ovulation through suppression of FSH and also stabilizes the endometrium for less scheduled bleeding Ethinyl estradiol (E2)
How does progestin in a COC work?
Inhibits ovulation through suppression of LH surge, inhibits sperm penetration by thickening cervical mucus
Progestins provide most of the contraceptive effect
Which progestin generation has the lowest potency and short half life?
1st generation (norethindrone, norethindrone acetate and ethynodiol diacetate)
Which progestin generation is more potent with a longer half life to decrease unscheduled bleeding but also creates more androgenic side effects?
2nd generation (norgestel, levonorgestrel)
What is the perfect use/typical use failure rate for COCs/patch/Nuvaring/POPs?
Perfect use- 0.3%
Typical use- 9%
What is the perfect/typical use failure rate for Nexplanon?
0.05% for both
What is the perfect/typical use failure rate for Copper T and LNG-IUS?
Perfect 0.6% and 0.2%
Typical 0.8% and 0.2%
What is the quick start method for COCs/patch/Nuvaring/POP?
reasonably certain not pregnant. Take pill on day of office visit and use a backup method for 7 days if it has been >5 days since LMP
If a woman missed two pills but it has been <48 hours since last pill, what should she do? Same applies for patch and nuvaring
Take the late/missed pill ASAP and continue taking pills at usual time. Emergency contraception is usually not indicated unless pills were missed early in cycle or in the last week of previous cycle
If a woman missed two or more pills and it has been >48 hours since last pill, what should she do? Same applies for patch and nuvaring
Take most recent pill ASAP and continue taking pills at usual time. Use backup contraception for 7 days. Emergency contraception should be considered.
How does a POP work?
By thickening cervical mucus, producing atrophic endometrium and inhibiting ovulation
How does progestin only injectable contraception (depo provera) work?
By inhibiting ovulation through suppression of FSH/LH, producing atrophic endometrium and thickening cervical mucus
What are the perfect/typical use failure rates of depo?
Perfect use- 0.2%
typical- 6%
How often do women have to get a depo injection?
Every 3 months (13 weeks). If given within 15 weeks after last injection, she does not have to have additional contraception
How does emergency contraception work?
Inhibiting/delaying ovulation but will not disrupt established pregnancy
Which emergency contraception pills can be bought OTC?
Levonorgestrel pill (Plan B or generic)
How do vaginal spermicides work?
By destroying sperm cell membrane, active agent is nonoxynol-9
How many days past LMP can one do a medication abortion?
70 days from LMP
What medications are used for a medication abortion?
Mifepristone plus misoprostol OR methotrexate plus misoprostol (less commonly used)
Dilation and evacuation can be performed up to how many weeks gestation?
20 weeks
What is the most common contraceptive method among married women in the US?
Sterilization
If a woman is taking ulipristal acetate for emergency contraception because she was late starting her new COC pack and had unprotected sex, what should she do in terms of starting her COCs and use of a backup method?
Abstain from sex or use barrier method for 5 days and then restart COCs
Which polypeptide hormone is produced by the ovaries and stimulates FSH production?
Activin
What vaginal organism is responsible for an acidic pH?
Lactobacilli
Where does squamous metaplasia of the cervix occur?
transformation zone
What hormone causes estrogen to be released in the ovary?
FSH
Which androgen can be converted to estradiol?
Testosterone
Which phase of the menstrual cycle is the most variable?
Follicular
Which hormone is dominant during the proliferative phase of the menstrual cycle?
Estrogen
What does the term spinnbarkeit refer to in terms of cervical mucus?
Elasticity
What effect can COCs have on bronchodilators?
They can potentiate the action of it
What is the MOA of misoprostol in medically induced abortion?
Stimulation of uterine contractions
Increased production of which hormone is associated with primary dysmenorrhea?
Prostaglandin
How soon after exposure to genital herpes can a test be done to assess antibodies?
1-2 months via a type specific serologic test
What anatomic area contains the urethral/vaginal openings, Skene’s glands and Bartholin’s gland?
Vestibule
If you are three or more hours late taking your POP, what should you do?
Use a backup method for 48 hours
When in regards to ovulation does BBT rise?
After ovulation has occurred
How does the calendar method work?
Have women chart periods for a couple of months. Subtract 11 days from longest period and 18 from shortest and have her avoid unprotected sex during those times.
