Gyn/Sexuality Module Flashcards
Clomiphene citrate:
Mechanism:
Used for?
Oral estrogen antagonist/agonist, increases gonadotropin
-Used to infertility
Absolute contraindications for OCPS
- Thromboembolic disorders (no risk with just Progesterone)
- Pregnancy
- Decreased liver function
- Smokers >35 years
- Known or suspected breast cancer
- Abnormal vaginal bleeding
OCP Mechanism of Action:
Estrogen + Progestin
Estrogen: Inhibits follicular maturation and selection of dominant follicle by decreasing FSH; also decreases breakthrough bleeding
Progestin: Prevents LH surge
Medroxyprogesterone acetate:
What is it and what is in it
Birth control shot
Progestin ONLY
May last up to 1 year
IUDS (Copper and Levonorgestrel)
When is it contraindicated?
Contraindicated in malshaped uterus, fibroids, active presence of gonorrhea or chlamydia
What is Leuprolide?
- Mechanism
- Indications
Leuprolide is a GnRH analogue. It suppresses pituitary LH and FSH release –> Leads to decrease in estrogen
Used to treat large submucosa fibroids
Side effects: vasomotor symptoms, decrease in bone density, insomnia, expensive
Can’t use longer than 6 months
Risk factors for Cervical Cancer?
Same risk factors as STDS: Women who have had multiple sex partners Begin sex at an early age Male sex partners with cervical cancer Current or Prior HSV infections Women who have HIV or history of STDS Smokers, abusers, immunocompromised
When is biopsy indicated for patients with breast cancer?
ALWAYS indicated in patients with suspicious physical exam and normal imaging
What is Lobular Carcinoma in situ a marker for?
It is a risk factor! Marker of increased risk or precursor of a potentially unstable breast
1 Risk factors for Breast Cancer
Age and Gender
Prognostic vs Predictive Factor
Prognostic: Relative benefit regardless of treatment (ex. HER-2 positive predictive and prognostic factor)
Predictive: relative benefit in terms of improved response to a specific Rx (Examples ER and PR positive tumors are predictive factors for therapy.
When do you do Manual Vacuum Aspiration?
Simplest, safest, least expensive - MUST exam aspirated tissue
Do in the first trimester, up to 5-10 from Last Menstrual Period.
Good for mothers who are Rh-
When do you do dilatation and curettage?
When is the procedure complete?
Also a vacuum. Do at a freestanding clinic.
MUST DILATE the cervix to perform the D&C
Procedure not complete until you provide adequate contraception
What is Mifepristone?
Progesterone antagonist - can give for those <9 weeks gestational age
Describe changes in menstrual cycle in Menopause
Have shortened cycles!
Fewer oocytes recruited –> decreased estradiol –> increased FSH
Higher FSH levels cause the follicles to mature faster and produce enough Estradiol to trigger an LH surge
Ovulation will occur 1 week early but Luteal phase remains the same
What site is infected with chlamydia in a 4 year old with Tanner 1 breast? Why?
Normal would infect the columnar epithelial of the cervix, but since there is no estrogen in a child of this age the squamous cells of the vagina are ‘thin’ and not cornified. So there is NO columnar epithelium on the cervix. Would see the infection in her VAGINA
Why don’t we do routine pap smears in adolescents?
Although HPV is high in adolescents, most will clear the infection and don’t develop cancer of the cervix
Endometrial adenocarcinoma: What features
NO STROMA
What is the most important risk factor for Ovarian cancer?
Age foo
Serous Tubal Intra-Epithelial Carcinoma (STIC)
Are ovarian inclusion cysts that might originate from epithelial lining of fallopian tube
Fimbril cell damage –> p53 mutation –> migration into the ovary
