Minor Ailments - Women's health Flashcards
1
Q
How to question for women’s health?
A
- Approach sensitively=personal topic for women
- Offer a confidential space
- Establish rapport
- Thorough questioning, accurate history = May have to ask sensitive quetsions, durations & other symptoms
- Sexual history – sexually transmitted infections
(STIs) i.e How many partners, married, who partner is(gender) , age of partner(potential for abuse), Abortions, given birth
2
Q
What is Bacterial vaginosis (BV)?
A
- Overgrowth of anaerobic bacteria (gardnerella vaginalis) and loss of lactobacilli in the vagina, pH increases to over 4.5
- Approx 50% of women with BV are asymptomatic
- Most common cause of abnormal vaginal discharge in women of child bearing age
- BV not sexually transmitted but more common in sexually active women, considered ‘sexually associated’
- Women with BV are at increased risk of STIs
- Vaginal swab & test pH to diagnise though this can not be done in the community
3
Q
What are the symptoms of BV?
A
- Strong fishy smelling vaginal discharge
- Discharge -grey/white colour, thin/watery consistency
- Usually no vaginal soreness, itching or irritation
4
Q
What causes of BV?
A
-Use of vaginal washes, douches= washes away protective lining for the vagina
- Being sexually active
- Concurrent STI
- Menstruation
- Smoking
- Copper intrauterine device = contraceptive device
5
Q
How to manage BV?
A
- Asymptomatic ( no symptoms) – do not treat
- OTC products- lactic acid based, restore normal pH
- 1st line – Oral metronidazole (POM) 400mg twice a day for
5-7 days (or single dose of 2g) - 2nd line – Intravaginal metronidazole gel (POM) or
clindamycin cream (POM) - 2nd line = if 1st line dosen’t work or red flag s= refer to GP for prescription
6
Q
What is candida or thrush?
A
- Thrush, Genital thrush, Vulvovaginal candidiasis
- Inflammation of the vagina and/or vulva caused by a fungal infection, usually candida albicans
- Up to 20% of women have candida part of normal
flora, overgrowth causes infection and symptoms - More common in women of child bearing age
- Very common, over diagnosed
- Approx 75% of women will experience candida once
- Recurrent infection - 4 or more episodes in 1 year
- Cold be an undelrying cause = i.e diabets= hgih blood glucose = good enviorment for thrush
7
Q
What are the symptoms of candida/ thrush?
A
- White discharge (usually no odour)
- Vaginal itching and irritation
- Dysuria = pain passing urine
- Pain during sexual intercourse
- Dysturia can also be symptoms of other thigs i.e STI’s so do they have other symptoms
8
Q
What cause candida/ thrush?
A
- Recent antibiotic use
- Local irritants: soaps, shampoo, shower gels
- Pregnancy
- Uncontrolled diabetes = good environment for thrush
- Immunocompromised
- Combined oral contraceptive pill = additional oestrogen
9
Q
How to manage candida/ thrush?
A
- 1st line -Fluconazole 150mg capsule (P) one dose OR
clotrimazole 500mg pessary (P) one at night equally effective,
clotrimazole gives more rapid relief
AZOLE = drug class - Pessaries work faster
- External itching – also offer clotrimazole 2% cream (P)
- Personal preference
- Drug interactions = Azoles interact w/ many med i.e carbamazepine = increase conc of carbemazeibine & decreases effect
- Treat partner if symptomatic = can be passed onto partner via sex
10
Q
How to adminster pessaries?
A
- Wash hands
- Remove the pessary from packaging, place into
applicator. Applicators are not always supplied - Lie on back with knees drawn towards chest,
insert applicator deeply in vagina as comfortable - Slowly press plunger of applicator until stops,
remove and dispose of applicator - Remain in supine position
- Can use lube to help w/ ease of insertion
- Insert via narrow end
11
Q
Prevent thrush via self care
A
- Avoid irritants: fragranced soaps, shower gels, bubble bath, shampoo
- Avoid tight clothing – underwear, jeans
- Thrush thrives in warm environments
12
Q
when to refer candida/thrush?
A
- Women under 16 or over 60 years = unlikley to be thrush as there is less oestrogen
- Recurrent infections
- Failed treatment= Thrush is resistant or wrong diagnosis
- Systemically unwell – fever
- Pelvic inflammatory disease (PID) – abdominal pain,
pain during intercourse, abnormal vaginal bleeding = Infection of female reporductive system - History of STIs = Can get overlap of symptoms
- Pregnant women
- Diabetic patients = likely that diabets = uncorntrolled & needs to be managed
13
Q
Testing for candida/thrush = Home test kits
A
- can be brought OTC
- Differentiate between thrush and BV
- Self test, vaginal swab, results in 10 seconds
- Based on vaginal pH and symptoms
- Back of box/ container guides you through the reuslts
14
Q
What other proudcts are availble for candida /thrush?
A
- Cleansing washes, wipes (GSL)
- Probiotics for vaginal use (GSL) = restores normal flore = not much evidence to support
- Local anaesthetic cream e.g. Vagisil (lidocaine)
(GSL) = helps w/ vaginal itching = numbs the area i.e vagisil
15
Q
What is Cystitis?
A
- Lower urinary tract infection
- Inflammation of urethra and bladder
- Bacteria from the GI tract, usually E.coli
- More common in women as shorter urethra
- Usually affects 15 – 34 years old’s = women of childbearing age
- 20 to 50% of all women experience at least once
- Not so common in men = refer men
16
Q
What are the symptoms of cystitis?
A
- Dysuria = pain urinating
- Urinary frequency
- Urinary urgency
- Nocturia = peeing more at night
- Haematuria = Blood in urine
- Lower back pain
- Change in urine appearance – cloudy
17
Q
What causes cystitis?
A
- Prior UTI’s
- Pregnancy
- Use of catheters = inserting can increae risk of infection
- Undiagnosed diabetes
- Increased sexual activity
- Immunocompromised
- Structural abnormalities
18
Q
How to manage cystitis?
A
- Acute cystitis usually resolves in a few days
- OTC: alkalinising agents (P) – sodium citrate, sodium bicarbonate, potassium citrate , 2 day treatment course= 3 sachets one day, 3 sachets the next day
- Restore normal urine pH
- Limited evidence and efficacy
- Caution – hypertension, heart disease, renal impairment = contains lots of sodium so can affect high bp
- Cranberry juice – ineffective, interacts with warfarin
19
Q
Managing cystitis
A
- Urine dipstick, urine sample for culture – help diagnose
- Non pregnant women:
- asymptomatic – do not treat
- symptomatic – immediate or delayed antibiotics = for sevre symptoms
- Antibiotic choice – local guidelines
- 1st line – Nitrofurantoin (POM) MR 100mg twice daily for 3
days OR Trimethoprim (POM) 200mg twice daily for 3 days - Self care: hydration, (urinating more) pain relief – paracetamol or ibuprofen
- if recurrent you can give for 5-7 days
20
Q
When to refer Cystitis?
A
- Children under 12, elderly women, men
- Duration of 7 days or more = resistance or wrong diagnosis
- Pregnancy = risk of complications is higher
- Pyelonephritis - fever, flank pain, nausea,vomiting = Infection of the kidney , bacteria has travelled up & is affecting the kidney
- Treat promptly w/ antibiotics
- Haematuria = blood in urine
- Diabetic patients
- Vaginal discharge
21
Q
What is Primary dysmenorrhoea (PD)
period pain?
A
- Menstrual cycle usually lasts 28 days, can vary from
21 – 45 days - Menstruation lasts 3-7 days
- PD affects between 16-91% of menstruating women
- 7-15% have severe debilitating pain
- More common in adolescents and early twenties
- Production of uterine prostaglandins during
menstruation which causes uterine muscle contractions and pain
22
Q
What are the symptoms of Primary dysmenorrhoea (PD)
period pain?
A
- Painful cramping – lower abdomen, start shortly before and/or during menstruation, lasts 72 hours after menstruation begins
- Pain may radiate to back, inner thigh
- Nausea, vomiting
- Irritability
- Headache
23
Q
What are the causes of Primary dysmenorrhoea (PD)
A
- Family history of dysmenorrhoea
- Menstruation at early age
- Heavy menstrual flow
- Nulliparity= Not yet had a child or gotten pregnant
24
Q
How to manage Primary dysmenorrhoea (PD)
period pain?
A
- Local application of heat – hot water bottle, heat patch
- Transcutaneous electrical nerve stimulation (TENS) =* Blocks the pathway where the pain goes through to the brain so brain doesn’t perceive pain as much
- 1st line – NSAID Ibuprofen 200mg (GSL/P) – 400mg (P) three times a day and/or paracetamol (GSL/P) 1g four times a day = Thins the lining of the uterus where the prostaglandins are found this reduces the uterine contractions & bleeding
- Hormonal contraception
25
Q
When to refer Primary dysmenorrhoea (PD/ period pain?
A
- Women over 30 years = unlikely to experince heavy period pain
- Systemically unwell – fever, malaise
- Pain that increases with onset of menstruation = should decrease may be another cause
- Pain not consistent with menstruation
- Pain last throught the month or long lasting even after period
- Heavy or unexplained bleeding
26
Q
what is menopause?
A
- No menstruation (amenorrhoea) for 12 months
- Mean age is 51 years
- No longer ovulate, decline in levels of oestrogen and progesterone
- Perimenopause - transition to menopause, on average 4 years = Not having regular periods
27
Q
Menopause
A
- 90% of women get menopausal symptoms
- 10% leave work
- 14% of women use hormone replacement therapy (HRT) in the UK
- HRT - replaces hormones oestrogen,progesterone and occasionally testosterone = taking artificial forms of the hormone to prevent symptoms
- HRT is not a form of contraception = potentila to get pregnant until they reach menopause
28
Q
Menopause awareness
A
- BMS= Brithish Menopause Society
- Women’s Health Concern
- IMS = International Menopause Society
- The menopause charity
- 18th oct = World Menopause day
29
Q
What are the Symptoms of Menopause?
A
- Brain fog
- Fatigue
- Hot flushes
- Irritabilty
- Loss of libido
- Anxiety & depression
- Insomnia
- many others
30
Q
How to manage menopause?
A
- HRT formulations (POM): tablets, gel, patches ( evorel), sprays, vaginal tablets
- Transdermal route preferred
- Type of HRT, dosage varies according to individual needs
- OTC – Gina vaginal tablets (P) (estradiol)
- Non HRT treatments - antidepressants = treaing the symptoms
- Self care: exercise, good sleep hygiene, wear light clothing
31
Q
NHS HRT prescription prepayment
certificate
A
- General prepayment certificate available, HRT prepayment
certificate newly introduced April 2023 - Help with prescription costs
- Valid for 12 months
- One off payment
- Unlimited number of certain HRT medicines
- Apply online – NHS Business Services Authority
