OB Exam 4 Women's Health Flashcards
when should mammograms for breast cancer be?
- 40-45: Optional Yearly
- 45-54: Yearly
- 55+: Every 2 years
- High Risk – Breast MRI and Mammogram Yearly – Age 30+
when should screenings for cervical cancer be?
- 21-29 years: Pap Test every 3 years
- 30-65 years: Pap Test + HPV test every 5 years
- > 65 years: screening is unnecessary if no precancerous cells in past 20 years
who is at risk for breast cancer?
- -Have a known BRCA1 or BRCA2 gene mutation (based on having had genetic testing)
- -Have a first-degree relative (parent, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves
- -Had radiation therapy to the chest when they were between the ages of 10 and 30 years
what is menarche
- -Girls: Ages 8-13
- -Menarche: Initial Menstrual Period
- -Occurs 2-2.5 years after the beginning of puberty
what triggers puberty
- -Puberty triggered by the production of gonadotropin-releasing hormone from the hypothalamus→
- -Gonadotropins stimulate the ovaries to secrete estrogen🡪
- -Estrogen → development of secondary sex characteristics
what is menopause
Menopause = Permanent cessation of menstrual activity
–Natural, biological process occurring between ages 35-58
what are the 3 stages of menopause
- perimenopause
- menopause
- postmenopause
what is perimenopause
Perimenopause (BEFORE)
- -40’s
- -Lasts 4-8 years
- -Irregular Menstrual Cycles
- -Pregnancy still possible
what is menopause
Menopause (DURING)
- -12 months after LMP (last mens period)
- -Average age: 51 (48-58)
what is postmenopause
Postmenopause (AFTER)
- -Time after menopause
- -no period
what happens in 30s regarding ova?
in 30s → decline of ova →gradual decline in estrogen and progesterone production
what are sx of menopause
- -anovulatory = menstrual cycle changes
- -Hot Flashes
- -Night Sweats
- -Sleep Disturbances
- -Sexual Dysfunction
- -dyspareunia
- -Hair Loss/Hair Thinning
- -Food Cravings
- -Dry Skin/Loss of Skin Elasticity
- -Weight Gain – Hips/Waist
- -Irregular Heartbeat/Palpitations
what are triggers of hot flashes
Warm Rooms
Alcohol & Caffeine
Hot/Spicy Foods
Stress
what is dyspareunia from vaginal atrophy
painful intercourse from changes in estrogen→ not lubricated
– from vaginal atrophy
what are psychological sx of menopause
Mood Swings Irritability Anxiety Lack of Energy Panic Attacks Forgetfulness Difficulty Coping Depression
what are lifestyle changes to treat menopausal sx?
8 hours of sleep/night Balanced Diet Weight Management Exercise Avoid Caffeine/Alcohol Avoid Smoking
What are 3 treatments for menopause sx
- -lifestyle changes
- -menopause hormone therapy
- -alternative medicine
what is menopause hormone therapy (MHT)
Estrogen Replacement
Oral, Transdermal, Vaginal
Non-Hysterectomy:
–Progesterone + Estrogen: Prevents Uterine Cancer
what are alternative medicine tx for menopause
Herbal Supplements
Acupuncture
Hypnosis
Biofeedback
osteoporosis
Loss of bone mass that occurs when more bone mass is absorbed than the body creates
when does the decline of bone mass start
35
what is a DEXA scan
Dual Energy X-Ray Absorptiometry
–Measures bone density in the hip, spine, and forearm
score difference between osteoporosis and osteopenia
> = -2.5: Osteoporosis
-1 to -2.5: Osteopenia
what are manifestations of osteoporosis
- -loss of height(collapsed vertebrae)
- -back pain (collapsed vertebrae)
- -stopped posture (collapsed vertebrae)
- -bone fractures (bone weakness)
risk factors for osteoporosis
- -caucasian
- -hip fractures
- -smoking
- -inactive lifestyle
- -Ca and vitD deficiency
- -alcohol 3/more drinks/day
- -BMI over 20
- -anorexia
- -weight loss surgery
- -meds (prednisone, aromatase inhibitors, proton pump inhibitors)
what 3 meds are risk factors for osteoporosis
- -Corticosteroids (prednisone)
- -Aromatase inhibitors
- -Proton Pump Inhibitors
how to decrease risk of osteoporosis
- -Diet high in Calcium/Vitamin D
- -Weight-bearing exercise 3-4x/week
- -Avoid Smoking
- -Limit Alcohol Use–leads to lower bone density
drug for osteoporosis and action
Biphosphonates
–Fosamax (Alendronate), Boniva (Ibandronate)
–Action: Inhibits resorption of bone
SEs of biphosphonates for osteoporosis
Musculoskeletal aches & pains
GI irritation
Esophageal ulcers
considerations for biphosphonate administration
- -Empty Stomach – 30 mins before breakfast
- -8oz water – not juice, coffee, tea
- -Take medication in a sitting or standing position
- -Remain upright for 30 minutes to decrease reflux
infertility
–Infertility = The inability to conceive and maintain a pregnancy after 12 months of unprotected sexual intercourse
–6 months if older than 35
causes of female factors of infertility vs male
1/3 female factors
- -Ovulatory Dysfunction
- -Tubal Damage
- -Cervical (Infection, Surgery)
1/3 male factors
- -Endocrine
- -Spermatogenesis
1/3 combo male/female
what are details of male causative factors for infertility
- Endocrine causes include pituitary diseases, pituitary tumors, and hypothalamic diseases that may interfere with male fertility. Low levels of LH, FSH, or testosterone can also decrease sperm production.
- Spermatogenesis–chemotherapeutics, calcium channel blockers, heroin, and alcohol; Infections/viruses; prolonged testicular heat exposure; pesticide exposure, radiation
- Sperm antibodies are an immunological reaction against the sperm that causes a decrease in sperm motility.
- Sperm transport factor includes missing or blocked structures in the male reproductive anatomy that interfere with sperm transport (prostatectomy)
- Disorders of intercourse include erectile dysfunction (inability to achieve and/or maintain an erection), ejaculatory dysfunctions (retrograde ejaculation), anatomical abnormalities (hypospadias), and psychosocial factors that can interfere with fertility.
what are details of female causative factors for infertility
- Ovulatory dysfunction includes anovulation or inconsistent ovulation from Hormonal imbalances; Hyperthyroidism/ hypothyroidism; High prolactin levels; Premature ovarian failure (menopause prior to age 40); Polycystic ovarian syndrome
- Tubal and pelvic pathology factors include damage to the fallopian tubes and uterine fibroids.
- Cervical mucus factors include infection and cervical surgeries such as cryotherapy, a medical intervention used to treat cervical dysplasia. These factors may interfere with the ability of sperm to enter or survive in the uterus.
what are male risks for infertility
Environmental pollutants Heavy use of alcohol, THC, cocaine Impotence Older age STIs Smoking
what are female risks for infertility
Autoimmune Disorders Diabetes Eating disorders, poor nutrition Excessive alcohol use Excessive exercising Hx of cancer treated with radiation, chemotherapy Obesity Older age STI’s
what are tests to determine infertility
- Screening for STI’s
- Laboratory Tests: TSH, FSH, LH, Testosterone
- Semen Analysis
- Ovulatory Dysfunction Analysis
what 4 things are part of an Ovulatory Dysfunction Analysis
BBT
Ovulatory Prediction Kits
Ovarian Reserve Testing
Detecting LH Surge
what are the emotional implications of infertility
roller coaster effect, relationship crisis, emotions, self esteem issues
Male treatments for infertility
- -Hormonal Therapy = endocrine factors
- -Lifestyle Changes = correct sperm count
- -Corticosteroids = decrease sperm antibodies
- -Antibiotics = clear UTI
- -Varicocele/Hernia Repair = facilitate sperm transport
Female treatments for infertility regarding anovulation
Anovulation
- -Lifestyle Changes = stress, smoking, diet, drugs
- -Drug therapy to stimulate ovulation = clomiphene citrate (high success rate); letrozole; injectable gonadotropins; gonadotropin-releasing hormone [GnRH] pump; and bromocriptine
- -Surgery to open fallopian tubes
- -Myomectomy = removal of uterine fibroids
- -Antibiotics = infection of cervix
What is Clomid (Clomiphene Citrate) for and how does it work?
- -Indication: for anovulatory Infertility
- -Action: Stimulates release of FSH and LH, which stimulates ovulation
- -Cycle day 3-7
What are SEs of Clomiphene Citrate
Hot Flashes Breast Discomfort Headaches Insomnia Bloating Blurry Vision Nausea Vaginal Dryness
What are 3 ART: Assisted Reproductive Technologies for infertility
- -Artificial Insemination (AI) = sperm put into cervix
- -In Vitro Fertilization – IVF = oocytes harvested and fertilized in lab
- -Embryo Transfer = embryo placed in uterus
what are ethical implications of Assisted Reproductive Technologies for infertility
- -Surplus Embryos
- -Ownership of Embryos
- -Access - Cost
what is artificial insemination
sperm from masturbation put into cervix
what is IVF
oocytes harvested and fertilized in lab
what is embryo transfer
embryo placed in uterus
what are diagnostic procedures for infertility
- -Bone Mineral Densitometry
- -Breast Biopsy/Aspiration
- -Cervical Conization
- -Colposcopy
- -Dilation & Curettage
- -Endometrial Biopsy
- -Laparoscopy
- -MRI
- -Ultrasonography
what does a bone mineral density test find
- -Diagnose bone loss and osteoporosis
- -Assess effectiveness of osteoporosis medication therapy
- -Predict risk of future bone fractures
what is a DEXA scan and considerations regarding supplements and metal
Dual-energy x-ray absorptiometry (DXA) Scan
- -X-ray is usually of the lower spine and hip
- -Remove metal from X-Ray area
- -No calcium supplements for 24 hours before exam
why are breast bx done
Breast abnormality noted by palpation, mammography, or ultrasound
–BIOPSY USED FOR DX
what is a colposcopy and what is it used for
–Speculum for visualization of vagina/cervix
Acetic Acid placed on the cervix
Colposcope – microscope with light
Biopsy of whitest area
–indicated for Dysplasia, condylomas, and abnormal Pap smear, used to rule out cancer of the cervix
what is cervical conization (cone bx or LEEP procedure)
Removal of a cone-shaped portion of cervical tissue
what is a LEEP procedure
Loop Electrosurgical Excision Procedure (cuts wedge of cervix and cauterizes at same time)
–AKA cone biopsy/conization
why do a conization procedure
for bx of abnormal Pap Smear to detect cervical cancer or for treatment of a cervical intraepithelial lesions
what is dilation & curettage for
- -Detect uterine malignancy
- -Evaluate fertility
- -Evaluate dysfunctional uterine bleeding
- -placental fragments tx
- -Molar pregnancy tx
what is a therapeutic reason for dilation and curettage
to treat heavy uterine bleeding, dysmenorrhea, and incomplete abortion
hysterectomy
Surgical Removal of the Uterus
reasons for hysterectomy
- -Leiomyomas (fibroids)
- -Endometriosis
- -Prolapsed Uterus
what are the 4 types of hysterectomy
- -Supracervical or Partial
- -Total Hysterectomy or “Simple”
- -Hysterectomy with Bilateral Salpingo-Oophorectomy
- -Radical Hysterectomy
what therapy is used if ovaries are removed
Hormone replacement therapy
what are surgical techniques for hysterectomy
- -Abdominal Hysterectomy (preferred)
- -Vaginal Hysterectomy
- -Laparoscope-Assisted Vaginal Hysterectomy (LAVH)
- -Robotic-Assisted Laparoscopic Hysterectomy
what are risks of surgery for hysterectomy
- Injury to ureters, bladder, bowel
- Hemorrhage
- Infection
- DVT
what is a risk of Laparoscope-Assisted Vaginal Hysterectomy (LAVH)
bladder injury and UTI
what position is woman in for Robotic-Assisted Laparoscopic Hysterectomy
Trendelenburg
what is Primary Dysmenorrhea
- -Painful menstruation: Cramping usually begins 12–24 hours before onset of flow and lasts 12–24 hours.
- -chills, nausea, vomiting, headaches, irritability, and diarrhea.
- -Excessive endometrial production of prostaglandin; women with primary dysmenorrhea produce 10 times the amount of prostaglandin. Prostaglandin is a myometrial stimulant and vasoconstrictor
what is Secondary Dysmenorrhea
–Painful menstruation associated with known anatomic factors or pelvic pathology.
Pain can be present at any point of the menstrual cycle.
--Related to: • Endometriosis • Pelvic adhesions • Inflammatory disease • Cervical stenosis • Uterine fibroids • Adenomyoma
what is PMS
Premenstrual syndrome = A combination of emotional and physical symptoms that begin during the luteal phase and diminish after menstruation begins.
s/sx
–lower abdominal and back pain, bloating, weight gain, breast tenderness, joint and muscle pain, oliguria, diaphoresis, diarrhea, constipation, nausea, vomiting, food cravings, acne, urticaria, headaches, vertigo, fainting, clumsiness, mood swings, depression, irritability, anxiety, lethargy, fatigue, confusion, tension, forgetfulness, sexual arousal or dysfunction
what is menorrhagia
heavy or prolonged menstrual bleeding