OB Exam 4 Women's Health Flashcards
1
Q
when should mammograms for breast cancer be?
A
- 40-45: Optional Yearly
- 45-54: Yearly
- 55+: Every 2 years
- High Risk – Breast MRI and Mammogram Yearly – Age 30+
2
Q
when should screenings for cervical cancer be?
A
- 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
3
Q
who is at risk for breast cancer?
A
- -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
4
Q
what is menarche
A
- -Girls: Ages 8-13
- -Menarche: Initial Menstrual Period
- -Occurs 2-2.5 years after the beginning of puberty
5
Q
what triggers puberty
A
- -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
6
Q
what is menopause
A
Menopause = Permanent cessation of menstrual activity
–Natural, biological process occurring between ages 35-58
7
Q
what are the 3 stages of menopause
A
- perimenopause
- menopause
- postmenopause
8
Q
what is perimenopause
A
Perimenopause (BEFORE)
- -40’s
- -Lasts 4-8 years
- -Irregular Menstrual Cycles
- -Pregnancy still possible
9
Q
what is menopause
A
Menopause (DURING)
- -12 months after LMP (last mens period)
- -Average age: 51 (48-58)
10
Q
what is postmenopause
A
Postmenopause (AFTER)
- -Time after menopause
- -no period
11
Q
what happens in 30s regarding ova?
A
in 30s → decline of ova →gradual decline in estrogen and progesterone production
12
Q
what are sx of menopause
A
- -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
13
Q
what are triggers of hot flashes
A
Warm Rooms
Alcohol & Caffeine
Hot/Spicy Foods
Stress
14
Q
what is dyspareunia from vaginal atrophy
A
painful intercourse from changes in estrogen→ not lubricated
– from vaginal atrophy
15
Q
what are psychological sx of menopause
A
Mood Swings Irritability Anxiety Lack of Energy Panic Attacks Forgetfulness Difficulty Coping Depression
16
Q
what are lifestyle changes to treat menopausal sx?
A
8 hours of sleep/night Balanced Diet Weight Management Exercise Avoid Caffeine/Alcohol Avoid Smoking
17
Q
What are 3 treatments for menopause sx
A
- -lifestyle changes
- -menopause hormone therapy
- -alternative medicine
18
Q
what is menopause hormone therapy (MHT)
A
Estrogen Replacement
Oral, Transdermal, Vaginal
Non-Hysterectomy:
–Progesterone + Estrogen: Prevents Uterine Cancer
19
Q
what are alternative medicine tx for menopause
A
Herbal Supplements
Acupuncture
Hypnosis
Biofeedback
20
Q
osteoporosis
A
Loss of bone mass that occurs when more bone mass is absorbed than the body creates
21
Q
when does the decline of bone mass start
A
35
22
Q
what is a DEXA scan
A
Dual Energy X-Ray Absorptiometry
–Measures bone density in the hip, spine, and forearm
23
Q
score difference between osteoporosis and osteopenia
A
> = -2.5: Osteoporosis
-1 to -2.5: Osteopenia
24
Q
what are manifestations of osteoporosis
A
- -loss of height(collapsed vertebrae)
- -back pain (collapsed vertebrae)
- -stopped posture (collapsed vertebrae)
- -bone fractures (bone weakness)
25
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)
26
what 3 meds are risk factors for osteoporosis
- -Corticosteroids (prednisone)
- -Aromatase inhibitors
- -Proton Pump Inhibitors
27
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
28
drug for osteoporosis and action
Biphosphonates
--Fosamax (Alendronate), Boniva (Ibandronate)
--Action: Inhibits resorption of bone
29
SEs of biphosphonates for osteoporosis
Musculoskeletal aches & pains
GI irritation
Esophageal ulcers
30
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
31
infertility
--Infertility = The inability to conceive and maintain a pregnancy after 12 months of unprotected sexual intercourse
--6 months if older than 35
32
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
33
what are details of male causative factors for infertility
1. 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.
2. Spermatogenesis--chemotherapeutics, calcium channel blockers, heroin, and alcohol; Infections/viruses; prolonged testicular heat exposure; pesticide exposure, radiation
3. Sperm antibodies are an immunological reaction against the sperm that causes a decrease in sperm motility.
4. Sperm transport factor includes missing or blocked structures in the male reproductive anatomy that interfere with sperm transport (prostatectomy)
5. 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.
34
what are details of female causative factors for infertility
1. 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
2. Tubal and pelvic pathology factors include damage to the fallopian tubes and uterine fibroids.
3. 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.
35
what are male risks for infertility
```
Environmental pollutants
Heavy use of alcohol, THC, cocaine
Impotence
Older age
STIs
Smoking
```
36
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
```
37
what are tests to determine infertility
- Screening for STI’s
- Laboratory Tests: TSH, FSH, LH, Testosterone
- Semen Analysis
- Ovulatory Dysfunction Analysis
38
what 4 things are part of an Ovulatory Dysfunction Analysis
BBT
Ovulatory Prediction Kits
Ovarian Reserve Testing
Detecting LH Surge
39
what are the emotional implications of infertility
roller coaster effect, relationship crisis, emotions, self esteem issues
40
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
41
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
42
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
43
What are SEs of Clomiphene Citrate
```
Hot Flashes
Breast Discomfort
Headaches
Insomnia
Bloating
Blurry Vision
Nausea
Vaginal Dryness
```
44
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
45
what are ethical implications of Assisted Reproductive Technologies for infertility
- -Surplus Embryos
- -Ownership of Embryos
- -Access - Cost
46
what is artificial insemination
sperm from masturbation put into cervix
47
what is IVF
oocytes harvested and fertilized in lab
48
what is embryo transfer
embryo placed in uterus
49
what are diagnostic procedures for infertility
- -Bone Mineral Densitometry
- -Breast Biopsy/Aspiration
- -Cervical Conization
- -Colposcopy
- -Dilation & Curettage
- -Endometrial Biopsy
- -Laparoscopy
- -MRI
- -Ultrasonography
50
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
51
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
52
why are breast bx done
Breast abnormality noted by palpation, mammography, or ultrasound
--BIOPSY USED FOR DX
53
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
54
what is cervical conization (cone bx or LEEP procedure)
Removal of a cone-shaped portion of cervical tissue
55
what is a LEEP procedure
Loop Electrosurgical Excision Procedure (cuts wedge of cervix and cauterizes at same time)
--AKA cone biopsy/conization
56
why do a conization procedure
for bx of abnormal Pap Smear to detect cervical cancer or for treatment of a cervical intraepithelial lesions
57
what is dilation & curettage for
- -Detect uterine malignancy
- -Evaluate fertility
- -Evaluate dysfunctional uterine bleeding
- -placental fragments tx
- -Molar pregnancy tx
58
what is a therapeutic reason for dilation and curettage
to treat heavy uterine bleeding, dysmenorrhea, and incomplete abortion
59
hysterectomy
Surgical Removal of the Uterus
60
reasons for hysterectomy
- -Leiomyomas (fibroids)
- -Endometriosis
- -Prolapsed Uterus
61
what are the 4 types of hysterectomy
- -Supracervical or Partial
- -Total Hysterectomy or “Simple”
- -Hysterectomy with Bilateral Salpingo-Oophorectomy
- -Radical Hysterectomy
62
what therapy is used if ovaries are removed
Hormone replacement therapy
63
what are surgical techniques for hysterectomy
- -Abdominal Hysterectomy (preferred)
- -Vaginal Hysterectomy
- -Laparoscope-Assisted Vaginal Hysterectomy (LAVH)
- -Robotic-Assisted Laparoscopic Hysterectomy
64
what are risks of surgery for hysterectomy
- Injury to ureters, bladder, bowel
- Hemorrhage
- Infection
- DVT
65
what is a risk of Laparoscope-Assisted Vaginal Hysterectomy (LAVH)
bladder injury and UTI
66
what position is woman in for Robotic-Assisted Laparoscopic Hysterectomy
Trendelenburg
67
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
68
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
```
69
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
70
what is menorrhagia
heavy or prolonged menstrual bleeding
71
what is metrorrhagia
abnormal bleeding from the uterus from stress or meds or other
72
what is Primary Amenorrhea
absence of menses at age 15 years in the presence of normal growth and secondary sexual characteristics
73
what is secondary amenorrhea
the absence of three or more periods in a row by someone who has had periods in the past
74
what is PCOS
- -Polycystic Ovary Syndrome (Stein-Leventhal Syndrome)
- -Endocrine Disorder characterized by Elevated Estrogen, Testosterone, and LH and Decreased FSH
- -most common cause of female infertility
75
what are Multiple Follicular Cysts
PCOS
| --hormonal changes can cause multiple follicular cysts on one or both ovaries
76
what are risks of PCOS
Main 4:
- -Type 2 diabetes
- -Sleep Apnea
- -Hypertension
- -Infertility
- -Endometrial, ovarian, and/or breast cancer
- -Dyslipidemia
- -Infertility
- -Pregnancy and birth complications
- -Metabolic syndrome
- -Cardiovascular disease
77
what are clinical manifestations of PCOS
Main 4:
- -Infertility
- -Hirsutism
- -Obesity
- -Pelvic Pain
- -Menstrual Disorders
- -Ovarian Cysts
- -Oily Skin/Acne
- -Male-Pattern Baldness
78
what are 4 ways of managing PCOS
- -Diet & Exercise for Weight Loss = Chain Reaction
- -Hormone Therapy = Low-Dose Hormonal Contraceptive, anti-androgen meds
- -Fertility Therapy= Clomid; ART, IVF
- -Antidiabetic Medications = Metformin
79
what does hormone therapy do for PCOS
contraceptives inhibit LH production, decrease testosterone levels, and reduce the degree of acne and hirsutism.
80
what can diabetic meds do for PCOS
lower blood glucose levels and can lower testosterone, which reduces the degree of acne, hirsutism, and abdominal obesity and may help regulate the menstrual cycle and treat infertility.
81
what is endometriosis
- -Chronic Inflammatory Disease
| - -Presence & Growth of Endometrial Tissue Outside the Uterine Cavity (Endometrial Lesions)
82
lesions respond to changes in what hormones in endometriosis
estrogen
| progesterone
83
what is retrograde menstruation
in endometriosis, menstrual flow is reversed
- -Menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body
- -Cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
84
what are clinical manifestations of endometriosis
- -Pelvic pain and dysmenorrhea
- -Pelvic pressure
- -Dyspareunia
- -Infertility
- -Premenstrual spotting and menorrhagia
- -Low back pain
- -Diarrhea, pain with defecation, and constipation
- -Bloody urine and dysuria
- -Enlarged & tender ovaries
1/3 of people are asymptomatic
85
what is the medical management for endometriosis
- -Analgesic Therapy
- -NSAIDS
- -Hormonal Therapy = Goal: Suppress Menstruation & Tissue Growth, OCP’s, Progestins
- -Surgical Treatment = Laparoscopy Removal of Lesions; Hysterectomy w/Bilateral Salpingo-Oophorectomy
- -ART = IUI, IVF
86
for endometriosis, what is Laparoscopy Removal of Lesions
laparoscopy procedure and laser treatment is used for women with severe symptoms who are infertile and desire pregnancy.
Endometriosis may recur after surgical intervention.
87
for endometriosis, what is Hysterectomy w/Bilateral Salpingo-Oophorectomy
Hysterectomy with bilateral salpingo-oophorectomy and removal of adhesions and lesions is used for women with severe symptoms who do not desire pregnancy.
88
what is ovulation induction used for in women with endometriosis
Ovulation induction with intrauterine insemination or in vitro fertilization may be used for infertile women with endometriosis who have not responded to other therapies for infertility
89
what is pelvic organ collapse
- -Weakened Pelvic Muscles --> Pelvic Organs Descend into the Vagina
- -Can affect Bladder, Urethra, Uterus, Rectum
90
what are risk factors
- -Childbirth Trauma = Vaginal Birth, Large Babies, Forcep/Vacuum Deliveries
- -Stress/Strain = Heavy lifting, constipation, violent coughing
- -Obesity
- -Menopause
- -poor suturing/repair of episiotomies/lacerations
91
what is the effect of menopause on the pelvic floor muscles
Menopause: Low levels of estrogen weaken the pelvic floor muscles.
92
what is uterine prolapse
uterus comes out
93
what is prevention for uterine prolapse
- -Importance of Kegel Exercises
- -Treatment/Prevention of Constipation
- -Avoid Heavy Lifting
- -Weight Management
94
what is vaginal pessary used for for uterine prolapse
Vaginal pessary: A rubber or silicone-based ring placed in the vagina to support the uterus; effective for a mild degree of uterine prolapse
95
what surgery may be needed for uterine prolapse
hysterectomy may be needed
96
what are risk factors for breast cancer
- -Increasing Age (55+)
- -Genetic – BRCA1, BRCA2
- -Dense Breasts
- -Hx Breast CA
- -Head/Chest Radiation
- -Smoking, carcinogen exposure
- -Estrogen (early menarche, late menopause, hormonal therapy)
97
what does a breast ultrasound look for?
Breast ultrasounds assist in determining if the area of concern is a fluid-filled cyst or solid mass.
98
what is an MRI of the breast useful for?
MRI is useful in differentiating benign from malignant tissue, especially in women with dense, fibroglandular breasts; when scar tissue is present from previous breast surgery; and for new tumors in women who have had previous lumpectomy. Yearly screening MRI and mammogram are recommended for women at high risk for breast cancer
99
what do diagnostic mammograms of the breast show regarding a mass
size and character of the mass
100
what is a lumpectomy for breast cancer
Lumpectomy: The lump and an area of surrounding normal tissue are removed. This procedure is usually followed by radiation therapy.
101
what is a partial or segmental mastectomy for breast cancer
Partial or segmental mastectomy: The tumor, the surrounding breast tissue, a portion of the lining of the chest wall, and some of the axillary lymph nodes are removed. This procedure is usually followed by radiation therapy.
102
what is a simple mastectomy for breast cancer
Simple mastectomy: All the breast tissue along with the area surrounding the nipple and areola are removed. This procedure may be followed by radiation therapy, chemotherapy, or hormone therapy.
103
what is a modified radical mastectomy for breast cancer
Modified radical mastectomy: The entire breast and several axillary lymph nodes are removed; the chest wall is left intact.
104
what is external radiation for breast cancer
External radiation: A radiation therapy machine aims radiation toward the tumor. Treatments are given 5 days a week for 5 to 6 weeks.
105
what is internal radiation for breast cancer
Internal radiation (mammo site): A radioactive substance sealed in needles, seeds, wires, or a catheter is placed directly into or near the tumor. Treatments are given twice a day for 5 days for a total of 10 sessions.
106
what is post op care for breast cancer surgery
Precautions on affected side
| --tubes/drains
107
what are precautions to reduce risk of lymphedema
- -Exercise as directed on the affected side
- -Perform ADLS with affected side
- -No lab draws or Blood Pressures on affected side
- -Avoid Injury
- -Avoid Infection
- -Avoid Constriction/Tightness
- -Avoid Muscle Strain
108
what is the main cause of cervical cancer
HPV
| --slow growing starts with cervical dysplasia
109
what are risk factors for cervical cancer
- -HPV
- -Early Onset of Sexual Activity (<16)
- -Cigarette Smoking
- -Multiple Sex Partners
- -STI’s – Genital Herpes, Chlamydia
- -Weakened Immune System
110
what are clinical manifestations of cervical cancer
- -no sx during early stages
- -Abnormal Vaginal Bleeding between Periods, After Intercourse, After Menopause
- -dysparenuria
- -appetite/weight loss
- -pelvic/leg pain
- -Vaginal Discharge (watery, pink, brown, bloody, foul-smelling)
111
clinical manifestations of ovarian cancer
- -Vague – Difficult to Diagnose
- -Early Stages – Asymptomatic
- -Abdominal & Pelvic Pressure/Pain
- -Swollen, Bloated Abdomen
- -Urinary Urgency/Frequency
- -Difficulty Eating or Feeling Full Quickly
112
what are risk factors for ovarian cancer
- -Family History
- -Age >55
- -1st Term Pregnancy >35
- -BRCA1, BRCA2 genes
- -Personal History of Cancer
- -Obesity
- -Infertility Medication (>1 year)
113
what is family planning
Family Planning: the conscious decision on when to conceive or avoid pregnancy throughout the reproductive years
114
what is contraception
Contraception: Intentional prevention of pregnancy during sexual intercourse
115
what is birth control
Birth Control: device or practice used to decrease the risk of conceiving or bearing offspring
116
what are 4 roles of the nurse regarding contraception
Assess knowledge
Identify misconceptions
Provide education
Support
117
what are 5 considerations when choosing contraception
- -Reliability
- -Cost
- -Protection from STIs
- -Individual’s comfort level with the method
- -Partner’s willingness to use a particular method
118
what are 5 methods of contraception
```
Natural Methods
Barrier Methods
Hormonal Methods
Long-Acting Reversible Contraceptives
Sterilization
```
119
what are 4 natural contraception methods
Barrier Methods
Hormonal Methods
Long-Acting Reversible Contraceptives
Sterilization
120
what is abstinence
Refraining from sexual intercourse
| --The only form of birth control that is 100% effective
121
what is the fertility awareness method (FAM) for natural family planning
--calendar method, monitoring body functions (Temperature, Cervical Mucus: Color, Amount, Texture)
122
what are advantages and disadvantages of FAM
- -Advantages = No chemicals, easily available, aware of fertility
- -Disadvantages = Does not protect against STI’s, Rigorous monitoring, 24% failure rate
123
for natural family planning, how long to abstain from sex before and after ovulation (fertile period)
Abstain from intercourse for 4 days before and for 3-4 days after ovulation (fertile period)
124
what is the amount of days between the beginning and the end of the fertile period of the menstrual cycle
~ 12-14 days before the next period
125
what is the only acceptable contraception practice acceptable by the roman catholic church?
natural family planning
126
how to calculate the start of the fertile period
Subtract 18 days from # of days in the shortest cycle
127
how to calculate the end of the fertile period
Subtract 11 days from # days of the longest cycle
128
what is basal body temperature and when to take
BBT is the lowest body temperature of a healthy person
| --taken immediately after waking before getting out of bed
129
during ovulation, what does basal temperature show
Basal temperature may show slight increase at time of ovulation (<0.5 F)
**Practice abstinence at this time
130
what is the withdrawal method
- -Coitus Interruptus
- -Male partner withdraws his penis from the vagina before ejaculation occurs
- -least effective method
131
when is postpartum infertility and what causes this
less than 6 months from birth
| --Increased levels of prolactin inhibits production & secretion of gonadotrophin releasing hormone, LH, & FSH
132
what are the 5 barrier methods for contraception
```
Condoms
Vaginal Sponges
Cervical Caps
Diaphragms
Spermicides
`
```
133
what is the best barrier method of protection against STIs?
condoms
134
what are disadvantages of condoms
allergy, may disrupt intercourse
135
how long should vaginal sponges be left in after sex
6 hours, up to 30
136
what is an advantage of a vaginal sponge
no fitting needed
137
what is a disadvantage of a vaginal sponge
1x use only
138
how long should a cervical cap be left in
6 hours, up to 48
139
what are disadvantages of the cervical cap
- -Spermicide
| - -No protection against STIs
140
what is the diaphragm for contraception
dome-shaped cup placed over the cervix
| Used in combination with spermicide
141
when does the diaphragm need to be refitted
after birth or large weight gain/loss
| --annual gyn exam needed, should be replaced every 2 years and inspected before each use
142
how long can you leave diaphragm in after sex
6 hours
143
what are disadvantages of the diaphragm
- -May increase risk of yeast infection, cystitis, TSS – Toxic Shock Syndrome
- -Must be fitted by a provider
- -May increase infections, STIs
144
what is spermicide
Chemical placed into the vagina before intercourse
145
what is a disadvantage of spermicide
allergy
146
what are hormonal methods of birth control
- -OCP – Oral Contraceptive Pills
- -Emergency Contraceptives
- -Progestin Only – “Mini Pill”
- -Depo-Provera
- -Contraceptive Patch
- -Vaginal Ring
147
what is the oral contraceptive pill (OCP)
suppresses ovulation, combined estrogen & progestin
comes in =
28-day packs
21-day packs
91 day packs
148
what 3 things does OCP do
Suppresses Ovulation
Thickens Cervical Mucus (blocks semen)
Alters Uterine Decidua
149
if one OCP pill is missed, what to do
If 1 pill is missed – take as soon as possible
--If 2 or 3 pills are missed, follow manufacturer’s instructions and use alternate form of contraception or abstinence until next cycle
150
what medications decrease the effectiveness of OCP pills
anticonvulsants
| antibiotics
151
what are contraindications for the OCP pill
- -Hx: DVT, pulmonary emboli, hypertension, heart disease
- -Women aged 35 or older, who smoke
- -Active cancer
- -Genetic clotting disorders, liver disease
152
what are SEs of OCP
Nausea, Headaches, Spotting, Weight Gain, Breast Tenderness, Chloasma
--Increased risks for blood clots, heart disease, and strokes
153
what is the ACHES serious complications of OCPs
```
Abdominal pain
Chest pain
Headaches
Eye probs
Severe leg pain
```
154
what is the POP or mini pill
- -progestin only, NO estrogen
- -1 pill/day
- -can be used with lactation and does not affect the production of breastmilk
- -less effective than combined OCPs
155
what is an emergency contraceptive
- -Postcoital ingestion of hormones
- -Must take within 72 hours to prevent pregnancy
- -Will not disturb an implanted pregnancy
- -SE: headache, nausea, vomiting, abdominal pain
- -Does not protect against STIs
156
what is Depo-Provera
Injectable (IM) every 3 months (4xs/year) that supresses ovulation
- -use every 11-13 weeks
- -longer form of BC
157
what are SEs of Depo-Provera
SE: weight gain, decreased bone density, delayed fertility, headaches, mood changes, breast tenderness
158
what is the contraceptive patch
Ortho Evra
- -Hormones are steadily delivered transdermal
- -Estrogen & Progestin – stop ovulation
- -Placement: Abdomen, Back, Butt
159
when to change contraceptive patch
Change patch weekly x 3 weeks: remove for 1 week
160
what meds decrease effectiveness of contraceptive patch
- -Antibiotics
| - -Anti-Seizure medications
161
what can be used for depression and menopause that is herbal and will not decrease effectiveness of contraception patch
St. John’s Wart – Herbal Remedy
162
what is the NuvaRing
vaginal contraceptive ring
- -Hormones are released from a flexible ring inserted into the vagina
- -delivers continuous levels of hormones for 3 weeks, replaced monthly
163
What are long acting reversible contraceptives
- -IUC – Intrauterine Contraceptives
| - -Hormone Implants
164
what is an IUD and 3 actions
--IUD is T shaped device
- -Thickens cervical mucus
- -thins uterine lining
- -suppresses ovulation
165
what is the benefit of a copper IUD
No hormones & 10 years
166
what hormone released with Mirena (levonorgrestrel) IUD
Hormone: Progestin (no estrogen) & 3-5 years
167
what is the risk of IUDs
Pregnancy risk – increased % ectopic pregnancy
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how is placement of an IUD verified
Strings protrude into vagina to verify placement
169
what is PAINS to remember IUD complications
- -Period Irregularities
- -Abdominal Pain
- -Infection
- -Not Feeling Well – Malaise
- -String Missing
170
what is Nexplanon
hormone implant
- -tiny thin rod in arm
- -progestin only
- -5 years
- -quick return to ovulation post removal
171
what are 3 surgeries for sterilization
Vasectomy
Tubal Ligation
Sterilization Implant
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what is bilateral tubal ligation
Uterine tubes are occluded
- -general anethesia
- -Only surgical removal of the ovaries (oophorectomy) or uterus (hysterectomy) or both will result in absolute sterility for a woman
173
what is vasectomy and a consideration for contraception use after
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Sperm ducts (vas deferens) are occluded
--requires alt contraception until 2 post-surgery sperm tests indicate effectiveness
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174
what is a sterilization implant
Implant placed into Fallopian Tubes
| --Creates scar tissue & blocks tubes
175
how only do you have to be to have sterilization
21
