Other Flashcards
importance of contraception postpartum
increased risk for maternal and fetal bad outcomes within first 6 months postpartum
COC postpartum
contraindicated for the first 6 weeks postpartum due to increased risk of VTE
absolute contraindication to COC
current breast cancer
severe decompensated cirrhosis
acute deep vein thrombosis
pulmonary embolism
high risk for recurrence of deep vein thrombosis or pulmonary embolism
major surgery with prolonged immobilization
migraine with aura
systolic blood pressure ≥ 160 mm Hg
diastolic blood pressure ≥ 100 mm Hg
history of ischemic heart disease
known thrombogenic mutations
hepatocellular adenoma
malignant hepatoma
moderately or severely impaired cardiac function
diagnosis of normal or mildly impaired cardiac function within the previous 6 months
patients < 21 days postpartum regardless of breastfeeding status
patients ≥ 35 years of age and smoking ≥ 15 cigarettes/day
history of cerebrovascular accident
complicated valvular heart disease
The most prevalent serious adverse effect of COC
VTE
how to use diaphragm
should be inserted less than 1 hours prior to intercourse up to 6 hours before intercourse and must be kept in place for at least 6 hours after intercourse. If it is placed more than 1 hour before intercourse, another applicator full of spermicide or vaginal pH regulator gel needs to be inserted into the vagina for maximum effect
how to use cervical cap
it can be inserted for up to 6 hours prior to intercourse and does not require reapplication of spermicide if time has elapsed between placement and intercourse
ADE cervical cap and diaphragm
urinary tract infections (especially with diaphragm use during multiple acts of intercourse) and a small risk of toxic shock syndrome
Max amount of time that a cervical cap or diaphragm should be inserted
12–18 hours
should cervical caps or diaphragms be used during menstruation
no
IUD contraindications
bicornuate uterus, septate uterus, uterine fibroids, cervical stenosis, active pregnancy and current or frequent pelvic inflammatory disease
can patients with current fibroids or a history of fibroids have an IUD place
patients with current fibroids or a history of fibroids that do not have severe distortion of the uterine cavity may be able to have an IUD placed, they should be counseled prior to intrauterine device insertion
risk of what illness is increased w IUD
PID
IUD placement
Intrauterine placement should occur at the end of menses or within 7 days after the last menstrual period. If this is not achieved, backup contraception should be used 7 days following placement
duration of 13.5 mg levonorgestrel-releasing intrauterine device
3 years
duration of 19.5 mg levonorgestrel-releasing IUD
5 years
duration of 52 mg levonorgestrel-releasing IUD
8 years
duration copper IUD
10 years
contraindications combined patch
history of thromboembolism, history of an estrogen-dependent tumor, abnormal liver function testing, and individuals with a body mass index ≥ 30 kg/m2
common ADE of combined patch
unscheduled bleeding during the first few cycles, breast tenderness, and application site reactions
application of combined patch
patch is applied weekly for 3 consecutive weeks prior to a patch-free week. The patch can be applied to the buttock, abdomen, or upper torso, and a different site should be used each time a new patch is applied. The patch can be reapplied if it is accidentally detached for < 24 hours. If it is detached for more than 24 hours, a new patch should be applied
Endometriosis
the presence of endometrial tissue outside the uterus
MC location for endometriosis to occur
ovaries
tx endometriosis
NSAIDs or COC
gonadotropin-releasing hormone analogs, such as leuprolide and nafarelin
Danazol, aromatase inhibitors (Anastrazole)
hysterectomy with oophorectomy
laparoscopy for endometriosis
areas of peritoneal endometriosis appear as blue-black powder burn lesions, raised flame-like patches, whitish opacifications, yellow-brown discolorations, translucent blebs, or irregularly shaped islands
Risk factors for endometriosis
nulliparity, early menarche, late menopause, shorter menstrual cycles, menorrhagia, obstruction of menstrual outflow, exposure to diethylstilbestrol in utero, height > 68 inches, lower body mass index, exposure to physical or sexual abuse in childhood, and excessive consumption of trans fats
endometrioma on US
appears smooth-walled with homogeneous internal echoes that have the appearance of ground-glass
The fluid inside endometriomas is old blood and appears chocolate-colored on biopsy
corpus luteal cyst
appears complex and heterogeneous with hypoechoic areas representing fluid and hyperechoic areas representing internal debris, such as hemorrhage
dermoid cyst
also known as a mature teratoma and arises from germ cells. Dermoid cysts consist of many materials, such as teeth and hair. For this reason, they appear heterogeneous on ultrasound with dots, fluid, and areas of acoustic shadowing
follicular cyst
appears smooth and thin-walled and completely fluid-filled on ultrasound. There will be through transmission and an absence of internal echoes
theca lutein cyst
An ovarian cyst that results from overstimulation by beta-human chorionic gonadotropin, such as occurs during molar pregnancy, multiple gestation, or clomiphene therapy
Infertility
the inability to conceive after 6 months of unprotected intercourse for women ≥ 35 years of age or after 1 year of unprotected intercourse for women < 35 years of age
four causes of infertility
female factors (37%), both female and male factors (35%), unexplained (20%), and male factors (8%)
MC cause of female infertility
ovulatory dysfunction, and polycystic ovary disease is the most common reason for ovulatory dysfunction
meds that can cause ovulatory dysfunction
antidepressants, antipsychotics, corticosteroids, and chemotherapy medications
what progesterone level indicates ovulatory dysfunction
A midluteal serum progesterone level < 10 ng/mL or the absence of the LH surge indicates ovulatory dysfunction
normal results for semen analysis
Normal results include volume > 2 mL, sperm concentration > 20 million/mL, motility > 50%, and normal morphology > 30%.
Abstinence for 3 days prior to semen collection is recommended
MC pelvic tumor in women
Leiomyomas
what are Leiomyomas
uterine fibroids
where is an intramural myoma located
within the uterine wall
where is a submucosal myoma located
below the endometrium and protrudes into the uterine cavity
where is a subserosal myoma located
originates from the myometrium at the serosal surface of the uterus; pedunculated
Factors associated with a decreased risk of leiomyomas
having one or more pregnancies extending beyond 20 weeks gestation and vitamin A consumption from animal sources
sx leiomyomas
heavy or prolonged menstrual bleeding, abdominal pressure or pain, reproductive dysfunction, dysmenorrhea, and dyspareunia
PE for leiomyomas
abdominal or pelvic mass or an irregular, enlarged, or mobile uterus
The most common benign ovarian cysts
follicular cysts or corpus luteal cysts
sx ovarian cysts
usually asx
cysts may rupture and cause a sudden onset of severe unilateral lower abdominal pain
when do ovarian cysts commonly rupture
during intercourse or strenuous activity
what would US show if ovarian cyst ruptured
blood in the pelvis; ovarian cyst with surrounding fluid in the pelvis
uncomplicated ovarian cyst rupture
Patients with low concern for malignancy and hemodynamic stability
managed outpatient w observation; given NSAIDs
tx for unstable/uncomplicated ovarian cyst
surgery
empiric abx after sexual assault
ceftriaxone to cover for gonorrhea and doxycycline or azithromycin to cover for chlamydia and metronidazole or tinidazole to cover for trichomoniasis
What is the most common cause of post-traumatic stress disorder in women?
sexual assault
urge incontinence is also called
overactive bladder
diagnostic test of choice for urge incontinence
urodynamic study
lifestyle tx options for urge incontinence
Scheduled toileting, weight loss, and Kegel exercises
pharm tx options for urge incontinence
antimuscarinics (e.g., oxybutynin, solifenacin, darifenacin, trospium, and tolterodine) and beta-adrenergics (e.g., mirabegron)
dx to confirm stress incontinence
bladder stress test
what may be used in postmenopausal women with urge or stress incontinence
vaginal estrogen
off label tx for stress incontinence and depression
duloxetine
surgical options for stress incontinence
midurethral sling or a pessary
mixed incontinence
both urge and stress
Overflow incontinence is caused by
urinary retention, resulting in bladder distention and overflow of the urine out of the urethra
dx for overflow incontinence
postvoid residual
The classic features of PCOS
irregular menses (amenorrhea or oligomenorrhea) or abnormal uterine bleeding (related to ovulatory dysfunction), infertility, endometrial hyperplasia and increased risk of endometrial cancer, type 2 diabetes mellitus, and metabolic syndrome
The diagnosis of PCOS
two of the three clinical Rotterdam criteria: oligomenorrhea, hyperandrogenism, and polycystic ovaries seen on ultrasound
tx PCOS
Weight loss is considered the first-line treatment because it may improve metabolic risk, restore ovulatory cycles, and improve infertility
COC are main pharm tx
Spironolactone is used as an adjunct in women who do not improve after 6 months of using combined oral contraceptives
what meds can be used to induce ovulation in PCOS
Clomiphene citrate and letrozole
the most common endocrine abnormality in women of reproductive age
PCOS
What is the black box warning for metformin?
lactic acidosis
pts w PCOS have increased risk of developing what type of CA
endometrial CA
What are common adverse effects of clomiphene citrate?
Hot flashes, abdominal distention and pain, nausea and vomiting, and breast discomfort
