Reproductive Review Flashcards
Ectopic Pregnancy
Sexually active female who has not had a period (or had period but light to scant bleed- ing) in 6 to 7 weeks complains of lower abdominal/pelvic pain or cramping (intermit- tent, persistent, or acute). Pain worsens when supine or with jarring. If ruptured, pelvic pain worsens and can be referred to the right shoulder. Medical history of pelvic inflam- matory disease (PID), tubal ligation, or previous ectopic pregnancy. Leading cause of death for women in the United States in the first trimester of pregnancy.
Dominant Breast Mass/Breast Cancer
Middle-aged to older female with a dominant mass on one breast that feels hard and is irregular in shape. The mass is attached to the skin/surrounding breast tissue (or is immobile). Among the most common locations are the upper outer quadrants of the breast (the tail of Spence). Skin changes may be seen, such as the “peau d’orange” (localized area of skin that resembles an orange peel), dimpling, and retraction. Mass is painless or may be accompanied by serous or bloody discharge. The nipple may be displaced or become fixed.
Paget’s Disease of the Breast (Ductal Carcinoma In Situ)
Older female reports a history of a chronic scaly red-colored rash resembling eczema on the nipple (or nipple and areola) that does not heal. Some women complain of itch- ing. The skin lesion slowly enlarges and evolves to include crusting, ulceration, and/or bleeding on the nipple.
Inflammatory Breast Cancer
Recent or acute onset of a red, swollen, and warm area in the breast of a younger woman. Can mimic mastitis. Often, there is no distinct lump on the affected breast. Symptoms develop quickly (few weeks to months). The skin may be pitted (peau d’orange) or appear bruised. More common in African Americans. A rare but very aggressive form of breast cancer (1% to 5%)
Ovarian Cancer
Older women with complaints of vague symptoms such as abdominal bloating and dis- comfort, low-back pain, pelvic pain, urinary frequency, and constipation (e.g., frequently blamed on benign conditions). By the time it is diagnosed, the cancer has already metas- tasized. If metastases, symptoms depend on area affected. Symptoms may be bone pain, abdominal pain, headache, blurred vision, others. Ovarian cancer is rarely diagnosed during the early stage of the disease (before metastasis). It is the fifth most common cancer among women in the United States
Breast development
Breast development starts in Tanner Stage II (breast buds) and ends at Stage V. During puberty, it is common for both girls and boys (gynecomastia) to have tender and asymmetrical breasts. One breast may be larger than the other breast. The upper outer quadrant of the breasts (called the “tail of Spence”) is where the majority of breast cancer is located. Very high risks factors for breast cancer includes the BRCA1 or BRCA2 gene mutation or a history of radiation therapy to the chest between the ages of 10 and 30 years. (Risk factors for breast cancer in men are cryptorchidism, positive family history, others.) The diagnostic test for breast cancer (or any type of cancer) is the tissue biopsy
Menstrual cycle Phases
Follicular (days 1-14);
Midcycle (Day 14-Ovulatory phase;
Luteal Phase (Days 14-28);
Menstruation
OCP complications
Unscheduled bleeding (spotting)
Menstrual cramps
Missing consecutive days
Drug interactions
Preferred birth control for breastfeeding women
progestin-only pills “mini pill” (Microno, Nor-QD
Side effects on mini pill:
spotting and irregular menses
OCP danger signs
Chest pain–Blood clot in coronary artery
Severe HA–Stroke, TIA
Weakness on one side–Ischemic stroke
Visual changes in one eye–Retinal arterial clot
Abdominal pain–Mesenteric clot
Lower leg pain–DVT
Yaz or Yasmin contains
estrogen and drospirenone
Yaz has higher risk for
blood clots, stroke, heart attack, hyperkalemia
IUD contraindications
Active PID or past year
Suspected or with STD/pregnant
Uterine or cervical abnormality (e.g. bicornate uterus)
Undiagnosed vaginal bleeding or uterine/cervical cancer
Hx ectopic pregnancy
IUD increased risk
Endometrial and pelvic infections (only after first few months of insertion)
Perforation of the uterus
Heavy or prolonged menstrual periods
IUD education
Check for missing or shortened string after your period
If no string–ultrasound
Depo-Provera has what % failure rate
6%
Depo-Provera injection lasts
3 months
Before starting Depo-provera
Check for pregnancy
When to start Depo
first 5 days of cycle–less likely to ovulate at this time.
This is your uterus on Depo (after 1 year)
atrophy from lack of estrogen–amenorrhea
Depo and fertility
Delayed return of fertility
Takes up to one year to start ovulating.
Black box warning: Depo
Avoid use >2 years.
Increased risk for osteopenia/osteoporosis that may not be fully reversible
Particular warning for patients with anorexia
What supplement is recommended for women on Depo
Calcium + Vitamin D
Weight-bearing exercise
Diaphragm with contraceptive gel and cervical cap failure rate
13%
Diaphragm instructions
Must use with spermicidal gel
After intercourse, leave inside vagina for at least 6-8 hours (up to 24 hours).
Needs additional spermicide before each act of intercourse
Apply foam/gel inside vagina without removing diaphragm
Cervical cap may be worn
Up to 72 hours.
Risks with cervical cap
Prentif cap may cause abnormal cervical cellular change
UTIs and TSS, though rare
Male condoms failure rate
18%
Female condom failure rate
21%–do not use with oil-based lubricants, creams…
Nuvaring failure rate
9%
What is the Nuvaring
Plastic cervical ring that contains etonogestrel and ethinyl lestradiol and is left inside the vagina for 3 weeks, then removed for 1 week (has period). Educate patient on how to apply and remove (the ring should fit snugly around cervix). Absolute and relative contraindications for combined estrogen-progesterone method of contraception are the same as oral contraceptives.
Ortho Evra contraceptive patch failure rate
9%
Ortho Evra risks
Higher risk of VTE (releases higher levels of estrogen) compared to oral contraceptive pills. Absolute and relative contraindications for combined estrogen-progesterone method of contraception are the same as oral contraceptives.
Contraceptive implants failure rate
<1%
