Responding to Symptoms: Women's Health Flashcards
What is dysmenorrhoea?
Period pains in the lower abdomen
What 2 classifications are associated with dysmenorrhoea?
Primary: pain in the absence of pelvic/uterine disease
Secondary: pain associated with pelvic/uterine disease
What causes period pains (primary dysmenorrhoea)?
Prostaglandins being released which shed the endometrium, and over-contraction causing reduced blood supply
What conditions can cause secondary dysmenorrhoea?
- Endometriosis
- Pelvic inflammatory disease
- IUDs
What is endometriosis?
It is when the presence/growth of endometrial tissue occurs outside of the uterus
What are the symptoms of endometriosis?
- Painful/heavy periods
- Pain during sex
- Pain in the lower abdomen
- Bleeding between periods
- Can lead to infertility
What should you do if you suspect a woman has endometriosis, fibroids, or pelvic inflammatory disease?
Always refer.
What are fibroids?
Non-cancerous growths in the uterus
What are the symptoms of fibroids?
- Bloating/swelling of abdomen
- Heavy/painful periods
- Constipation
- Pain during sex
- Urinary frequency
- Can lead to infertility/miscarriage
What is pelvic inflammatory disease?
It is an infection of the uterus & fallopian tubes, due to e.g. an STI, childbirth, IUDs
What are the symptoms of pelvic inflammatory disease?
- Pain in lower abdomen
- Abnormal vaginal bleeding
- Bleeding between periods, and after sex
- Could be asymptomatic
- Infertility
What is premenstrual syndrome (PMS)?
It is the symptoms some woman experience before or during their period.
What are the symptoms of PMS?
- Mood changes
- Fatigue
- Breast swelling/tenderness
- Weight gain
- Irritable/tension
- Abdominal bloating
What OTC treatment options can be given for PMS (think of minerals)?
- Calcium
- Magnesium
- Pyridoxine (vit. B6) 5-10mg
- Evening primrose oil - for breast discomfort
What things do you need to ask to determine if a woman is experiencing dysmenorrhoea?
- Their age
- Nature of the pain
- Timing of pain
- Bleeding - during sex, abnormal, between periods
- Associated symptoms
- Taking oral contraceptives - refer
What are the NSAIDs used for dysmenorrhoea? Include doses
- Ibuprofen max 1.2g
- Diclofenac 12.5mg
- Naproxen 500mg, then 250mg if required 6-8h later
What other medications can be used to treat dysmenorrhoea?
- Paracetamol - with or without NSAID
- Aspirin - GI upset, try to avoid
- Hyoscine
- Caffeine - can be taken with ibuprofen
What non-pharmaceutical treatments can women do to relieve their dysmenorrhoea?
- Hot water bottle/warmth
- TENS machine - electric pulses to relieve pain
- Exercise/supplements
What happens to the epithelial glycogen present in a woman’s vagina?
It gets broken down by bacteria & enzymes into acids
Which conditions can vaginal thrush mostly occur in?
- Immuno-compromised patients
- Diabetics
- Pregnancy
What causes vaginal thrush?
- Alkaline vaginal environment
- Low oestrogen = low glycogen = higher pH = more susceptible to infections
- Can be a sign of child abuse
What are the symptoms of vaginal thrush?
- Cream-coloured, thick, cottage-cheese like discharge
- Odourless
- Burning itch
- Skin red and raw
- Pain/discomfort in urination
- Discomfort during sex
What are the symptoms of bacterial vaginosis (BV)?
- White-ish grey discharge
- Fishy odour
- Heaviest after period
- No itch or soreness in vagina
What type of infection is trichomoniasis and how does someone contract it?
It is a protozoa infection via sexual intercourse.
What are the symptoms of trichomoniasis?
- Green-yellow, frothy discharge
- Sometimes fishy smell
- Itchy/uncomfortable around vagina
- Pain during sex/urination
When should you refer if you suspect a patient has vaginal thrush?
- Age (<16, >60)
- Pregnancy
- Abnormal bleeding, blood in discharge
- Blisters or ulcers present
- No improvement with previous treatment
- Recurrent infections present
- Diabetics, immuno-compromised patients
- if it is her first time
What things do you need to know to determine if a woman has vaginal thrush?
- Age
- Nature of discharge
- Itch
- Other symptoms
- Other conditions present
What are some examples of azoles used to treat vaginal thrush?
Clotrimazole, econazole, miconazole (ending in -azole)
How is oral fluconazole given for treatment of vaginal thrush?
150mg single dose, 12-24h for symptom relief
How is the partner of the infected women treated?
- Only treat partner if they are symptomatic
- Azole cream BD for 6 days, or oral fluconazole
What counselling points can you mention for a woman who has vaginal thrush?
- Avoid tight fitted clothing
- Cotton underwear
- Avoid perfumed products around vagina area
- Avoid douches
- Do not use feminine itching products
What is cystitis?
It is inflammation of the bladder due to a bacterial infection.
Why can cystitis be recurrent in diabetics?
Because they have high sugar in their urine which can encourage bacterial growth
What are the symptoms of cystitis?
- Dysuria - pain when passing urine
- Urine frequency
- Nocturia
- Only passing small amounts of urine
- Feeling of incomplete bladder emptying
- Lower abdomen pain
- Cloudy/strong smelling urine
What conditions can cause systemic symptoms & haematuria?
- Kidney stones
- Bladder cancer
- Kidney infection
Why are older women more prone to cystitis?
Their vaginal lining becomes thinner due to postmenopausal oestrogen deficiency –> this causes a lack of lubrication in the vagina –> cystitis can occur
After how many days should you refer if you suspect a person has cystitis?
> 2 days = refer
When should you refer someone with suspected cystitis?
- Children & men
- Elderly
- Pregnancy
- Symptoms of suggested diabetes
- Recurrence of cystitis
- Haematuria
- Vaginal discharge
How do you treat mild cystitis (<2 days)?
- May not need treatment
- Paracetamol or ibuprofen for pain
- Alkalinising agents
What is phleonephritis?
It is when a UTI travels up to the urethra and into the kidneys, causing an infection
What other advice can you give for a person with suspected cystitis?
- Drink lots of fluids
- Cranberry juice
- Complete emptying of bladder
- Urinate immediately after sex
