RTS- women's health Flashcards
treatments for dysmenorrhoea (periods pain)
- NSAIDS
(a) ibuprofen 200-400mg TDS - neurofen, feminax
(b) Naproxen 250mg tabs- day 1 2 tabs to start then 1 every 6-8 hours. day 2&3 - 1 tab every 6-8 hours. MAX 3 DAYS USE - and 750mg nail. only licensed for dysmenorrhea.
If NSAIDS contra indicated -
(a) paracetamol - 500-1000mg up to QDS
(b) codeine with ibuprofen or para - co-codamol 8/500mg, solpadeine = 200/12.8g
(c) dihydrocodeine - 7.46g with paracetamol 500mg - paramol
(d) hycosine butylbromide - 10mg tabs- buscopan cramps
what is the limit on naproxen for dysmenorrhoea
max 3 days use, 750mg daily
brand names for ibuprofen and naproxen for period pain
ibuprofen - feminax, neurofen
naproxen - feminax ultra, boots period pain relief
red flags for dysmenorrhoea
pain and bleeding between periods, after sex or urination
sudden severe pain
amenorrhoea/menorrhagia
post menopausal women
unpleasant discharge
IUD
painkillers used for 3-4 cycles and not worked
what is menorrhagia?
heavy period - excessive menstrual blood loss which interferes with women physical, emotional and social quality of life.
treatment for menorrhagia?
tranexamic acid tablets - OTC (switched from POM to P in 2011)
2 x 500mg tablets TDS - for a max 4 days
Up to 4g daily (8 tabs)
Mechanism & indication of tranexamic acid tablets
anti-fibrinolytic competitive inhibitor of activation of plasminogen to plasmin
Indication - to reduce menstrual bleeding for ages 18-45 years with regular 21-35 day cycles
red flags for menorrhagia
irregular bleeding increase blood loss pain in sex discharge pelvic pain tranexamic acid tabs oTC not suitable
physical & psychological symptoms of pre menstrual syndrome
physical - bloated, pain, headache, sleep issues weight gain (1kg)
Psychological - mood swings, irritable, anxiety, forgetfulness, tired, restless, loss of libido
how is PMS treated?
(a) symptom specific - NSAIDS, paracetamol, buscopan
(b) holistic - changes to diet e.g reduction in caffeine, evening primrose oil, calcium ,magnesium,
Herbal - vitex agnus -castus
What is thrush?
vulvovaginal candida
common opportunistic infection with yeast like fungus Candida albicans - vaginal area
precipitating factors of thrush
ages 20-30 pregnancy antibiotics immunocompromised diabetes mellitus
symptoms of thrush
vaginal - itchy, burn, sore, discharge or creamy and curd like or thin and watery - odourless
Dysuria- pain / sting on urination
dyspareunia - pain in sex
what is treatment for thrush?
Topical imidazole antifungals
- Clotrimazole:
canesten pessary 500mg alone or with +2% thrush cream
canesten 10% vaginal cream, +2% thrush cream
canesten 200mg pessary x3
canesten 100mg pessary x6 - Miconazole cream 2% for vulval use
Treatment for thrush - oral triazole antifungals
fluconazole - capsule 150mg single dose (canesten oral or generic)
- Also marketed as canesten duo (fluconazole capsule and clotrimazole cream)
- LOTS of contra indications e.g. preg/BF, under 16, >60
fluconazole 150mg / clotrimazole 2% cream is licensed for balanitis
Can clotromazole be used in pregnancy?
Yes under the physician supervision - the pessary must be inserted without an applicator
red flags for thrush
first occurrence >2 in 6 months under 16 or over 60 pregnancy discharge is yellow/green blisters abnormal bleeding lower abdominal pain pain in sex or urination treatment fail
what is cystitis?
inflammation of the bladder - usually caused by bacterial infection - caused by e.g not emptying the bladder properly, bacteria transferred from anus to urethra (common as urethra shorter), soaps, chemicals, medication
what bacteria causes cystitis?
E.coli
staphylococcus saprophyticus
symptoms of cystitis
frequency/urgency
pain during urine
pain in blader
strong smelling urine and cloudy
red flags of cystitis
first time occurring very dark or cloudy urine (indicates haematuria) fever is 38 degrees or above vomiting discharge 3 or more occurrences in a year lasting longer than2 days pregnancy men and children
cystitis treatment
plenty of water avoid alcohol, caffeine, tea juices avoid sex until clear paracetamol and ibuprofen alkalinising agents e.g - sodium citrate/bicarbonate, potassium citrate/bicarbonate
what are the medication interactions with the alkalinising agents sodium and potassium citrate/bicarbonate?
sodium - lithium
Potassium - ACE inhibitors (e.g ramipril),
K+ sparing diuretics e.g amiloride,
aldosterone antagonists
what are sodium and potassium bicarbonate contra-indicated in in cystitis?
heart disease renal disease pregnancy men children (sodium in hypertension)
Name 2 types of emergency hormonal contraception
Do they interrupt existing pregnancies?
- levonelle one step (levonorgestrel 1500mcg, 1.5 mg)
- EllaOne - ulipristal acetate 30mg
Neither EHC interrupt existing pregnancies
describe levonelle one step EHC?
prevents ovulation & fertilisation if the intercourse is in the preovulatory phase, when the likelihood is the highest
- ineffective once implantation has begun
License - >16 years
Time frame for levonelle one step?
within 72 hours of intercourse - 3 days
describe EllaOne EHC?
inhibits/postpones ovulation via binding to the progesterone receptor and suppress LH surge.
LICENSE- any woman of child bearing age including adolescents
Time frame for EllaOne?
120 hours- 5 days
side effects of EHC?
nausea, abdominal pain, headache, dizziness, fatigue, menstrual cycle disruption
NOTE: must repeat dose if vomit within 3 hours of taking.
- Must wear a barrier method e.g condoms until the next period and continue with oral contraception as usual
how is pregnancy detected?
pregnancy tests - used from day 1 of missed period - measures human chorionic gonadotrophin - clearblue
Common pregnancy symptoms
morning sickness (goes by week 20)
heartburn/indigestion
Constipation
Haemorrhoids - enlarged veins around anus
itching - due to stretching of skin or increased blood perfusion of skin
backache
how can morning sickness be treated?
small frequent meals acupressure bands ginger- capsules, lozenges, biscuits pregnancy vitamins e.g pregnacare folic acid
treatment of haemorrhoids symptom pregnancy?
diet, moist wipes, sudocrem, germoloids
treatment of itching during pregnancy
emollient creams etc, bio oil
if It is severe then it may be possible obstetric cholestasis - so refer then
what is menopause?
end of menstruation caused by reduction in oestrogen levels.
45-55 years old it starts
Usually gradual i.e
perimenopausal stage heavy or lighter periods, and longer intervals between them
Symptoms of menopause? last for 2-5 years
hot flushes loss of libido vaginal atrophy - dryness, pain headaches moods - depression insomnia UTIs
what are treatments for vaginal dryness and hot flushes in menopause?
vaginal dryness - replens MD, sylk
balance activ moisture plus
acidic intravaginal moisturisers
flushes: avoid triggers e.g caffeine, exercise, cool room
what are alternative treatments for menopause?
yoga, aromatherapy
vitamin D
evening primrose oil (helps breast pain) BUT contains gamma linolenic acid which is bad for flushes
red clover, soya, flaxseed - contains phytoestrogens for flushes
- st johns wort, Agnus Casus, valerian root
What are the common minor ailments in women health?
- dysmenorrhoea (period pain)
- Menorrhagia (heavy period)
- pre menstrual syndrome
- thrush
- bacterial vaginosis
- cystitis
- suspected pregnancy/pregnancy
- menopause
what is bacterial vaginosis?
shift in the bacterial flora - anaerobic bacterial growth which increases pH - leads to discharge, fishy odour, white, thin, grey colour.
Usually caused by soaps, IUD, sex, douching, antibiotics
treatments for BV
POM - metronidazole tablets, gel, clindamycin vaginal cream
OTC - balance activ BV gel, pessaries Canesbalance gel (contains lactic acid and glycogen which restores ph to 4-4.5) - use daily 1 week
also use of yoghurts, acidifiers (replace lactobacilli bacteria)
how can thrush be prevented?
wash vagina with water
avoid soaps
use emollient e.g E45 as soap substitute and greasy moisturiser to protect vagina
toilet hygiene - wipe front and back with different paper
avoid tight clothing
ALSO pharmaceutically: yoghurt/probiotic supplements, canesflor vaginal capsules - lactobacillus planar - 1 cap each night for 6 days then 1 cap weekly for 4 weeks
