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professional practice ND > RTS - Womens Health > Flashcards

RTS - Womens Health Flashcards

1
Q

What are some common womens conditions? (9)

A
  • Dysmenorrhoea
  • Menorrhagia
  • Pre Menstrual Syndrome (PMS/ PMT)
  • Vaginal thrush
  • Bacterial vaginosis
  • Cystitis
  • Suspected pregnancy
  • Minor ailments during pregnancy
  • Menopause
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2
Q

1) What is dysmenorrhoea?

2) Who suffers fro it? (2)

A

1) Commonly known as ‘PERIOD PAIN’

2) - Up to 1 in 2 women suffer, maybe up to 90%
- Up to 1 in 10 take time off from work/ school

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3
Q

What are the symptoms of dysmenorrhoea? (4)

A

Symptoms occur shortly before / during menstruation

1) Pain:
- Abdominal/ pelvic area
- Lower back
- Thighs/Legs
2) Abdominal Cramps
3) Nausea and Vomiting
4) Constipation, dizziness, headache, bloating

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4
Q

What are the two variations of dysmenorrhoea? (2)

A

1) Primary Dysmenorrhoea
- No underlying pelvic pathological cause
- Related to endometrial release of prostaglandins and leukotrienes-↑levels or sensitivity
- Most common in ages 15 -25 years

2) Secondary Dysmenorrhoea
- Underlying pelvic pathological cause
- More common in ages 30 – 45 years.
- REFER

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5
Q

Conditions to Eliminate

A

Secondary Dysmenorrhoea:

  • Fibroids (benign tumours)
  • Endometriosis
  • Adhesions
  • Pelvic Inflammatory Disease (PID)
  • Intrauterine device (IUD)

Other Conditions:

  • Acute Appendicitis (pain on right side)
  • Ectopic Pregnancy (fertilised egg planted outside uterus (abnormal bleeding))
  • Inflammatory Bowel Disease (IBD)
  • Irritable Bowel Syndrome (IBS)
  • Urinary Tract Infection (UTI)
  • Tumours
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6
Q

What are the RED FLAG Referral Indicators for Dysmenorrhoea? (9)

A
  • Pain or bleeding between periods
  • Pain or bleeding after sex or urination
  • Sudden severe pain
  • High temperature
  • Amenorrhoea or severe menorrhagia
  • Post menopausal women
  • Unpleasant discharge from vagina
  • IUD insertion
  • Painkillers tried for 3-4 cycles-not working
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7
Q

Define the differences in information needed for diagnosis for primary/secondary Dysmenorrhoea. (4, 4)

A 
Primary Dysmenorrhoea
- When did it start? 
At, or slightly after, menarche
- Where in cycle does pain occur? 
Within 24 hrs of menstruation (lasts 24-72 hrs)
- Other gynaecological symptoms present?
No
- Response to NSAID’s  or Oral Contraceptives?
Good

Secondary Dysmenorrhoea
- When did it start?
Can be years after menarche
- Where in cycle does pain occur?
Any stage of cycle . If only during menstruation, usually prolonged and may start 2-3 days before.
- Other gynaecological symptoms present?
Yes (eg bleeding between menstruation, discharge, bleeding or pain after or during sex)
- Response to NSAID’s or Oral Contraceptives?
Little or none

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8
Q

Describe TWO medicines used for dysmenorrhoea treatment. (2)

A

1) Drug: Ibuprofen
- Dose: 200-400mg TDS
- Risk of GI adverse effects: Low
- Brand names: Nurofen, Feminax Express (Generic available)

2) Drug: Naproxen
- Dose: Day 1: 2 tabs stat then 1 tab 6 to 8 hours later prn
- Dose: Day 2 and 3: 1 tablet every 6 to 8 hours (Max 3 days and 750mg daily) - available to 15-50yo women
- Risk of GI adverse effects: Moderate
- Brand names: Feminax Ultra, Boots period pain relief

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9
Q

What treatment options are available for dysmenorrhoea if NSAIDs are contraindicated? (4)

A
  • Paracetamol 500-1000mg up to QDS (max 4g in 24 hours)
  • Codeine with Ibuprofen or Paracetamol
    i) Co-codamol (Paracetamol/Codeine 8/500mg)
    ii) Solpadeine Migraine (Ibuprofen/Codeine 200/12.8mg) also licensed for dysmenorrhoea
  • Dihydrocodeine 7.46mg with paracetamol 500mg as Paramol tablets
  • Hyoscine butylbromide 10mg tablets-Buscopan Cramps tablets
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10
Q

Give some non-pharmacological advice for dysmenorrhoea treatment. (7)

A
  • Stop smoking
  • Aim for ideal weight
  • Exercise (e.g. swimming, walking or cycling)
  • Local Heat Application (Applying heat to abdomen can reduce pain - use Hot water bottle/ heat pads)
  • Warm bath, massage, relaxation techniques
  • TENS (Transcutaneous Electrical Nerve Stimulation)
  • Oral Contraceptives REFER
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11
Q

Define Menorrhagia, who suffers from it and how it can occur. (3)

A

i) ‘HEAVY PERIODS’ - Heavy loss – SUBJECTIVE
- 30% of women suffer
- 5% of women aged 29-44 will consult GP
- Bleeding increases with age

ii) Clinically defined as ‘excessive menstrual blood loss which interferes with the woman’s physical, emotional, social and material quality of life’.
iii) Can occur alone/combined with other symptoms

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12
Q

What are the causes for Menorrhagia? (3)

A

i) No known cause - >60% of cases

ii) Gynaecological – >30% of cases
- PID
- Fibroids
- Endometriosis

iii) Endocrine & haematological -

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13
Q

What are the RED FLAG Referral Indicators for Menorrhagia? (5)

A

i) Irregular bleeding
ii) An increase in blood loss – different to what is normal
iii) Postcoital bleeding
iv) Other symptoms such as pain during intercourse or pelvic pain
v) Tranexamic acid OTC not suitable

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14
Q

Periods are known as the (1), which begin at the (2) (around 12 years of age).

The lining of the uterus is called the (3).

Symptoms of painful periods are called (4).
Heavy periods are termed (4).

A

1) Menstrual cycle
2) Menarche
3) Endometrium
4) Menorrhagia

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15
Q

What OTC Treatment is recommended for Menorrhagia? (5)

A

Tranexamic acid Tablets (2011 POM-P switch)

i) Mechanism of action- antifibrinolytic-competitive inhibitor of activation of plasminogen to plasmin (reduces blood loss during period).
ii) Indications- Reduction of menstrual bleeding for ages 18-45 yrs with regular 21-35 day cycles
iii) Dosage- 2 x 500mg tabs TDS (max 4 days), up to 4g daily (8 tabs)

iv) Contraindications
- Current or past thromboembolic disease
- Haematuria
- Irregular menstrual bleeding
- warfarin/ other anticoagulants/ OCs/ tamoxifen

v) Consult Dr if- obese and diabetic/ family history of endometrial cancer

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16
Q

1) What is Pre-Menstrual Syndrome?
2) When do symptoms occur?
3) What triggers symptoms?

A

1) A collection of physical and mental symptoms with incidence related to the menstrual cycle.
2) Symptoms occur at the same time in the menstrual cycle each month, up to two weeks before day 1, improving from day 1
3) Ovulation triggers symptoms. Women with PMS may be more sensitive to progesterone, leading to a reduction in the neurotransmitter serotonin.

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17
Q

What are some physical symptoms of Pre-Menstrual Syndrome? (9)

A
  • feeling bloated
  • pain/ discomfort in the abdomen
  • headaches
  • backache
  • muscle and joint pain
  • breast pain
  • trouble sleeping (insomnia)
  • nausea
  • weight gain (up to 1kg)
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18
Q

What are some psychological and behavioural symptoms of Pre-Menstrual Syndrome? (10)

A
  • mood swings, crying, feeling upset or emotional
  • feeling irritable or angry
  • anxiety
  • difficulty concentrating
  • confusion and forgetfulness
  • clumsiness
  • tiredness, restlessness
  • decreased self-esteem
  • loss of libido
  • food cravings
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19
Q

1) What is Premenstrual Dysphoric Disorder (PMDD)?

2) What are the symptoms? (5)

A

1) more severe psychiatric symptoms than PMS, which can cause major disruption to life and relationships.

2) Symptoms are cyclical:
- feelings of hopelessness, depression
- suicidal ideation
- extreme anger and anxiety
- sleeping much more or less than usual
- very low self-esteem
REFER

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20
Q

1) What are the symptom specific treatments for Pre-Menstrual Syndrome? (2)
2) What are the holistic (placebo effect) treatments for Pre-Menstrual Syndrome? (4)

A

1) Symptom specific
- NSAIDs, paracetamol e.g. for breast pain
- Buscopan Cramps-hyoscine butylbromide 10mg tablets

2) Holistic- placebo effect?
- Diet- reduce caffeine and alcohol intake
- Supplements: pyridoxine, evening primrose oil, calcium, magnesium
- Herbal remedy-Vitex agnus-castus
- Exercise

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21
Q

1) What is Thrush (Vulvovaginal candidiasis)?

2) Approximately how many women get thrush and recurrent thrush? (2)

A

1) Common opportunistic infection with the yeast-like fungus candida albicans in vulval and vaginal area.
2i) Approx 75% of women experience vaginal thrush at some point
ii) Around 1 in 20 women have recurrent thrush (> 4x per year)

22
Q

What are the precipitating factors of thrush? (5)

A
  • Age: common in 20-30 age group
  • Pregnancy (change in pH of fluid - causes imbalances)
  • Diabetes mellitus
  • Immunocompromised and debilitated patients
  • Antibiotic or immunosuppressant drug use
23
Q

What are the symptoms of Thrush? (3, 1, 1)

A

i) Vaginal:
- Itch-intense and burning
- Soreness
- Discharge (creamy, thick curd-like or sometimes thin and watery. Odourless)

ii) Dysuria (pain/stinging on urination)
iii) Dyspareunia (pain during sex)

24
Q

What are the RED FLAG Referral Indicators for Vaginal Thrush? (11)

A
  • First occurrence of symptoms
  • > 2 episodes in previous 6 months
  • Under 16 or over 60
  • Pregnancy
  • Previous history of STD (self or partner)
  • Vaginal discharge that is yellow/greenish or has odour
  • Vulval/vaginal sores/ulcers/blisters
  • Abnormal or irregular bleeding
  • Lower abdominal pain
  • Pain during sex/ urination
  • No improvement or reaction to previous treatment
25
Q

What are the OTC Treatment: topical imidazoles for thrush? (2)

A

i) Clotrimazole
- Canesten pessary (hard or soft gel) 500mg alone or with +2% thrush cream
- Canesten 10% vaginal cream +2% thrush cream
- Canesten 200mg pessary x 3
- Canesten 100mg pessary x 6

ii) Miconazole cream 2% for vulval use if preferred.

26
Q

What are the OTC Treatment: oral imidazoles for thrush? (6)

A

i) Fluconazole
ii) Capsule 150mg (generic and Canesten oral) single dose

Iii) Also marketed as Canesten Duo (fluconazole capsule + clotrimazole 2% cream

iv) Contraindicated during pregnancy, breastfeeding, under 16s, over 60s
v) Interactions: ergotamine, carbamazepine, phenobarbital, sirolimus, losartan, fentanyl, methadone, warfarin, sulphonylureas , hydrochlorothiazide, benzodiazepines, phenytoin, rifampicin, ciclosporin, tacrolimus, theophylline, zidovudine, anti-arrhythmics
vi) Fluconazole 150mg / clotrimazole 2% cream licensed for balanitis

27
Q

What are some Complimentary Therapies / Non-pharmacological methods for treatment of thrush? (2)

A

i) Bathe genital area with diluted tea tree oil or plain bio-live yoghurt
ii) Treat with plain live yoghurt internally and externally

28
Q

What is the advice for Thrush-Prevention? (8)

A

i) Wash vaginal area with water
ii) Avoid using soaps, shower gels, foam baths, vaginal deodorants or douches, especially highly perfumed products.
iii) Use a regular emollient such as E45 cream as a soap substitute, then apply a greasier moisturiser to protect the vulval area.
iv) Avoid using latex condoms, spermicidal creams or lubricants if they irritate the genital area. Use a vaginal lubricant during sex.
v) Toilet hygiene -wipe front and back with different paper
vi) Avoid tight-fitting clothing e.g. jeans, tights-use loose cotton underwear. Avoid washing underwear with biological washing powders or liquids and avoid fabric conditioners (perfumed).
vii) If had previously, request thrush treatment when prescribed antibiotics
viii) Some women eat plain live yoghurt or take probiotic supplements to prevent vaginal thrush-no evidence

29
Q

1) What is Bacterial Vaginosis (6)
2) What are its symptoms?
3) Is it sexually transmitted?
4) What is the treatment? (2)

A

i) Bacterial vaginal infection - Involves a shift in bacterial flora of vagina:
- Growth of a wide variety of anaerobic bacteria
- Increase in pH

ii) Symptoms include discharge with a ‘fishy’ odour
iii) Not sexually transmitted

iv) Treatment is POM
- metronidazole tablets
- Metronidazole vaginal gel or clindamycin vaginal cream
- Vaginal gel Balance-Activ available OTC for prevention

30
Q

1) What is Cystitis?
2) What can it be caused by?
3) Who is it more common in?
4) What is the common bacteria associated?

A

i) Inflammation of the bladder, usually caused by a bacterial infection.

ii) Bladder infections can be caused by:
- not emptying the bladder properly
- damage or irritation around the urethra
- bacteria being transferred from the anus to the urethra

iii) More common in women as they have a short urethra with an opening located very close to the anus
- Common in sexually active women, pregnancy, post menopausal women

iv) Common bacterial spp. E.Coli, Staphylococcus saprophyticus, Proteus mirabilis

31
Q

What are the precipitating factors of cystitis? (3)

A

i) Diabetes
ii) Toiletries (bubble baths, deodorants)and other chemicals (spermicides)
iii) Medication -cytotoxics such as cyclophosphamide

32
Q

What are the symptoms of cystitis? (4)

A

i) Frequency/ urgency
ii) pain or stinging during urination (dysuria)
iii) pain in the bladder
iv) Cloudy or strong smelling urine

33
Q

What are the RED FLAG Referral Indicators for Cystitis? (11)

A

i) cystitis symptoms for the first time
ii) haematuria (blood in urine) /v.dark or cloudy urine
iii) fever(≥38ºC)
iv) vomiting
v) loin pain
vi) vaginal discharge
vii) ≥three episodes in a year
viii) duration of >2 days
ix) failed OTC treatment
x) pregnancy
xi) men or children

34
Q

What is the recommended treatment for cystitis? (5)

A

OTC for mild symptoms ONLY:

i) Drink plenty of water
ii) Avoid alcohol, coffee, strong tea or fruit juices.
iii) Avoid sex until clear
iv) Paracetamol/ ibuprofen
v) Alkalinising agents

  • wouldn’t give to anyone over 70
35
Q

What is the advice for Cystitis-Prevention? (5)

A

i) Drink plenty of water
ii) Always empty bladder fully when urinating
iii) After defecation, wipe front to back or use different paper
iv) Urinate after sexual intercourse
v) Cranberry juice/ capsules

36
Q

Suspected Pregnancy-Emergency Hormonal Contraception (EHC) ‘MORNING AFTER PILL’ - Levonelle One Step (levonorgestrel 1500mcg)

1) How does levonelle work?
2) When is it ineffective? and what does it not interrupt?
3) When should it be used?
4) Who is it licensed for?

A

1) Prevents ovulation and fertilisation if intercourse has taken place in the preovulatory phase, when the likelihood of fertilisation is the highest.

2) Ineffective once the process of implantation has begun
- Does not interrupt an existing pregnancy

3) Use within 72 hours (3 days) of unprotected sexual intercourse or contraceptive failure
4) Licensed for women >16 years of age as P

37
Q

Suspected Pregnancy-Emergency Hormonal Contraception (EHC) ‘MORNING AFTER PILL’ - ellaOne (ulipristal acetate 30mg) (POM to P switch Jan 2015)

1) How does ellaOne work?
2) What does it not interrupt?
3) When should it be used?
4) Who is it licensed for?

A

1) Inhibits or postpones ovulation via binding to the progesterone receptor and suppression of the LH surge
2) Does not interrupt an existing pregnancy
3) Use within 120 hours (5 days) of unprotected sexual intercourse or contraceptive failure
4) Licensed for any woman of child bearing age, including adolescents

38
Q

Levonelle and ellaOne:

1) What are the side effects?
2) What are the interactions?

A

1) Side effects:, nausea, abdominal pain, menstrual cycle disruption, headache, dizziness and fatigue
- Repeat dose required if vomiting occurs within 3 hours

2) Interactions: CYP3A4 inducers (e.g. primidone, phenobarbital, phenytoin, carbamazepine, oxcarbazepine, Hypericum perforatum (St. John’s Wort), rifampicin, ritonavir, rifabutin, griseofulvin).
- Use a barrier method (e.g. condoms) until the next menstrual period starts. Continue with OCs as normal.

39
Q

What free and purchasable methods are available for the detection of Pregnancy? (2)

A

1) Pregnancy tests:
i) Free at local community sexual health clinic, NHS walk-in centres and some GPs.

2) Products to purchase:
i) Can be used from day 1 of missed period (2 weeks after ovulation)-measure hCG.
- Clearblue-shows weeks from conception on digital display
- First Response

40
Q

What are the Common Symptoms in Pregnancy? (6)

A

i) Morning Sickness
ii) Heartburn
iii) Constipation
iv) Haemorrhoids
v) Itching/ skin irritation
vi) Backache

41
Q

What are the Common Symptoms for Morning Sickness? (5)

A

i) Nausea and/or vomiting
ii) More than 80% of pregnant women experience it
iii) Usually gone by week 20 of pregnancy
iv) Occurs at any time of day
v) If severe-hyperemesis gravidarum-REFER

42
Q

What is the treatment for Morning Sickness? (4)

A

i) Small frequent meals, eat plain biscuits when nauseous
ii) Acupressure bands (Sea Bands)
iii) Ginger capsules, lozenges, biscuits
iv) Vitamin supplements for pregnancy (Pregnacare/ Sanatogen mum to be) Healthy Start vits (folic acid,C,D)

43
Q

What are the common symptoms for Pregnancy associated Heartburn/Indigestion? (4)

A

i) acid burning pain
ii) belching
iii) regurgitation
iv) nausea (feeling sick)

44
Q

What is the treatment for Pregnancy associated Heartburn/Indigestion:

1) Non-Pharmacological? (5)
2) Pharmacological? (2)

A

1i) Stop smoking
ii) Avoidance of trigger foods, alcohol, caffeine
iii) Smaller meal portions/ eat main meal earlier
iv) Milk
v) Sleep with head raised

2i) Calcium carbonate containing antacids e.g. Tums
ii) Alginate containing preparations e.g. Gaviscon

45
Q

What are the Common Symptoms/treatment for pregnancy associated:

1) Constipation? (2)
2) Haemorrhoids? (4)

A

1) Constipation ↓intestinal contractility
i) ↑fibre and fluids
ii) lactulose

2) Haemorrhoids-enlarged and swollen veins in or around the lower rectum and anus
i) Diet (reduce constipation)
ii) Moist wipes
iii) Sudocrem,
iv) Anusol, Germoloids cream/ ointment (can be used if pregnant or breast feeding but discuss with Dr first).

46
Q

What are the Common Symptoms/treatment for pregnancy associated:

1) itching? (3)
2) backache? (4)

A

1) Itching/ skin irritation
i) Mild-due to stretching of skin (localised to abdomen) or ↑blood perfusion of skin (generalised itching)
ii) Emollient creams or lotions, Bio-oil
iii) Severe/ extensive-possible obstetric cholestasis-REFER

2) Backache
i) Avoid heavy lifting/ lift bags of equal weight on both sides.
ii) Flat shoes
iii) See NHS choices website for gentle exercises in pregnancy.
iv) paracetamol

47
Q

1) What is Menopause?
2) When does it occur?
3) How does it usually occur? (3)

A

1) The end of menstruation and ovulation caused by a reduction in oestrogen levels
2) Occurs between 45-55 yrs. Premature menopause is before 40 yrs.

3) Usually gradual rather than sudden:
- During the perimenopausal stage, menstruation may be light or heavy (menorrhagia).
- Longer intervals between menstruation

48
Q

1) How long do the symptoms for menopause last?

2) What are the symptoms for menopause? (9)

A

1) Symptoms (2-5 yrs duration)

2) - hot flushes and night sweats
- loss of libido
- Vaginal atrophy- dryness/ pain/ itching/ discomfort during sex
- palpitations
- headaches
- mood changes e.g. depression, anxiety, tiredness
- insomnia
- urinary tract infections (UTIs)

49
Q

What is the treatment/advice for Menopause:

1) Night sweats? (3)
2) Vaginal dryness?

A

1) Hot flushes/ night sweats
i) Avoid triggers (spicy foods, caffeine, smoking, alcohol)
ii) Regular exercise
iii) Cool bedroom

2) Vaginal dryness
i) e.g. Replens MD, Sylk (acidic intravaginal moisturisers)

50
Q

What are some alternative treatments for Menopause? (8)

A

1) Red clover, soya extract and flaxseed contain phytoestrogens (red clover/soya- isoflavones such as genistein and daidzein); flaxseed-lignans): avoid if HRT unsuitable
2) Dong quai (angelica sinensis) Traditional Chinese medicine-photosensitisation
3) Dong quai/ some spp of red clover contain coumarins (anticoagulant properties)
4) Black cohosh-oestrogenic properties or central action-potential hepatotoxicity (recent MHRA warning)
5) Evening primrose oil-rich in gamma linolenic acid. ineffective for hot flushes, but may help breast pain
6) St John’s Wort, Agnus Castus (Chasteberry)and Valerian root
7) Vitamin D beneficial after the menopause (osteoporosis prevention)
8) Yoga, aromatherapy, Tai Chi

professional practice ND (30 decks)

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