Sexual Healthš¤°š» Flashcards
Ethnicity is one of the risk factors for developing fibroids. What other risk factors does KS have for fibroids and what lifestyle advice would you advise to mitigate these risks?
Risk factors
Age - risk increases with age up until menopause, KS is 32
Obesity - BMI is 29.7 almost >30 which would be obese, excess body fat raises oestrogen levels promoting fibroid growth
Vit D deficiency - 28 nmol/l should be >50 nmol/l
Ethnicity - higher risk in black and Asian women compared with white women. In addition, fibroids are more likely to be symptomatic, occur at an earlier age, be larger, and multiple in these ethnic groups.
Family history - mother had breast cancer at 58 increases risk of fibroids
Lifestyle advice
Weight management - weight loss through diet and physical exercise, can reduce oestrogen production which is essential for fibroid growth
KS could continue her zumba classes more frequently and implement other forms of exercise where possible / swimming
Encourage a diet rich in fruit, veg, whole grains to reduce risk of fibroids, reduce red meat and processed foods
Vitamin D supplement - [loading dose] 40 000 units once weekly for 7 weeks, 4000 units a week / oily fish
Manage stress
Regular cervical screening
Maintain bp within healthy range (history of hypertension)
Reduce alcohol intake
What hormones does Microgynon 30 contain and how does it prevent pregnancy?
Contains ethinylestradiol (30 mcg) and levonorgestrel (150 mcg).
Prevents pregnancy by:
Preventing ovulation.
Thickening cervical mucus to block sperm.
Thinning the uterine lining to prevent egg implantation.
How should Microgynon 30 be taken?
1 tablet daily at same time for 21 days, followed by a 7-day break (hormone-free interval) before restarting next pack.
When does Microgynon 30 provide immediate contraception?
Starting pill 1stā5th day of period: Immediate protection.
After 5th day of period: Use additional contraception for 7 days.
What should a patient do if they miss a pill?
If missed by more than 12 hours, use additional contraception and contact their GP.
Can Microgynon 30 be used as emergency contraception?
No, it is not an emergency contraceptive and should not be taken after unprotected sex.
What are common side effects of Microgynon 30?
Nausea, breast tenderness, headaches, mood swings, and changes in menstrual bleeding.
These often subside after the first few months.
What severe side effects require contacting a GP immediately?
Chest pain, shortness of breath, severe headaches, and visual disturbances.
What interactions should patients be aware of?
Certain antibiotics and anticonvulsants may interact.
Inform the GP about all medications being taken.
What should be done if vomiting occurs after taking Microgynon 30?
Within 3 hours: Take another pill immediately and continue as normal.
After 3 hours: No need to take another pill.
How should severe diarrhoea be managed while on Microgynon 30?
Continue taking pills as scheduled.
Use additional contraception during diarrhoea and for 2 days after recovery.
What should a patient do if unsure whether to ingest (due to sickness)?
Wait until the next day, then take 2 active pills 12 hours apart, while using additional contraception like condoms.
Why are follow-up appointments important for patients on Microgynon 30?
To monitor for side effects and ensure the contraception is effective.
If KS missed pills on days 18 to 20 of her cycle and was prescribed Levonelle as emergency contraception what advice would you give her about taking Levonelle, and restarting her Microgynon?
Explaining that Levonelle is an emergency contraceptive pill which can help prevent pregnancy if taken within 72 hours of an unprotected sex by delaying or inhibiting ovulation
Instructing the patient to continue taking Microgynon 30 as scheduled even after taking Levonelle to ensure ongoing contraceptive protection (taking the missed pill as soon as remembering even if it means taking 2 pills in one day). But on the day of the new one donāt take the usual one.
Using an additional form of contraception, such as condoms for the next 7 days to ensure a continued protection as the effectiveness of Microgynon 30 may be temporarily reduced
Advising the patient they may experience irregular bleeding or spotting after taking Levonelle, which is a common side effect and not a cause of concern
Informing the patient that timing of the menstrual cycle may be affected after missing a pill and taking Levonelle through which the next withdrawal bleeding may be different than usual
Summary:
Levonelle is an emergency contraceptive that prevents pregnancy if taken within 72 hours of unprotected sex by delaying or inhibiting ovulation.
Continue taking Microgynon 30 as scheduled, even after taking Levonelle, to maintain contraceptive protection. If a pill is missed, take it as soon as remembered (even if taking 2 pills in one day).
Use additional contraception (e.g., condoms) for the next 7 days as Microgynon 30ās effectiveness may be temporarily reduced.
Irregular bleeding or spotting may occur after taking
Levonelleāthis is common and not concerning.
The menstrual cycle timing may change, and the next withdrawal bleed may differ from usual.
If KS missed pills on days 18 to 20 of her cycle and was prescribed Levonelle as emergency contraception what advice would you give her about taking Levonelle, and restarting
In case of missing a Combined Hormonal Contraceptive with Ethinylestradiol & Drospirenone (CHC-ED) and taking Levonelle, it is important to provide specific advice for the situation as the following:
Explaining that Levonelle is an emergency contraceptive pill which can help prevent pregnancy if taken within 72 hours of an unprotected sex by delaying or inhibiting ovulation
Ā· Instructing the patient to continue taking (CHC-ED) as scheduled even after taking Levonelle to ensure ongoing contraceptive protection (taking the missed pill as soon as remembering even if it means taking 2 pills in one day)
Ā· Using an additional form of contraception, such as condoms is recommended for the next 7 days to ensure a continued protection
If KS missed pills on days 18 to 20 of her cycle and was prescribed Levonelle as emergency contraception what advice would you give her about taking Levonelle, and restarting
In case of missing a Progestin-Only Pill (POP) and taking Levonelle, it is important to provide specific advice for the situation as the following:
Explaining that Levonelle is an emergency contraceptive pill which can help prevent pregnancy if taken within 72 hours of an unprotected sex by delaying or inhibiting ovulation
Ā· Instructing the patient to continue taking (POP) as scheduled even after taking Levonelle to ensure ongoing contraceptive protection (taking the missed pill as soon as remembering even if it means taking 2 pills in one day)
Ā· In case a POP is missed by more than 3 hours, the patient should take the missed pill as soon as remembering then taking the next pill at the regular time
Ā· Using an additional form of contraception, such as condoms is recommended for the next 2 days to enhance a continued protection
KS hopes to have a second child in the next few years. Based on her presenting complaint, family history, observations, investigations and family planning intentions, consider the appropriateness of Microgynon 30 as contraceptive for this patient.
Desire for future pregnancy indicating a desire for a reversible contraception
Ā· Menstrual symptoms represented in dysmenorrhoea and heavy irregular bleeding
Ā· Suspected uterine fibroids
Ā· Medical history of asthma ānot contradicting use of Microgynon 30ā
Ā· Being overweight with low vitamin D levels, which should be considered when discussing overall health and potential impacts on contraceptive methods . Obese use with caution.
Ā· Family history of hypertension, diabetes, DVT and breast cancer
Look at dvt risk , family history, obesity
Not appropriate take Tranexamic acid - heavy periods
When stopping micro, may be delay to get pregnant may not be straight away
Considering intentions for a future pregnancy, Microgynon 30 is an appropriate option as it provides reversible contraception through its hormonal combination and mode of action
Ā· Microgynon 30 can potentially help regulate menstrual cycle, reduce bleeding and alleviating symptoms of dysmenorrhoea
Ā· Considering the suspected uterine fibroids, it is important to monitor the symptoms and any fibroid growth while taking Microgynon 30
Ā· Considering high BMI and low vitamin D levels, they do not necessarily contraindicate the use of Microgynon 30 however should be taken into consideration and clinically adjusted
Ā· Considering family history of hypertension, DVT and breast cancer, Microgynon 30 can increase the chance of the patient developing these conditions. Therefore, , it is important to monitor the symptoms of tenderness, pain and unusual discharge from the breast, pain, tenderness and swelling in the leg and monitoring blood pressure regularly
Ā· Regular follow-up appointments are required to assess the effectiveness of Microgynon 30, monitor any potential health impacts and ensure it remains a suitable choice of contraception for her specific health needs and family planning goals
Whoās appropriate for cervical screening (every 3 years)?
25-64 years (65+ risk is reduced)
Not had a total hysterectomy (removed cervix)
Trans man 50+- if cervix every 5 year. Under 50 every 3 years up until 64
TY previously had their endometriosis symptoms managed with a GnRH (leuprorelin) and a LARC (levonorgestrel). Explain how these agents helps to reduce the symptoms associated with endometriosis.
Utilise oestrogen dependency of endometrial growth
Anti-oestrogenics to inhibit of endometrial growth
GnRH analogues(Leuprorelin) - gonadotropin releasing hormone: initially stimulate the pituitary gland to releasing luteinizing hormone(LH) and follicle-stimulating hormone(FSH). But it downregulates the pituitary gland with continuous administration, leading to reduced secretion of LH and FSH, and further oestrogen production. Oestrogen can promote endometrial proliferation, thus decreased oestrogen production helps to reduce endometriosis symptoms.
LARC(Levonorgestrel) - long acting reversible contraception: levonorgestrel is a exogenous progestin. It can thicken cervical mucus, oppose endometrial proliferation, thin endometrial lining. LARC can also provide a continuous release of progestin, which helps regulate hormonal fluctuations.
Acts on endometrium (lining of uterus), inhibits endometrial cell growth and thins lining. Reduced glandular activity
Condensing
GnRH Agonist (Leuprorelin)
Location of Action: Hypothalamic-Pituitary-Ovarian Axis.
How it Works:
Overstimulates GnRH receptors in the pituitary gland, causing downregulation of LH and FSH secretion.
Leads to reduced ovarian estrogen production, inducing a hypoestrogenic state.
This shrinks ectopic endometrial tissue and reduces inflammation and pain associated with endometriosis.
LARC (Levonorgestrel)
Location of Action: Uterus (Endometrium).
How it Works:
Released locally from intrauterine devices (IUDs).
Thins the endometrial lining, suppressing growth of ectopic endometrial tissue.
Reduces local inflammation, blood vessel growth, and prostaglandin production, alleviating pain.
What lifestyle advice could you suggest to TY to manage the menopausal symptoms they are experiencing?
Current symptoms: low mood, anxiety, vaginal dryness and irritation, sleep disturbance and hot flushes
Hot flushes: regular exercise, weigh loss, wearing lighter clothing/layers of clothing, turning down central heating, sleeping in a cooler room, using fans, reducing stress, and avoiding possible triggers (such as spicy foods, caffeine, smoking, and alcohol).
Sleep disturbances: avoiding exercise late in the day and maintaining a regular bedtime
Low mood and anxiety: adequate sleep, regular physical activity, and relaxation exercises
Vaginal dryness and irritation: avoid tight fitting clothing/underwear, use non perfumed soaps when washing, avoid douching, wear cotton underwear, avoid possible triggers
Advise TY to seek occupational health advice
Manage CVD risk factors.
Endometriosis and endometrial tissue responds and grows when exposed to oestrogen. Given their past medical history and family history, outline the risks associated with OestrogelĀ® for TY.
Oestrogel: hormone replacement therapy for oestrogen deficiency symptoms in postmenopausal women
Risk:
Ovary cancer
Impact on endometrial tissue (proliferates in gi tract eg outside of uterus)
Compare the formulation of vaginal rings with the formulation of contraceptive implants.
Contraceptive Implants
small, flexible rods inserted under the skin, usually in the arm, and comprise a biocompatible polymer, such as ethylene vinyl acetate (EVA) or other non-reactive polymers. In the core there is also barium sulphate and magnesium stearate These implants are designed to release synthetic hormones, often a progestin like etonogestrel, over a long period (up to 3-5 years). They generally avoid the specific binding issues seen in silicone elastomer vaginal rings, as implants use non-silicone materials less prone to binding reactions with progestins.
Designed for continuous release of progestins (e.g., etonogestrel) over 3ā5 years via non-reactive, biocompatible polymers like EVA.
Advantages:
Stable release without binding issues seen in silicone-based vaginal rings.
Single-progestin formulations reduce drug interaction risks.
Contains additives like barium sulfate and magnesium stearate for functionality.
99% effectiveness
Limitation: Primarily for contraception, unlike dual-function vaginal rings.
Vaginal Rings
3 weeks then 1 week break during menstration. Repeat.
99% effectiveness rate
Made from silicone elastomers that release drugs over time (matrix-type or reservoir-type).
Often combine progestins (e.g., levonorgestrel) with other agents (e.g., Dapiverine for HIV prevention).
Can also contain oestrogen, unlike implants.
Challenges:
Certain progestins (e.g., levonorgestrel) may chemically react with the silicone elastomer, reducing release effectiveness due to platinum-catalyzed hydrolysation.
What is the purpose of lactose in a vaginal ring?
Zinc sulphate - moisture control & better release of drug
Magnesium sulphate - reduces LNG reaction & results in better release
Lactose - bulking agent. Stabilises API. Controls release of drug as reduced LNG binding and reactions with hydrodaline groups.
Excipients for oestrogen gel
Ethanol: acts as solvent.
Carbonmer: thickener; gives smooth consistent texture. Stabilises formulation
Purified water: acts a solvent to dilute API
Neutralising agents: Trolamine - ph adjuster; balances acidity to match skin ph. Allows effective absorption w/out irritation
