Test 1-StudyGuide Flashcards
What are the phases of the menstrual cycle?
Cycle: day 1-5
Early follicular (ovarian phase)
Endometrial Phase **(menstrual) ** (bleeding)
Estrogen is low
Cycle: days 6-14
late follicular (ovarian phase)
(endometrial phase) proliferative (the egg forms)
estrogen increases so thicken your uterus so that a fertilized egg can implant
Cycle: days 15-28
Luteal (ovarian phase)
(endometrial phase) secretroy
progesterone
**prepares body for pregnancy thickens the uterine lining
I disorder of this phase can affect you getting & staying pregnant
Which phase deals with the uterus or (endometrial)?
Proliferative phase (Follicular Phase): Endometrial cells proliferate and the lining thickens.
Which phase deal with the ovary or ovarian?
Secretory phase (Luteal Phase): An egg is expelled from the ovary (ovulation) into the pelvic cavity.
Function of GNRH?
Gonadotropin-releasing hormone (GnRH) is a signaling hormone that stimulates the release of other hormones. More specifically, it triggers two hormones in the gonadotropin family: follicle-stimulating hormone (FSH) and luteinizing hormone (LH) [1].
The gonadotropins regulate the growth, development, and function of the reproductive organs. FSH and LH stimulate the production of eggs, sperm, and the sex steroids (estrogen, progesterone, and testosterone). They’re released from the pituitary [1, 2].
GnRH is, therefore, vital to sperm production in men and egg release (ovulation) in women. GnRH levels are very low before puberty; however, as puberty approaches, GnRH levels increase to prepare for sexual maturity
Function of LH?
In the pituitary, LH is released only in the second part of the menstrual cycle. That is, after an initial surge causes the release of an egg (ovulation), LH is released at a constant pace for two weeks. This stimulates ovarian progesterone production
Ovulation: A surge in LH causes your ovary to release a mature egg around the second week of each menstrual cycle. A high LH level around this time means that you’re at that moment in your cycle when you’re most likely to get pregnant.
Your hypothalamus secretes a hormone called gonadotropin-releasing hormone (GnRH) that signals your pituitary gland to secrete LH. LH signals your ovaries or testes to make the hormones needed to start and maintain reproductive processes.
Function of FSH?
FSH and LH trigger their ovaries to begin producing estrogen. This hormone is responsible for physical changes of puberty, such as breast development and menstruation.
Specifically, FSH stimulates follicles in the ovary to grow and prepare the eggs for ovulation. As the follicles increase in size, they begin to release estrogen and a low level of progesterone into your blood.
FSH causes follicles in one of the ovaries to begin to mature. However, during days 10 to 14, only one of the developing follicles forms a fully mature egg.
Function of estrogen?
The ovaries make estrogen during reproductive years. The adrenal glands, and adiopose tissue (body fat) secrete estrogen.
- in puberty helps develop mammary mammary gland ducts during puberty & pregnancy (helps milk production)
- helps endometrial cells in the proliferative phase of the menstrual cycle. Thickens endometrial lining in preparation for pregnancy
- Can suppress GnRH & FSH & LH in preventing ovulation during the cycle
- vagina- helps maintain the lining (without it vagina becomes thinner)
- Protects bones (lack of it) is not good for estrogen deficient & post-menopausal women
Function of progesterone?
- Progesterone is produced from the corpus luteum of the ovaries. *This gland is made after an egg is released from the ovary.
- A rise in LH hormone causes ovulation (release of an egg)
- The corpus luteum forms & produces progesterone
- Progesterone helps body prepare for pregnancy by stimulating glandular devlelopment of new blood vessels
If egg is not fertilized the corpus luteum breaks down & progesterone levels drop. When progesterone levels drop the endometrial lining dies . . . causing a period
What is the progesterone challenge test?
**progesterone prevents ovulation
Given to women who have amnorrhea (no period)
1. Give progestrone medication to see if this causes bleeding
2. Bleeding after progesterone test= anovulation (woman has estrogen but is not ovulating)
3. No bleeding after test= order FSH
If FSH is high= decreased ovarian reserve
4. Normal FSH= add estrogen to see if there is vaginal bleeding
Indications of Amenorrhea:
-low serum estrogen
-hypothalamic-pituitary axis dysfunction
-nonreactive endometrium
-ashermans syndrome
-cervical stenosis (uterine outflow tract problem)
Never give test when woman is pregnant
Can induce bleeding in irregular period
What is dysfunctional bleeding?
Vaginal bleeding happens outside of the menstrual cycle
*Often caused by hormonal imbalance
What are the causes of abnormal uterine bleeding?
- Hormonal imbalance
- structural: fibroids, polpys, adenomyosis
- anovulation (not ovulating)
- bleeding disorders
What are the normal characteristics of the cervix?
Small canal that connects uterus & vagina
muscular-tunnel like organ
The female diaphragm:
How is it inserted?
How long can it stay in?
Barrier method of contraception
Must be fitted to the individual
you need contraceptive jelly
must be inserted prior to intercourse
leave in 6-8 hours after
How do you manage an abnormal pap smear?
- Do a colposcopy (magnifying lens to look at cervix & see abnormal cells) Turns the cells white
- MD takes a biopsy for testing
- Then Leep .
- Then paps more frequently
How do you manage combine oral contraceptives (COCs)?
Has both estrogen & progesterone
Take at the same time each day!!
Do not take if:
-35 y/o & smoke
-h/o blood clots
-h/o breast cancer
How do you manage progesterone only pill (POPs)?
called the mini pill
progesterone only
taken at the same time each day
better for women you can’t take estrogen
This does not help to clear acne
*good option for BF
*better for people who smoke, h/o blood clots, HTN
How do you manage the NuvaRing?
99% effective just like the pill
releases low dose of hormones
Good for busy women because insert & leave in
Pinch ring & insert into the vagina
in for 3 weeks
1 week break for period
then insert a new ring
Can be removed for up to 3 hours and during intercourse
How do you manage the implant? IUD LAC (long acting contraception)
Mirena IUD
this releases levonorgestrel (progestin)
small flexable plastic
thickens cervical mucous
makes lining of the uterus thin
Benefits:
can stay in for 5 years
decreased menstrual bleeding
less systemic hormone
no estrogen
annual failure rate is 0.1%
—–
Copper IUD (paraguard)
nonhormonal
increase menstrual bleeding/spotting/pain
paragaurd is good for?
10 years
Sklya is good for 3 years
How do you manage the patch?
Can’t put it on the inner arm or breast
**releases daily hormones into the skin to prevent pregnancy
**works in the same way as combined oral contraceptive pills (estrogen & progesterone)
Pros- only have to think about it once a week
Con- have to think about it once a week
-Has a higher level of estrogen- increased risk for getting blood clots
-nausea (because estrogen can cause this)
-con-possible acne
-progesterone (may make you more hungry & have more cravings)
change the patch on the same day at the start of the week
for 3 weeks
then have 1 week for your bleeding (patch free)
start new cycle even if you are still bleeding
Good idea to change the position of each new patch
How do you develop a plan of care for their annual exam?
Purpose:
-To get the pt. well do appropriate screening & education.
-Update pt’s health info
-medical history
-meds taking?
-any surgical history?
-family history?
-social history?
-GYNO history
-sexual history- number of partners, sex practices
-menstrual history
-are you happy with your contraceptive method?
-GTPAL (OB history)
check thyroid
& head
listen to heart & lungs
breast exam
abd exam
pelvic exam (scoot bottom to the end of the table)
bimanual exam- 1-2 fingers to inspect uterus & ovaries
What is the plan of care to for contraceptive management?
- Do you plan on having children?
2 Do you have a time in mind of when you want start having children? - How important is it for you to wait until that time?
-Assess further what are their preferences
what is important to you about your contraceptives?
- is having a period important to you
2.hormone vs. non-hormones - lifestyle
- are you okay taking something every day?
- are you okay with having devices in your body?
- risk for fertility in the future
- ability to stop the birth control
**understand where pt. comes from very permission based & very noncoercion based
**patient based & then we guide them
***empower pt’s
How do you manage or develop a plan of care for dysfunctional uterine bleeding?
**Any vaginal menstrual bleeding that is not expected
*Any vaginal menstrual bleeding that is not expected!!
menstruation starts at around 14- lasts until menopause
Irregular- longer cycle times or missed periods
history:
how many days?
how many pads/tampons do they use?
where is the bleeding? cervical, vag, fallopian, ovarian
polyps, STIs, uterine hyperplasia, fibroids
pregnancy
anything in uterus causing bleeding
hypothyroidism
PCOS
bleeding disorders
**menstruation is irregular with the onset of menarche
Menstrual History
A-age of menArche (age of period)
menopause vs. last menstrual period
B- bleeding- duration? blood loss? pad/tampons changes
C- cycle duration (28 days) & is it normal vs. abnormal
C- clots
D- pain dysmenorrhea or discomfort (abd cramps)
E- extra points
Sexual History
1P- partners
2P- practices
3P-past h/o STI’s
4P-prevention of preggers
5P -protection of STIs
6P-plus- pride, problems with sexual functioning, pleasure
**approach with an open mind & non-judgemental questioning
*lead with care & love
*check your own bias before encounter
GTPAL
G-# of times a woman has been pregnant (include current pregnancy, miscarriages, abortions) twins= counts as 1 pregnancy
T- term birth 37 wks unward
P- preterm birth 20-37 weeks
A- abortions & miscarriages
L -living children that she has (multiples count individually)
Managing abnormal pap smears
pap result:
cytology vs. HPV result
what kind of cells are we looking at
squamous cells
epithelial cell abnormality = bad
**ASCCP app for paps
asces (looks strange)
lsil (low grade)
hsil (high grade)
** be mindful of lubrication & bleeding can affect the cytology
pap screening
sampling of cervical cells to assess for cervical cancer
when do you start pap screening?
ages 21-65
patients 21-30 pap screening?
cervical cytology every 3 years
cervical cancer screening prevents against cervical cancer
outside the the US its the number 2 cause of cancer for women patients with a cervix
HPV?
40 different types
15 are the most serious 1’s
HPV highest risk is
16 & 18
HPV
by the age of 30 patients have cleared in on their own its a virus
It takes 15 years for cervical cancer to progress to
severe
highest risk for HPV?
- no pap within past 5 years
- pt’s outside of the US (different screening guidelines)
3.low economic status - racial & ethnic disparities
Trichomonous
shift in the vili suggestive of BV
**if seeing this you should test for Trich
