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AANP Class - Leik, Sarah Michell, MedMastery, & Other > Woman's Health > Flashcards

Woman's Health Flashcards

1
Q

Combination oral birth control
estrogen and progestin

A

Consists of estrogen and progestin
ORAL Examples: Yaz, Yasmin, Loestrin (iron-containing)

21-day packs: 1 pill per day for 21 days, followed by 7 days of nonuse for menstruation

28-day packs: 21 or 24 hormonal pills (brand dependent). The remaining pills either contain estrogen only or do not have hormones.

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2
Q

Combination oral birth control
estrogen and progestin

Start times
3 options

A

Quick start: takes the first pill the day she receives them, no matter where she is in her cycle, then back up method for 7 days

First day start: start the first day of her next period (when it starts) - no back up up method needed

Sunday start: start pack on Sunday FOLLOWING start of menses, AVOIDS PERIODS ON WEEKENDS, but back up method is needed for at least 7 days if not a month
*popular start

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3
Q

Combination oral birth control
estrogen and progestin

Missed Pills

A

Missed one pill: take it as soon as possible, taking others on timed schedule (even two in one day)

Missed two pills: take the most recent missed pill as soon as possible, discard the other missed pills. Continue taking the rest of the pack on schedule and use a back up method

Missed more than that: back up methods

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4
Q

Combination oral birth control
estrogen and progestin

Contraindications

A

Age over 35 AND smoker (must be both)
History of blood clot
Migraines with aura
Current liver disease
Current cancer
Uncontrolled hypertension
breastfeeding
systemic lupus erythematous (cardiovascular disease and thromboembolism)

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5
Q

Combination oral birth control
estrogen and progestin

Side Effects

A

nausea
breast tenderness or swelling
bleeding between periods
melasma (irregular dark patches of skin to develop on face)

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6
Q

Combination oral birth control
estrogen and progestin

Advantages

A
  • Improved cycle control
  • ovarian cysts
  • help with dysmenorrhea symptoms: cramping/pain in lower abdomen, down the legs, nausea, vomiting, fatigue, weakness, fainting, or headaches
  • improved acne
  • helps with endometriosis: where tissue grows outside of the uterus causing painful periods, fatigue, heavy bleeding
  • decreased risk of endometriosis and ovarian cancer
  • can get pregnant right away
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7
Q

Combination oral birth control
estrogen and progestin

Disadvantages

A

Clot risk
These get better after 2-3 months
breast tenderness
nausea
breakthrough bleeding
slightly higher risk for cervical and breast cancer

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8
Q

Combination estrogen and progestin

ring options (Nuvaring)

A
  • etonogesterol/ethinyl estradiol vaginal ring
  • keep it in place for three weeks, remove for one week providing low and steady amounts of hormones
  • reinsert ASAP if it falls out (within 3 hours) does not lose effectiveness
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9
Q

Combination oral birth control
estrogen and progestin

Disadvantages

A

Clot risk
breast tenderness
nausea
breakthrough bleeding

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10
Q

Combination estrogen and progestin transdermal patch

Xulane patch

*used to be Ortho-Evra (pulled off the market due to high risk of blood clots - 60% more estrogen than advertised)

A
  • highest amount of estrogen
  • ethinyl estradiol and norelgestromin transdermal system
  • apply once per week
  • highest risk of blood clots due to the higher amount of estrogen
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11
Q

Progestin-ONLY

A

Prescribe to (think this covers the people who cannot use combo estrogen and progestin)
- only option for breastfeeding moms
- greater than 35 y.o. and smoke
- migraines with aura
- 3 hour window

  • contraindicated with active cancers or liver disease
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12
Q

Medroxyprogesterone Acetate
Depo-Provera (2 - 5 years max)

A

Progestin - Only Option
- can be given to breastfeeding patients if administered in the 6th postpartum week
- suppresses ovulation for 12-13 weeks

Delay in return to fertility (year+)
Weight gain, increased acne, depression
Long term use can impact bone density placing them in higher risk of osteoporosis
- Eat Vitamin D & Calcium

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13
Q

Intrauterine Device
IUD
no ectopic pregnancies!

A

piece of T-shaped plastic, about the size of a quarter, placed inside the uterus to prevent pregnancy: copper OR hormone progestin (amenorrhea / some breakthrough bleeding)
- over 21
- STI screenings
- pain with exertion
- maybe dislodged, can feel strings, ultrasound to locate it
- progestin IUDs are Liletta (8 yrs), Mirena (8 yrs), Skyla/Kyleena (5 yrs)

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14
Q

Cooper T IUD = Paraguard

A
  • can be used in emergency contraception (unplanned pregnancy) and birth control, must be inserted 7 days after unprotected sex for emergency contraception
  • can be given to cancer patients
  • placed within first 48 hours after birth or wait until 4-6 weeks after to reduce risk of expulsion
  • heavier menses, stays in place for 10 years
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15
Q

Emergency Contraception Option
Morning After Pill
Plan B and Ella

A
  • unplanned pregnency
  • Progestin only
  • Side Effects: spotting, nausea, vomitting until next period
  • Take w/in 72 hours after intercourse, up to 75% effective
  • not abortive in nature
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16
Q

Hormone Replacement Therapy

A

Manage menopause symptoms
Prevent osteoporosis

Risks:
Heart disease
Blood clots (DVT/strokes/PEs)
Breast cancer
Ovarian cancer

Goal is to have patients on HRT as little time as possible, ideally less than 3-5 years

Not for patients older than 60 years old

17
Q

Combination oral birth control
estrogen and progestin

Missed Pills

A

Missed one pill: take it as soon as possible, taking others on timed schedule (even two in one day)

Missed two pills: take the most recent missed pill as soon as possible, discard the other missed pills. Continue taking the rest of the pack on schedule and use a back up method

Missed more than that: back up methods

18
Q

Emergency Contraception Option
Morning After Pill
Plan B and Ella

A
  • unplanned pregnency
  • Progestin only
  • Side Effects: spotting, nausea, vomitting until next period
  • Take w/in 72 hours after intercourse, up to 75% effective
  • not abortive in nature
19
Q

Hormone Replacement Therapy
HRT
Estrogen / Progestin Combination

A

In tact uterus must be on estrogen / progestin combination to help prevent endometrial hyperplasia and endometrial cancer

20
Q

Hormone Replacement Therapy
HRT
Estrogen ONLY

A

hysterectomy (uterus removed) patients

21
Q

Hormone Replacement Therapy
HRT - Alternative Therapy

A
  • Selective serotonin reuptake inhibitors (SSRIs) paroxetine (Paxil) - hot flashes, night sweats, mood
  • Ginkgo biloba
  • Black cohosh
  • Soy isoflavones
  • Evening primrose
22
Q

Topical hormone replacement therapy

A
  • does not have the same risks as oral
  • provide vagina relief from dryness, pelvic floor function, prevent UTIs
23
Q

Combination oral birth control
estrogen and progestin

Missed Pills

A

Missed one pill: take it as soon as possible, taking others on timed schedule (even two in one day)

Missed two pills: take the most recent missed pill as soon as possible, discard the other missed pills. Continue taking the rest of the pack on schedule and use a back up method

Missed more than that: back up methods

24
Q

Minors = No parental consent needed

A

STD treatment
Contraceptives (check state/office guidelines)
Pregnancy care

25
Q

Childbearing age reports of genitourinary complaints

A

Order Human chorionic gonadotropin (hCG) urine pregnancy test

26
Q

Pap Smear Guidelines
aka papanicolaou test

A

American College of Obstetrics and Gynecology
Age 21
Every 3 years despite sexual activity
Age 30
Every 5 years (normal results with cytology + HPV test)

27
Q

Abnormal Pap Smear

A

1) low-grade squamous intraepithelial lesions (LSIL)
2) high-grade squamous intraepithelial lesions (HSIL)
3) atypical squamous cells of undetermined significance (ASCUS) indicate abnormal cells present but not diagnostic for lesion (test for reflexive HPV)

  • refer for colposcopy to look at cervix, vagina, and vulva through a special magnifying device called a colposcope
  • abnormal results show will cervical intraepithelial neoplasia (CIN 2 and/or 3) usually caused by certain types of human papillomavirus (HPV) that is treated to prevent cervical cancer
28
Q

HPV test is positive…

A

referral for colposcopy

29
Q

Gardasil vaccine

A
  • prevent HPV (affects 85% of population)
  • prevent cervical cancer as HPV subtypes 16 and 18 cause 70% of all cervical cancers
  • prevent genital warts (TCA acid or cryotherapy)
  • Two dose vaccine for people who get the first dose before their 15th birthday, start at 11-12 yo (0, 6–12-month schedule)
  • Three dose vaccine A 3-dose schedule is for people who get the first dose on or after their 15th birthday, or have immunocompromising conditions (0, 1–2, 6-month schedule)
30
Q

Vaginal bleeding in post-menopausal patient…

A

After 12 months of no menses, refer for endometrial biopsy for endometrial cancer

31
Q

Polycystic Ovary Syndrome - PCOS

What is it?
s/s
diagnosis
tx

A

may not ovulate, high levels of androgens, small cysts on the ovaries

s/s
ovulatory dysfunction
irregular menstrual periods, infertility
hyperandrogenism/hirsutism
hair loss / alopecia
mood changes
excess hair growth, acne,
weight gain

Rotterdam Criteria diagnosis - meet 2
1. presence of abnormal menstrual pattern due to ovulatory dysfunction for >1-2 years
2. presence of hirsutism (growth of hair around mouth and chin) or elevated serum testosterone levels
3. presence of cysts on ovaries (string of pearls)

tx metformin, hormonal contraceptives, spironolactone

32
Q

Galactorrhea

A

non lactating person expresses milk from breast associated with breast stimulation and drug side effects (atypical anti-psychotics like olanzipe or zyprexa)

  • check prolactin level for prolactinoma is a benign (noncancerous) tumor of the pituitary gland that produces a hormone called prolactin that signals a woman’s breasts to produce milk during pregnancy and breastfeeding
33
Q

Yeast Infection / vulvovaginal candidiasis
s/s
tx

A

s/s
vaginal burning / itching
vaginal irrigation
chunky white vaginal discharge
pH is still 4-4.5 as it is unaffected

wet mount / microscope
- budding yeast
- spores
- pseudohyphae

tx
- fluconazole (Diflucan)

34
Q

Bacterial Vaginosis
“CLUE CELLS”

A

pH of vagina changes allowing for overgrowth of anaerobic vaginal bacteria

s/s - presence of 3 of 4 for diagnosis
1. increased white homogeneous vaginal discharge
2. clue cells on wet prep
3. positive Whiff Test - foul smell when mixed with potassium hydroxide
4. pH > 4.5

Tx: metronidazole (Flagl) 500 mg BID for 7 days
- cause disulfiram-like reactions if alcohol is consumed while taking this and for 3 days after completion

35
Q

Ovarian Cancer

A

leading cause of death in older women

Risk
- positive family history is best predictor risk
- early menarche, late menopause, nullparity

Protective against ovarian cancer
- oral contraceptive use for 5 years
- breastfeeding for 1 year
- hysterectomy

Gold Standard Diagnosis
transvaginal ultraound

AANP Class - Leik, Sarah Michell, MedMastery, & Other (20 decks)

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