Women Flashcards
Women as Patients
Prescribing during childbearing years
- constant awareness of possible pregnancy
Lactation- requires careful prescribing
Risk for violence- all women should be screened
Longer life span compared with men
- living alone, poverty, changes in cognitive and physical functioning
Women: Puberty
Female adolescent athletes at risk for female athlete triad
- Disordered eating and overexercise leads to suppression of hypthalamic-pituitary-ovarian axis
- Reduction in estrogen levels leads to amenorrhea and decreased bone mineralization
- Treatment is with calcium, vitamin D, and oral contraceptives
“Normal” adolescent diet low in calcium, vit D, & iron; may need replacement
Depo-provera: may cause bone mineral density loss
- Should not be used for longer than 2 years
Pregnancy: Pharmacokinetic Changes, Anemia, Caffeine, Herbs, Smoking
- Pharmacokinetic changes
- – Drug absorption from lungs and skin increases
- – Increased plasma volumes affect volume of distribution
- – Drug clearance increases
- Iron-deficiency anemia concerns
- – Iron supplement needed
- Teratogen risk from many drugs, alcohol, and tobacco use
- Caffeine use to be limited
- Smoking /tobacco use affecting oxygen availability to fetus
- – Low birth weight, preterm, abruptio placenta
- Herb use in pregnancy not well-studied
Menopause: Changes
Changes in:
- reproductive
- musculoskeletal
- cardiovascular
- cognitive
Dysmenorrhea
Primary dysmenorrhea caused by myometrial activity induced by prostaglandins
NSAIDs first-line therapy
- Start 2-3 days before menses
Oral contraceptives also effective
- Nonpharmacological interventions: massage, yoga, exercise, heating pad
Premenstrual Syndrome (PMS)
Symptoms include: irritability, depression, angry outbursts, anxiety, confusion, social withdrawal, mood swings, fatigue, insomnia, dizziness, HA, breast tenderness, weight gain, bloating, water retention, muscle and joint pain
Ibuprofen days 17-28 of cycle may help
Reduce salt, sugar, caffeine, chocolate, red meat, dairy, and alcohol
Vitamin B6 100 mg/day may be helpful
Calcium carbonate 1,200 to 1,600 mg/day may help
Premenstrual Dysphoric Disorder (PMDD)
Diagnostic criteria (must have 5 or more): - Markedly depressed mood, heightened anxiety/tension/edginess/ nervousness, affective liability, persistent marked anger & irritability, decreased interest, lack of energy, hypersomnia, or insomnia
Symptoms cyclical and improve during menstruation
SSRI first-line therapy
- Spironolactone, oral contraceptives, and NSAIDs also helpful
Endometriosis
Presence of functioning endometrial tissue outside of uterus
- cyclical changes and inflammation causing pain
- can lead to fibrosis, scarring, adhesions, infertility
Drug treatment
- Gonadotropin-releasing hormone agonists for 3 months
- Danazol for 6 months
- NSAIDs to decrease pain
- Oral Contraceptives
Diet changes: need to remove xenoestrogen exposure
Calcium, magnesium, and omega-3 supplements
HIV/AIDs in Pregnancy
- 27% of new HIV infections occur in women
- Infected pregnant women can pass virus to babies during pregnancy, delivery, or breastfeeding
- – Zidovudine greatly reduces transmission risk from 25% to 2% if started early in pregnancy
- – All pregnant women should be offered HIV testing
Infertility
Absence of conception after 1 year of unprotected intercourse
Incidence increasing with age
Referral for fertility evaluation
Prolonged amenorrhea after long-term Depo-Provera use cause for concern; but pregnancy can occur without return to menses
Polycystic Ovarian Syndrome (PCOS)
Endocrine disorder
- High estrogen, testosterone, and luteinizing hormone
- Decreased follicle-stimulating hormone
- Ovaries double in size with multiple follicular cysts
- Impaired glucose tolerance and hyperinsulinemia
- High risk of developing type 2 diabetes mellitus
Treatment
- Oral contraceptives
- Metformin or insulin
Health Promotion for Women
Immunizations
Screenings- mammogram, pap smear, colon cancer screening
Bone mineral density screening
Gay and Lesbian Issues
Lesbian health is not the same as women’s health
- Lesbians can get STIs
- Lesbians need cervical cancer screenings
Providers need to treat all patients with respect and dignity
Providers should be thoughtful about how to ask questions regarding sexuality
It is important to provide an accepting environment for all patients
