Women Health Flashcards
Contraception Methods
- abstinence
- withdrawal
- natural family planning
- hormonal
- barrier
- permanent sterilization
Vasectomy
- scalpel technique: cut and ligate/cauterize vas deferens
- no-scalpel technique: puncture scrotum to deliver vas deferens then ligate or cauterize
Traditional tubal occlusion
- ligating
- blocking with clips or rings
- cauterizing
Newer tubal occlusion
- brand name: essure
- micro-inserts placed into proximal fallopian tubes
- no reported pregnancies to date
IUD’s
- most effective
- NOT for patient with current STD, PID, or uterine anomalies
ParaGard T
- releases copper
- causes inflammation of endometrium and decreased sperm motility
- placed for 10 years
Mirena & Skyla
- releases levonorgestrel
- creates inhospitable environment
- decreased ovulation
- Mirena placed up to 5 years
- Skyla up to 3 years
IUD decreases…
risk of ectopic pregnancy compared to patients no using birth control
Nexplanon
- most effective
- contains progestin
- implanted in inner upper arm
NOT for:
- hx of clot
- hx of br cancer
- liver dz
- smoker
Combination Oral Contraceptives
- very effective
- administration of estrogen and progesterone prevents ovulation
- come in various forms and combo’s
- very effective if used as directed
General risks: hypercoagulability
How to take contraceptives
-usually, active pills are taken for 21 days, then 7 days inactive pills
Monophasic
- fixed ratio estrogen/progesterone
prototype: Lo/Ovral
Biphasic
- estrogen stays same, progesterone increased in 2nd half
prototype: mircette
triphasic
- estrogren and progesterone increase in 3 phases
prototype: ortho tricylcen Lo
Combo pills serious side effects
- thrombosis
- accelerated breast tumor growth
Patient teaching oral contraceptives
A: abnormal liver fx C: CP - SOB H: HA E: eye problems S: severe leg pain (thromboembolic process)
Progestin-only products
- mini pill
- work more by creating inhospitable environment than preventing ovulation
- less effective, more breakthrough
- safer is a smoker, heart dz, breastfeeding
- all 28 pills are active
Prototype: Micronor
Depo
- lasts 3 months
- safe postpartum
- must stay on schedule
- side effects: irregular spotting at first, eventually may have amenorrhea
- wt gain, HA, decreased libido, depression, hair loss, delayed return to fertility
- loss of bone mineral density
Xulane: The Patch
- 1 combo patch q wk x3, then 1 wk off
- advantages: easier to remember
- not effective if over 198lbs, skin rxns common
- other side effects similar to combo pills, greater risk for VTE compared to pills
- not for pt with hx of VTE
NuvaRing
- combo hormone
- indwelling ring placed against the cervix
- remains for 3 wks, then removed for 1 wk to allow meses
- need backup for 1 wk after ring placed for first time
- side effects similar to combo pill
- other issues: client comfort with use
Barrier Method
- moderately effective
- male/female condoms
- vaginal sponge
- diaphragm
Cervical Cap
- FemCap
- more effective for nulliparous women
Spermicide
- effective
- available as creams, gels, film, foam, and suppositories containing nonoxynol-9
- used alone or with a barrier method
Fertility Awareness
- effective
- rhythm method
- standard days method (cycle beads)
- BBT Method
- Billings ovulation method
- Symptothermal method
Emergency Contraception
- prevents pregnancy after sex
- not the same as abortion pill
- methods: plan B, Ella, Copper T IUD
Abortion
Spontaneous vs. Elective
- purposeful interruption of pregnancy before 20 wks gestation (elective, therapeutic)
- legal and moral issues
Concurrent use of spermicides and latex condoms…
provides protection against STIs
Tubal ligations and vasectomies are…
permanent sterilization methods
Induced abortion performed in the ____ trimester is safer and less coplex
first
most common complications of induced abortion
- infection
- retained products of conception
- excessive vaginal bleeding
Infertility
defined as a lack of conception with unprotected SI x12 months
-increases with age
Sterility
inability to conceive
Contributing factors to infertility
- 1/3 female issue
- 1/3 male issue
- 1/3 related to a combination of both male and female problems or unknown
Causes of female infertility
- hormone imbalance
- structural: endometriosis, scar tissue, congenital anomalies
- polycystic ovarian syndrome
- infections
- genetics
- weight
- age
- environment
PCOS
- 4-12% of women in US
- abnormal metabolism of androgen and estrogen leading to a hormone imbalance that impedes ovulation
- small cysts form in the ovaries rather than producing a mature egg (anovulatory)
- peripheral insulin resistance and hyperinsulinemia
- dyslipidemia
- increased clotting factors
- obesity
PCOS Symptoms
- abnormal menstrual patterns
- male pattern hair growth
- increased muscle mass, deepened voice
- infertility
- obesity
- DM
- acanthosis nigricans
- apple shape
- HTN
PCOS Infertility Tx
- weight loss
- metformin
- ovulation induction using agents like clomiphene (Clomide)
Metformin
regulates insulin resistance and improves hormone balance, thus reducing symptoms after 2 or 3 months of use in many patients
Assistive Reproductive Technologies
IVF-may include donor egg or sperm costs for this is very high with no guarantees for success
- gestational surrogacy
- adoption
Menopause
- climacteric period
- permanent cessation of menstrual flow with mean age of 51 years
- just one event occurring over months when ovarian function and hormone production decline call peri-menopausal period
- decreasing levels of estrogen and progesterone result in many of the classic symptoms
Labs for menopause
- FSH
- LH
Symptoms of menopause
- vasomotor symptoms “hot flashes” r/t low levels of estrogen and increased levels of LH
- sleep disturbances
- urogenital atrophy leading to vaginal thinning, incontinence, cystocele and rectoceles
- osteoporosis and kyphosis
- hair loss and hair growth in annoying places
Menopause Key Points
- alt in thermoregulation
- alteration in comfort
- trauma, risk for r/t bone loss
- sleep pattern disturbance
- altered urinary elimination
- knowledge deficit
HRT
most beneficial in minimizing vasomotor symptoms, bone loss, and maintaining higher levels of high density lipoproteins (HDL) lipids
Herbal Approaches
soy: may help…more research needed
black cohosh, red clover, ginseng probably don’t help
