Women's Health Flashcards
COC CI
cancer, heart disease, VTE, diabetes with micro complications, <6w postpartum if breastfeeding, migraines w aura, BP>160/100, liver tumor/cirrhosis, smoker >35yo (>15cig/day)
older progesterones
levonorgestrel, norethindrone, norethindronacetate
some testosterone activity
newer progesterones
desorgestrel, norgestimate
greater VTE risk
antiandrogenic progesterones
drosperinone, cyproterone
good for acne, bloating, but inc VTE risk
How to start COC
Sunday start +7d backup
quick start +7d backup
1st day menses no backup
Missed pills
1st 7d then need EC +7d backup
w2-3 1 missed pill is ok but 2-3 missed start new pack and skip PFI and use EC + 7d backup
COC AE
spotting in 1st 3m normal
E: nausea, breast tenderness
P: wt gain, mood swings
ACHES: abdominal pain, chest pain, headaches, eye problems, severe leg pain
What are leuprolide, goserelin and nafarelin?
Gonadotropin-releasing hormone (GnRH) agonists which suppress FSH, preventing proliferation of the endometrium and causing amenorrhea. May be used to shrink fibroids and manage heavy bleeding. AE: bone loss (if >6mth), hot flashes, vaginal dryness, decreased libido.
What is tranexamic acid?
An antifibrinolytic, used for heavy bleeding. AE: n/v/d. CI: history of thrombosis, hemorrhage, hematuria.
Plan B Counselling
Indicated within 3 days (70% effective at day 5)
AE: Nausea, vomiting (repeat dose if <1h) take Gravol, spotting. Take pregnancy test if don’t get period at usual time. Decreased efficacy if >80kg, consider Ulipristal (rx, $).
Mifegymiso Counselling
Mifepristone PO (antiprogestin terminates pregnancy) + Misoprostol buccal (prostaglandin induces contractions within hours, taken 24-48h after). CI: asthma, adrenal failure, ectopic pregnancy. AE: n/v/d, bleeding may last 2 weeks. Red Flags: soaking 2 maxi pads in 2h, fainting, fever, flu-like sx, severe pain uncontrolled by NSAID. May start COC next day. Must follow-up w Dr after.
Supplements recommended pre-pregnancy
Supplement:
Folic acid 0.4-1.0mg/day
Vit D 600IU/day
Iron 27mg elemental iron daily
Diet & Supplement:
Calcium 1000mg/day
Essential fatty acids omega-3,6
Vit B12 2.6mcg/day
Pregvit Dosing
Morning pink has iron, take on empty stomach
Night blue has folic acid 1.1-5mg and calcium
If n/v from iron can flip timings or use low iron in T1. Note both should be separated from levothyroxine.
Gestational diabetes tx and targets.
Insulin is the therapy of choice. Metformin and Glyburide safe until insulin initiated.
Target A1C<6.5, FBG<5.3, PPBG<7.8
How do levothyroxine doses change during pregnancy?
Doses increase 20-30% as soon as pregnancy suspected, then monitor TSH q4w until week 20. Post-partum doses return to pre-pregnancy and monitor TSH 6wk post.
PO med for ovulation induction
Aromatase inhibitor letrozole start on days 3-7 or 5-9 of cycle, stimulates ovulation in 7days. AE: hot flushes, headaches, mood swings, n/v, bloating, breast tenderness, increased risk of multiples.
Injectable meds for ovulation induction
Injectable gonadotropins (FSH, hMG, LH) stimulates ovaries directly- start on day 2 of cycle and continued 7-12 days usually. AE: n/v/d, bloating, breast tenderness, injection site irritation, malaise, multiples.
meds to trigger ovulation + maturation
hCG injection (ex. Ovidrel) triggers ovulation in 36h, used after letrozole or gonadotropin, may cause false + pregnancy test
misc. meds used in infertility tx
progesterone, glucocorticoids, sildenafil, ASA
Meds used to boost milk flow
Domperidone -3-4 day onset, doesn’t need to be empty stomach (that’s for stomach motility)
or
Metoclopramide - CNS AE (not commonly used)
or
NHPs: fenugreek, blessed thistle, milk thistle, alfalfa, brewer’s yeast
Counselling antifungal for thrush during breastfeeding
Miconazole 2% cream applied after each feed for 2w, wipe away visible cream before next weed
+/-
Fluconazole 150mg po then 50-100mg ID F10D
Mastitis non-pharms, tx recommendations
continue feeding q2h and massage while feeding, warm compress before feeds and cold compress between feeds for pain/inflammation. If sx don’t improve within 12-24h consider antibiotics f10-14days.
Tx for N/V during pregnancy?
Pyridoxine (B6) q8h prn
Diclectin (pyridoxine+doxylamine) B6+antihistamine - delayed release tab takes 4-6h, commonly used 2 tabs hs for morning sx + 1am and 1 mid afternoon (max 8/day) -CI in glaucoma, PUD, MAOI -AE: drowsiness, vertigo, headache, diarrhea
Dimenhydrinate or diphenhydramine
Last lines: metoclopramide, phenothiazines, ondansetron (controversial)
Prometrium counselling
Contains soy/peanut (ask allergies)
Causes drowsiness use QHS
Insert at least 1 inch
Pregnant May use up to 36w
Role of estrogen in menstrual cycle
“The builder”
Causes proliferation of the endometrial lining
Role of progestin in the menstrual cycle
“The mover/decorator”
Prevents over-proliferation and changes proliferative lining into secretory lining. Fall in P triggers menstruation.
How estrogen and progesterone in contraceptives acts as birth control
E: HPOA axis suppression (tricks hypothalamus into not sending LH FSH which cause ovulation)
P: thins lining, thickens mucus, slows motility. Plan B prevents fertilization and implantation and (controversial) ovulation. Depo provera stops ovulation for sure since high dose.
Non-hormonal treatments for menopause
Gabapentin
SSRI/SNRI
Reduce vasomotor sx (hot flashes) by ~50%
