Women's health Flashcards
What are the list of conditions covered
- Dysmenorrhoea
- Menorrhagia
- Endometriosis
- FGM
- The menopause
- Vaginal dryness
- Female cancer
What are the 7 stages of women and what are the signs
Reproduction
>Early: 12-18y/o- variable to regular periods and normal FSH
>Peak: 18-35 - regular periods and increasing FSH
>Late: 35-47- Regular periods and increasing FSH
Perimenopause
> Early: 45-49- variable periods <7 days
>Late 40-58 - more than 2 consecutive periods missed and amenorrhoea > 60days
Post menopause
>Early: 40 up/47-51 - 1 to 4 years of amenorrhoea
>Late: NO periods
Definition of endometriosis
A chronic oestrogen dependant condition.
Growth of endometrial tissue in sites other than the uterine cavity
The cells bleed monthly however there is no way for it to leave the body = inflammation, pain and scar tissue
Impact of endometriosis
Chronic pain, Fatigue, depression, problems with sex life, inability to conceive and difficulty fulfilling work.
Causes of endometriosis
Retrograde menstruation: back flow of endometrium through fallopian tubes into abdomen.
> tissue implants itself on organs
Genetic predisposition: suggestions that endometriosis can pass done from gen to gen through genes,
Lymphatic or circulatory spread: tissues travel round the body through lymphatic system and bloodstream
Immune dysfunction: Immune system can’t fight the endometriosis
Environmental causes: toxins in the environment such as dioxin can effect the body, immune and reproductive system.
Metaplasia: When once cell morphs into another to adapt to a change in environment
What is the differential diagnosis for endometriosis
Pelvic inflammation disease Ovarian Cyst Ectopic pregnancy Appendicitis IBS Uterine fibrosis
What are the general symptoms of endometriosis
Dysmenorrhoea Pain during intercourse(Dyspareunia) cyclical/ pelvic pain Subfertility Bloating, lethargy and constipation Worsens during menstruation
Endometriosis and the bladder symptoms
Rare with unknown cause
Can be on surface or deeper
Symptoms: Alter menstrual cycle, bladder irritation, pain when bladder in full, loin pain in kidney area.
Endometriosis and the Bowel symptoms
can be superficial or deep
Similar symptoms to IBS
Treatment options for Endometriosis
Hormone: -COC: Supresses ovulation. -Mirena coil: T shaped intra-urine device (PO) -Progesterones -GnRH -Testosterone derivative -Danazol (form of testosterone) -Gestrinone (testosterone) Pain relief: -Heat/comfort -NSAIDS/codeines and analgesia -Pain modifiers: Amitriptyline -TENS(transcutaneous electrical nerve stimulators): Electrical pulses through the body Pain clinics.
Stages of FGM
Stage 1: Prepuce removed and/or partial closure of clitoris
Stage 2: Removal of clitoris and part or all of labia minera
Stage 3: Small hole for urine for menstruation and urine left
Causes of vaginal dryness
Lack of oestrogen causes thinning and reduces elasticity of vaginal walls.
Reduction in glands to produce lubricating mucus.
Factors linked to vaginal dryness
Hormone contraceptive, cigarette smoking, radiation therapy or chemo
Symptoms of vaginal dryness
Pain during intercourse
Inflamed valvula causing discomfort
Itch/scratch/inflammation cycle
Urinary problem due to thinning.
Treatment/management of vaginal dryness
OTC: lubricating gels (ReplensMD and sylk)- non hormone, drug free bio degradable
OTC: water based lubricant K-Y jelly
Avoid douching, perfumed soaps and bath products
HRT or hormone based vaginal gels
Types of female cancers
Breast
Endometrial
Ovarian
Cervical
Risk factors for breast cancer
Age, ethic group, pervious history of breast cancer, FH, early menarche, menopause, HRT.
Risk Risk factors of endometrial cancer
Age, obesity, high fat diet, not having children, menstrual disturbances, history of endometrial hyperplasia, PCOS, FH, tamoxifen and HRT
Risk factors of ovarian cancer
FH, history of breast cancer, fertility drugs, HRT, being overweight, being tall, history of endometriosis and smoking
risk of cervical cancer
HPV infection, history of other STI, smoking, weakened immune system, contraceptive pills, personal hygiene, having kids young
What is dysmenorrhoea
It is period pains which is located at the lower abdominal or pelvic pain that radiates to back and thighs,
there is primary and secondary dysmenorrhoea (refer for secondary)
symptoms of primary dysmenorrhoea
Most sever pain from day before to 48 hrs after menstrual flows begins
pain, headache, constipation, nausea, vomiting, diarrhoea, dizziness
most common in young females`
symptoms of secondary dysmenorrhoea
Late onset
pain throughout menstrual cycle
dyspareunia, intermenstrual bleeding.
causes of secondary dysmenorrhoea
Endometriosis Fibroids Pelvic inflammatory disease Ovarian cysts/tumours Copper IUD
Treatment for Dysmenorrhoea
Analgesia
contraceptive
Age
Heat therapies
exercise
TENs
Lifestyle
signs of Menorrhagia (heavy bleeding)
30-40ml of blood loss during period
9/10 women loss less than 80ml
Heavy loss = >60ml per cycle
Causes of menorrhagia
PCOS fibroids Pelvic inflammatory disease Endometriosis Hypothyroidism Anti-coagulants IUD Bleeding after C-section
Treatment of menorrhagia
1st line: Mirena coil
2nd line: NSAIDs
3rd line: Norethisterone 5mg daily
What is Bacterial vaginosis
overgrowth if anaerobic organism in vagina: Lactobacilli (present in normal flora)
pH goes from 4.5 to 6
Risk factors of BV
- New sexual partner.
- Other sexually transmitted infections (STIs).
- Ethnicity (more common in women of Afro-Caribbean descent).
- Presence of a copper intrauterine contraceptive device (IUCD).
- Vaginal douching.
- Bubble baths.
- Receptive oral sex.
- Smoking.
Protective factors from BV
- Combined oral contraceptive pill (oestrogen encourages lactobacilli).
- Condoms.
- Circumcised partner
Presentation of BV
Offensive, fishy-smelling vaginal discharge without soreness or irritation.
Approximately half of all women infected are asymptomatic.
On examination there is usually a thin layer of white discharge covering the vaginal wall.
Treatment for BV
Antibiotics. Metronidazole is the most common and preferred antibiotic treatment for BV.
Further treatment. For some women, the first course of treatment doesn’t treat BV effectively.
Vaginal pH correction treatments.
Referral to a specialist.
Definition and properties of osteoporosis
loss in bone density, increased bone fragility, high risk of fracture.
osteoporosis is asymptomatic and the condition usually presents only after first bone fracture
Bone mass density can decline during menopause due to lack of oestrogen
Osteoporosis management and advice
Ask a set of questions when deciding on the various treatment options for a patient with Osteoporosis:
-Is bone sparing treatment required?
>Bisphosphate, raloxifene, strontium ranelate
-Is calcium intake adequate?
>700mg/day
-Is the patient male of female?
>Alendronate is only licenced to be used in men
-Is the patient in premature menopause?
>HRT can be considered
-Lifestyle
> Balanced diet,
>stop smoking,
Treatment for osteoporosis
- Bisphosphonates e.g. alendronate, risedronate-
>Can’t be sucked or chewed due to oropharyngeal ulceration risk
>Sit and remain up right for half an hour
>Take between meals (2 hours between or first thing)
-Work by slowing osteoclasts and the build up of osteoblasts - HRT
- Raloxifene: Selective oestrogen receptor modulator which reproduce effect of oestrogen without side effects on breast and endometrium
- Tibolone (hormone therapy): Selective tissue oestrogenic activity modulator, reduces bone turnover and increase bone mineral density.
- Calcium & Vitamin D: Excreted through the kidney
> 700mg/Day
