Women's Health Flashcards
preeclampsia htn
new htn after >20w of gestation with proteinuria
gestational htn
new htn after >20w of gestation without proteinuria
chronic htn with superimposed preeclampsia
new htn <20w of gestation with proteinuria
chronic htn
new htn <20w of gestation without proteinuria
treatment options for htn in pregnancy
nifedipine
labetalol
methyldopa
progestin moa
- induces endometrial atrophy
- blocks LH surge, prevents FSH release, prevents ovulation
progestin SE
androgenic (except 4th gen - drospirenone)
benefits of drospirenone
less water retention
less acne
disadvantage of drospirenone
hyperk
thromboembolism
bone loss
benefit of cyproterone
excessive androgen conditions (only use when pt also has androgen issues)
disadvantage of cyproterone
thromboembolism
estrogen moa
stabilised endometrial lining, provides cycle control
when initiating coc on first day of menstrual cycle, need backup?
no
when initiating coc on first sunday of menstrual cycle, need backup?
backup for 7d
when initiating coc now, need backup?
at least 7d, safer until next cycle start
risks of COC
- breast cancer
- VTE
- ischemic stroke/MI
COC c/i in?
> 40 yo
fam hx/pmh of breast cancer
migraine with aura
<21 days postpartum
uncontrolled HTN
smoking at least15 sticks a day and older than 35yo
low dose ee? who should take
20-25mcg. for adolescents, underweight, >35 yrs, peri-menopausal
reducing progestational activity reduces
dysmenorrhoea, late cycle breakthrough bleeding
benefits of multiphasic coc
less progestin, less side effects
how to handle breast tenderness/weight gain
keep both hormone conc as low as possible
how to deal with bloating/NV SE of COC
decrease estrogen amount
how to deal with menstrual cramps for COC
increase progestin / switch to continuous
how to deal with headache (usually during pill free week)
change to extended / continuous
ddi with rifampin what to do
backup until rifampin discontinued for at least 7 days
ddi with anticonvulsants result
reduces free serum conc of both estrogen and progesterone
what to do if miss one dose
eat immediately, can take 2 pills on same days, no backup needed
what to do if miss two doses during first 2 weeks of hormone period
take the immediate missed dose, throw the rest away. continue as per normal with 7day backup
what to do if miss two doses during third week of cycle (last hormone week)
eat as per normal, skip hormone free period and straight away continue with new pack.
minipill ci
current or recent hx of breast cancer
minipill start within 5d of bleed, need backup?
no backup
minipill start outside of 5d bleed, need backup?
2d
if you miss minipill by 3hrs, need backup?
2d
how to apply transdermal
once weekly for 3 weeks, followed by 1 patch free week
how to apply vaginal rings
used for 3 weeks then discarded
risks of transdermal and vaginal rings
VTE!! (higher exposure to estrogen)
how to administer progestin injection
IM every 12 weeks
progestin injection concerns
return to fertility delayed
breakthrough bleeding in first 9 months
amenorrhoea after 1.5-2y
progestin injection SE
weight gain, short term bone loss
progestin injection avoid in
older women, osteroporosis risk factors, stop after 2 years
IUD/implants benefits
highly effective, effects reverisble upon removal
IUD moa
inhibition of sperm migration, damage ovum, damage/disrupt transport of fertilized ovum. If with progestin -> endometrial suppression, thicken mucus
IUD ci
pregnant, current STI, undiagnosed vaginal bleed, uterine issues
levonorgestrel IUD (5y)
decreased menstrual flow / amenorrhea
good for dysmen
