women's health Flashcards
primary amenorrhea
no menarche by age 15
needs referral
secondary amenorrhea
3-6 months of amenorrhea
pregnancy is the most common cause
management depends on underlying cause
first thing to do if no menses
pregnancy test
causes of no menses
menopause
stress
obesity
anorexia
thyroid disorder
menopause ages
ages 45-55
symptoms of menopause
amenorrhea x 12 months
hormone changes
atrophic vaginitis
lichen sclerosis
weight gain
hot flashes
mood changes
dry skin
lichen sclerosis
Lichen sclerosus is a condition that causes patchy, discolored, thin skin. It usually affects the genital and anal areas. Anyone can get lichen sclerosus but postmenopausal women are at higher risk. It isn’t contagious and can’t be spread through sexual contact.
atrophic vaginitis
A condition in which the tissues lining the inside of the vagina (birth canal) become thin, dry, and inflamed. This is caused by a decrease in the amount of estrogen (a female hormone) made by the body. Symptoms of atrophic vaginitis include vaginal dryness, itching, and burning, and pain during sexual intercourse.
complications of menopause
If a woman goes through menopause and then has bleeding
she needs to have a biopsy
atrophic vaginitis treatment
vaginal lubrication or moisturizers
or cream with hormones
potential complications of menopause
increased cardiovascular risk and increased risk of osteoporosis
Management of menopause
herbal supplements- black cohosh
hormone replacement therapy
Hormone replacement therapy
should never be initiated lightly- has it’s own risks and its own complications
pap smears
starts at age 21
age 21: every 3 years no cotesting
age 30: every 5 years with cotesting
age 65 can discontinue
abnormal results pap smear
AS-CUS atypical squamous cells of undetermined significance- this means that there aren’t cancerous cells present, but the cells aren’t totally normal either.
These patients would follow up with HPV testing. If it is positive- we would refer them to gynecology for a possible colposcopy.
If any thing higher than that is noted, especially the high grade lesions- even the low grade LSIL and HSIL- refer for a colposcopy.
How often should you perform a pap and HPV test? With normal and abnormal results, how often will you perform tests?
*
* Begin pap screening at age 21
* Ages 21-29: Pap every 3 years
* Ages 30-65, there are 3 options:
* Pap every 3 years
* Pap/HPV co-test every 5 years
* HPV alone every 5 years
- Post menopause hormone therapy, benefits, and contraindications
- Benefits
- For women with a uterus: Estrogen + Progestin = less risk of endometrial CA
Only use for < 5 years as risk of breast CA increases
Use younger than 60 y/o - For women s/p hysterectomy: Estrogen can alleviate dyspareunia (painful sex) and vaginal/urethral atrophy
- contraindications
- Estrogen only: increases the risk of developing/exacerbating SLE (lupus?)
- Estrogen + Progestin: increase risk of breast CA, CVA, CAD and PE
- Other contraindications: pregnancy, untreated HTN, liver disease, DVT, AUB
Post hysterectomy patients, cervix intact or removed, when should they be screen for cervical cancer
- Cervix intact: continue regular screenings (pap every 3 years, HPV or Cotest every 5 years)
- Total hysterectomy(benign): may stop screening
- Total hysterectomy d/t CIN3 or AIS (adenocarcinoma in situ): requires HPV based testing at 3-year intervals for 25 years
- Symptoms of menopause
*
Menopause occurs in 100% of women
* Not all women experience s/s with menopause
* Symptoms Same as above
* Hormone therapy is the most effective treatment for VMS and GSM and prevents bone loss/fractures
* Paroxetine (Brisdelle) is the only non-hormonal med FDA-approved for VMS
What screening test will you perform for a sexually active female and how often? What screening test will you perform for a non-sexually active female and how often?
*
* What screening test will you perform for a sexually active female and how often? (CDC)
* < 25 y/o: test for Chlamydia and gonorrhea annually
* > 25 y/o with risk factors such as new or multiple sex partners, or positive partner, should test annually
* What screening test will you perform for a non-sexually active female and how often? (CDC)
* Pap smear for all women >21 y/o
- Abnormal uterine bleeding, causes
*
Causes:
* PALM: polyps, adenomyosis, leiomyoma, malignancy
Adenomyosis: when the tissue that normally lines the uterus grows into the muscular wall of the uterus
Leiomyoma: “uterine fibroids”, growths that appear in the uterus (benign and common up to 75-80% of people will have)
* COEIN: coagulopathy, ovulatory disorders/hormone changes, endometrial, iatrogenic, not classified
* Acute: episodes requiring intervention; Chronic episodes lasting > 6 months
AUB what test will you perform:
pregnancy test (r/o miscarriage)
* CBC (evaluate hemodynamic stability)
* Coags
* STD tests/Wet prep (r/o STIs and vaginitis)
* Pap smear
* hormone levels, prolactin/estrogen/testosterone levels
* hysteroscopic exam of uterine lining (r/o fibroid, polyps and CA)
* 1st line imaging: Pelvic/transvag US (r/o tumors, PID)
* Endometrial Biopsy (r/o CA)
* MRI
- What is the usual age of menopause?
45-55, AVG=51
Post hysterectomy patients, cervix intact or removed, when should they be screen for cervical cancer
- Cervix intact: continue regular screenings (pap every 3 years, HPV or Cotest every 5 years)
- Total hysterectomy(benign): may stop screening
- Total hysterectomy d/t CIN3 or AIS (adenocarcinoma in situ): requires HPV based testing at 3-year intervals for 25 years
