Women's Health

Question 1

How long is an average menstrual cycle? How long does bleeding last?

Answer 1

Cycle: 21-35 days
Bleeding: 1-7 days

4 phases: Menstrual, Follicular, Ovulatory, Luteal

Question 2

MCC of 2ndary dysmenorrhea?

Answer 2

Endometriosis

Question 3

What is integrative therapy for dysmenorrhea?

Answer 3

• Thermal therapy (heat), acupressure, acupuncture
• TENS (electrical nerve stim)

Question 4

When should NSAIDs be used for primary dysmenorrhea?

Answer 4

Begin day 1 of menses for 3 days and use around the clock; NOT PRN

Take with food
If one fails (Ibuprofen), try the other one (Naproxen)

Question 5

Which 2 NSAIDs are preferred for primary dysmenorrhea?

Answer 5

Ibuprofen
Naproxen

Question 6

distant places endometrial tissue can be found in endometriosis

Answer 6

lung pleura, lungs, brain

Question 7

Pain control options for endometriosis

Answer 7

• NSAIDs - safe and effective for pelvic pain -> Naproxen sodium (Aleve), Naproxen (Naprosyn), Ibuprofen (Motrin), Diclofenac (Voltaren)
• Opioids

Question 8

Pt with endometiosis is seeking tx after NSAIDs fails. options if preg is desired or not?

Answer 8

Preg not desired -> progestin, COC

Preg desired -> GnRH agonist, Laparascopy

GnRH agonists includenafarelin,leuprolide,buserelin,goserelin, andtriptorelin.

Question 9

What are these:
nafarelin,leuprolide,buserelin,goserelin, andtriptorelin.

Answer 9

GnRH agonists
MOA: decr estrogen
USE: Endometriosis pain where NSAIDs, COCs, Progestins FAIL

Question 10

Considerations for endometriosis therapies

Answer 10

• Progestogens, GnRH agonists, and aromatase inhibitors decrease bone density
• DXA monitoring is recommended
• Depending on duration: potentially osteoporosis prescription medications
• Surgery is the is an option for deep endometriosis

Question 11

ACOG Guidelines for PMS/PMDD Tx

Answer 11

1. carb diet, exercise, therapy, incr Calcium, spironolactone, vit B6
2. SSRIs
3. Hormonal ovulation suppression
4. Hysterectomy + BSO

Question 12

Wdyd if SSRIs fail for PMDD

Answer 12

Use anxiolytics

Question 13

1st line for PMDD or MOD/SEVERE PMS

Answer 13

SSRIs:
Fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro)

Question 14

PMS/PMDD Tx

_____ may be considered for 2nd line for augmentation of SSRI

Answer 14

Alprazolam

3-4days max

Question 15

Med for PMS/PMDD Tx if SSRIs/Alprazolam FAIL & CI to contraceptives

Answer 15

GnRH Agonist (Lupron)

Question 16

Which progesterone BC is Spironolactone derived?

Answer 16

• 1st gen: norethindrone, ethynodiol diacetate
• 2nd gen: norgestrel, levonorgestrel
• 3rd gen: desogestrel, norgestimate
  * Spirinolactone derived: drospirenone
• MOA: blocks ovulation; production of cervical mucous; contributes to atrophy of endometrium

Question 17

COC Contraindications

Answer 17

Question 18

Vaginal Ring May not be as effective in women with BMI > ___

Answer 18

30

Waterman thinks this is BS and the pharmacist was thinking the patch, not the ring

Question 19

BC option for pt who wants Better cycle control and decreased breakthrough bleeding compared to OC &
Lower systemic exposure to estrogens

Answer 19

Vaginal ring

Question 20

One injection of progestin (depo shot) suppresses ovulation for ____wks

Answer 20

12 - 13wks

Question 21

Nexplanon must be replaced in ___yrs

Answer 21

3

Question 22

Paragard (Copper IUD) is FDA approved for ____yrs

Answer 22

10

Question 23

Generic Plan B

Answer 23

Levonorgestrel
MOA: delays ovulation

Question 24

Drugs to avoid when on hormonal contraceptives

Answer 24

• Anticonvulsants: phenytoin, carbamazepine, topiramate, oxcarbazepine
• Anti-infectives: rifampin, griseofulvin
• St. John’s wort

Question 25

do hormonal contraceptives decr your risk for endometrial and ovarian cancer?

Answer 25

yes ## Footnote unsure if this is actually true

Question 26

MCC of infertility in women

Answer 26

PCOS

Question 27

PCOS 1st line Tx

Answer 27

1. Lifestyle 2. COCs 3. Metformin

Question 28

Is PCOS infertility very common?

Answer 28

yes (75%)

Question 29

What is Clomiphene Citrate used for? MOA?

Answer 29

PCOS - 1st line Infertility Tx MOA: hypothalamus action on estrogen receptor, increases pulsatile GnRH leading to increase FSH and LH causing follicle growth and rupture

Question 30

Infertility Tx for PCOS

Answer 30

1. Comiphene Citrate 2. Gonadotropins 3. Aromatase Inhibitors 4. Metformin + IVF to prevent hyperstimulation syndrome

Question 31

PCOS Tx options for - Acne - Alopecia - Hirsutism

Answer 31

* Acne -> Isotretinoid (acutane) * Alopecia -> Oral finasteride or cyproterone, Topical minoxidil * Hirsutism -> COCs, Metformin, Elfornithane, Antiandrogens (Spironolactone, Flutamide, Finasteride)

Question 32

# Menopause Hormone replacement therapy (HRT) therapy for women WITH UTERUS

Answer 32

* Women w/intact uterus: estrogen + **progestin** * Women w/hysterectomy: unopposed estrogen ## Footnote used to replace low estrogen levels

Question 33

names for synthetic - Estrogen - Progestin - Testosterone

Answer 33

* Estrogen -> Estradiol, equine estrogen, esterified estrogen * Progesterone -> Medroxyprogesterone, norethindrone, micronized progesterone * Methyltestosterone

Question 34

Phytoestrogens & botanical/herbals (Red clover, soy, black cohosh, etc) have effects of which hormone?

Answer 34

Estrogen inconsistent results

Question 35

CI to estrogen replacement therapy

Answer 35

* Abnormal, undiagnosed genital bleeding * Breast cancer (known, suspected, or history of) * History of DVT or PE * Estrogen-dependent neoplasia * Pregnancy * Stroke or MI in past year * Liver dysfunction or disease

Question 36

bone accumulates until age ____

Answer 36

30

Question 37

Osteopenia vs Osteoporosis DEXA T-scores

Answer 37

Osteoporosis: < -2.5 Osteopenia: -1.0 - -2.5