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Phase 3a - GP > Women's Health > Flashcards

Women's Health Flashcards

1
Q

What is atrophic vaginitis?

A

Dryness and atrophy of the vaginal mucosa related to a lack of oestrogen.

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2
Q

Who does atrophic vaginitis commonly occur to?

A

It occurs in women entering the menopause.

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3
Q

Describe the pathophysiology of atrophic vaginitis?

A

Inc. oestrogen = epithelial lining of vagina and urinary tracts = thicker, more elastic and producing secretions.

Therefore in menopause = oestrogen low = mucosa becoming thinner, less elastic and more dry = tissue more prone to inflammation + vaginal pH change = inc. infections.

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4
Q

Sx of atrophic vaginitis?

A

Itching
Dryness
Dyspareunia (discomfort or pain during sex)
Bleeding due to localised inflammation
Vaginal burning

In old ladies: Recurrent UTI’s, stress incontinence, pelvic organ prolapse

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5
Q

What would examination of the labia and vagina demonstrate in someone with atrophic vaginitis?

A

Pale mucosa
Thin skin
Reduced skin folds
Erythema and inflammation
Dryness
Sparse pubic hair

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6
Q

Management of atrophic vaginitis?

A

Vaginal lubricants can help dryness. E.g. Sylk, Replens and YES.

Topical oestrogen. E.g. Estriol cream

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7
Q

What is bacteria vaginosis?

A

An overgrowth of bacteria in the vagina, specifically anaerobic bacteria.

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8
Q

Describe pathophysiology of bacterial vaginosis

A

Lactobacilli (healthy vaginal bacterial flora) = produces lactic acid = keeps vaginal pH low (<4.5) = prevent other bacteria from overgrowing.

Low lactobacilli = high pH = alkaline = enables anaerobic bacteria to multiply

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9
Q

What anaerobic bacteria’s are associated with bacterial vaginosis?

A

Gardnerella vaginalis (most common)
Mycoplasma hominis
Prevotella species

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10
Q

RF for developing bacterial vaginosis

A

Multiple sexual partners (although it is not sexually transmitted)
Excessive vaginal cleaning (douching, use of cleaning products and vaginal washes)
Recent antibiotics
Smoking
Copper coil

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11
Q

Sx of bacterial vaginosis

A

Fishy-smelling watery grey or white vaginal discharge.
No other sx

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12
Q

Ix for bacterial vaginosis

A

Vaginal pH (a swab and pH paper) pH >4.5
Vaginal swab - microscopy (clue cells)

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13
Q

Tx for bacterial vaginosis

A

1st line - Metronidazole (oral or vaginal gel)
2nd line - Clindamycin

When giving metronidazole advise patients to avoid alcohol for the duration of treatment.

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14
Q

What should patients avoid when taking metronidazole for bacterial vaginosis?

A

Alcohol and metronidazole can cause a “disulfiram-like reaction”, with nausea and vomiting, flushing and sometimes severe symptoms of shock and angioedema.

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15
Q

Complications of bacterial vaginosis?

A

Increase the risk of catching sexually transmitted infections, including chlamydia, gonorrhoea and HIV.

Can also cause miscarriage and preterm delivery.

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16
Q

What is candidiasis (thrush)?

A

Vaginal infection with a yeast of the Candida family.

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17
Q

What kind of fungus causes candidiasis?

A

Candida Albicans

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18
Q

What are the RF for candidiasis? (4)

A

Increased oestrogen (higher in pregnancy, lower pre-puberty and post-menopause)

Poorly controlled diabetes

Immunosuppression (e.g. using corticosteroids)

Broad-spectrum antibiotics

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19
Q

Sx of candidiasis?

A

Thick, white discharge - no smell
Vulval and vaginal itching + irritation.

If severe:
Erythema
Fissures
Oedema
Pain during sex (dyspareunia)
Dysuria

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20
Q

Ix for candidiasis?

A

Vaginal pH - to differentiate between bacterial vaginosis and trichomonas (pH > 4.5) and candidiasis (pH < 4.5).
Charcoal swab with microscopy

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21
Q

Tx for candidiasis?

A

If mild:
Antifungal cream (i.e. clotrimazole) inserted into the vagina with an applicator

If systemic or more severe:
Antifungal pessary (i.e. clotrimazole)
Oral antifungal tablets (i.e. fluconazole)

22
Q

What should women be warned about when using antifungal creams and pessaries?

A

It can damage latex condoms and prevent spermicides from working, so alternative contraceptive is required for at least five days after use.

23
Q

What is a breast abscess? What are the 2 types?

A

A collection of pus within an area of the breast, usually caused by a bacterial infection.
May be:
Lactational abscess (associated with breastfeeding)
Non-lactational abscess (unrelated to breastfeeding)

24
Q

What is mastitis? How does it happen?

A

Inflammation of breast tissue.
Bacteria enter nipple → back-track into ducts → cause infx + infl.

Note: Breast abscess may or may not be associated with mastitis.

25
Q

What are the RF for development of breast abscess/mastitis?

A

Smoking **
Damage to nipples (i.e. nipple eczema, piercings)
Breast disease (i.e. cancer)

26
Q

What are the common causative bacteria for breast abscess/mastitis? (2)

A

Staphylococcus aureus (the most common)
Streptococcal species
Enterococcal species
Anaerobic bacteria (such as Bacteroides species and anaerobic streptococci)

27
Q

Sx of mastitis with infection?

A

Nipple changes
Purulent nipple discharge (pus from the nipple)
Localised pain
Tenderness
Warmth
Erythema (redness)
Hardening of the skin or breast tissue
Swelling

28
Q

What are the key features of a breast abscess?

A

A swollen, fluctuant (able to move fluid around within lump), tender lump within the breast.

29
Q

Tx of lactational mastitis?

A

Conservatively: continued breastfeeding, expressing milk and breast massage. Heat packs, warm showers and simple analgesia.

If infection or sx persist after 12-24hrs post conservative mx: Abx (flucloxacillin, if penicillin allergy - clarithromycin)

30
Q

Tx of non-lactational mastitis?

A

Analgesia
Broad spectrum abx:
Co-amoxiclav
Erythromycin/clarithromycin (macrolides) plus metronidazole (to cover anaerobes)

31
Q

What’s the average age for menopause and how long would a women have no periods for to be diagnosed with menopause?

A

Around 50+ yrs
No periods for 12 months

32
Q

A lack of what causes menopause?
Describe changes in hormone in menopause.

A

Lack of ovarian follicular function

Changes in hormone:
Oestrogen and progesterone levels are low
LH and FSH levels are high, in response to an absence of negative feedback from oestrogen

33
Q

What are perimenopausal sx

A

Hot flushes
Emotional lability or low mood
Premenstrual syndrome
Irregular periods
Joint pains
Heavier or lighter periods
Vaginal dryness and atrophy
Reduced libido

34
Q

What can a lack of oestrogen increase the risk of?

A

Cardiovascular disease and stroke
Osteoporosis
Pelvic organ prolapse
Urinary incontinence

35
Q

What is pelvic inflammatory disease?

A

Inflammation and infection of the organs of the pelvis, caused by infection spreading up through the cervix.

36
Q

What are the causes of PID?

A

MC - sexually transmitted pelvic infections:
1. Neisseria gonorrhoeae
2. Chlamydia trachomatis
3. Mycoplasma genitalium

37
Q

RF for PID

A

Same as STIs:
No barrier
Multiple sexual partners
Existing STIs

38
Q

Sx of PID

A

Pelvic or lower abdominal pain
Abnormal vaginal discharge - purulent
Abnormal bleeding (intermenstrual or postcoital)
Pain during sex (dyspareunia)
Fever
Dysuria
Inflamed + tender cervix

39
Q

Ix for PID

A

Tests to find STI causative organisms:
1. NAAT swabs for gonorrhoea and chlamydia
2. HIV test
3. Syphilis test
4. High vaginal swab - bacterial vaginosis, candidiasis and trichomoniasis

Pregnancy test - rule out ectopic pregnancy (Ddx)

40
Q

Tx for PID

A

Intramuscular ceftriaxone (cover gonorrhoea)
Doxycycline (cover chlamydia + Mycoplasma genitalium)
Metronidazole (cover anaerobes i.e. Gardnerella vaginalis)

41
Q

Describe each of the following types of oral contraceptive pill instruction:
1. Monophasic
2. Tricyclic regimen
3. Everyday pills

A
  1. 21 days of administration, followed by 7 days off
  2. 9 weeks of taking a pill every day (63 pills total) followed by 4, or 7 days off
  3. One pill to be taken each day. The packets include 21 active pills and 7 inactive pills
42
Q

What are some rules for starting the OC pill in terms of if the patient is:
1. Starting the pill 1st day of her period (upto 5 days)
2. Starting at any other time in her cycle
3. New mother

A
  1. She will be protected from pregnancy immediately
  2. Will need to use condoms for 7 days
  3. Can begin to take the pill 21 days after giving birth, providing they are not breastfeeding.
43
Q

Side effects of progesterone only pill?

A

Depression
Breast tenderness, enlargement
Headache
Changes to mood and libido
Nausea and vomiting
Irregular menstrual bleeding, spotting, amenorrhoea
Ovarian cysts

44
Q

What is a levonelle tablet and what time period should it be taken within?

A

Progesterone only tablet that should be taken within 72 hours (3 days) of unprotected sexual intercourse

45
Q

What are the side effects of levonelle and also when should a single’double dose be given?

A

Side effects include headache, nausea and dysmenorrhoea

Levonelle may be less effective in women weighing >70 kg or with a BMI >26 kg/m2. An unlicensed “double dose” may be used in these circumstances

If vomiting occurs within 3 hours of taking Levonelle, a repeat dose should be given

46
Q

Can women with a history of breast cancer use hormonal contraception?

A

Women with a history of breast cancer require the use of a copper intrauterine device for contraception due to hormonal treatments being contraindicated.

47
Q

When are women advised to stop taking contraception in the postmenopausal period?

A

Stop contraception after one year of amenorrhoea if over 50 years old or two years if under 50.

48
Q

Which cancers does the OCP decrease and increase the chances of having?

A

Reduces risk of ovarian and endometrial cancer, increases risk of breast and cervical cancer

49
Q

What is a EllaOne tablet and what time period should it be taken within?

A

It’s a progesterone receptor modulator that works by inhibiting or delaying ovulation.

It is licensed for use within 120 hours (5 days) of unprotected sexual intercourse

50
Q

What are some CI for taking EllaOne (emergency contraceptive) and what are some of the SE?

A

CI - severe asthma controlled with oral steroids, severe liver impairment, avoid breastfeeding for 1 week after raking meds.

Common side effects include headache, nausea and dysmenorrhoea.

Phase 3a - GP (15 decks)

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