women's health Flashcards
(139 cards)
1
Q
what organism causes most cases of vaginal thrush?
A
candida albicans
overgrowth causes symptomatic inflammation of vagina and/or vulva
2
Q
is it an STI?
A
no as it is part of the natural flora
but can be passed on through sex = balanitis in men
3
Q
what are the key symptoms of vaginal thrush?
A
thick white discharge (cottage cheese-like), intense itching (burning itch sensation - defining symptom), soreness, dyspareunia, dysuria
4
Q
name 7 risk factors for vaginal thrush
A
antibiotics, pregnancy, diabetes, local irritants - perfumed toiletries, HRT, immunosuppression, vaginal douching
5
Q
when should vaginal thrush be referred?
A
age <16 or >60, pregnancy, recurrent episodes, first-time presentation, abnormal bleeding
6
Q
name two treatment options for thrush
A
fluconazole 150mg PO (moderate CY3A4 inhibitor so check for interactions), clotrimazole 500mg pessary
for symptomatic relief, clotrimazole 10% cream can be given
7
Q
what self care advice should be offered?
A
use just water and soap
dry properly after washing
wear cotton underwear
avoid sex till thrush resolved
wipe front to back after bowel movement to avoid candida transfer from bowel to vagina
avoid fragranced products
avoid deodorants/douching in genital area
avoid wearing tight underwear or tights
avoid application of live yoghurt, tea tree oil
8
Q
what causes bacterial vaginosis?
A
overgrowth of anaerobes + loss of lactobacilli → ↑ vaginal pH
9
Q
what are the key symptom that distinguishes BV from thrush?
A
fishy-smelling, grey-white watery discharge without itching
10
Q
what are risk factors for BV?
A
sexually active, change in sexual partner, female-female sex, smoking, ethnicity (black African women more likely), copper IUD, pregnancy, menopause
11
Q
what OTC treatment helps restore vaginal flora in BV?
A
vaginal gels (with prebiotics/postbiotics
prebiotics: glycogen, provide nutrients to bacteria for growth to restore normal flora, postbiotics: lactic acid, restores normal pH, relieving odour), probiotics: helps prevent recurrence
12
Q
when should BV be referred?
A
pregnancy, recurrent BV (>4/year)
needs to be resolved as increased STI risk - HIV, chlamydia, gonorrhoea, trichomonas
13
Q
what is the most common cause of cystitis?
A
E coli
infection of the bladder
E coli ascends through the urethra into bladder - could be from GI tract (from rectum - females have shorter urethra)
14
Q
what are the symptoms of cystitis?
A
dysuria, frequency, urgency, suprapubic pain, haematuria, cloudy urine
15
Q
what are signs of pyelonephritis?
A
back pain
fever
n+v
flu like symptoms
(along w UTI symptoms)
16
Q
when should cystitis be referred?
A
<16, men, pregnancy, recurrent UTIs, systemic signs (fever, flank pain)
17
Q
what is the first-line Pharmacy First treatment for uncomplicated cystitis?
A
nitrofurantoin 100mg MR BD for 3 days
18
Q
what self care advice should be offered?
A
hydrate, wipe from front to back, urinate ASAP post-sex, showers > baths, change pads regularly, keep genital area clean + dry
avoid fragranced toiletries, avoid delaying urination, void - empty bladder, avoid consuming lots of sugary food
19
Q
what are the 4 types of urinary incontinence?
A
stress, urgency, overflow, mixed
20
Q
what is stress incontinence and what are risk factors for it?
A
involuntary leakage upon exertion (i.e., coughing)
elderly, pregnancy, obesity, smoking, FHx
21
Q
what is urgency incontinence and what are risk factors for it?
A
involuntary leakage with
or followed by the
sudden urge to urinate
–> part of a larger cause called ‘overactive bladder syndrome’ which also causes nocturia and increased urination
22
Q
what is mixed incontinence?
A
involuntary leakage is
linked to physical stress
and urgency.
23
Q
what is overflow incontinence and what are risk factors for it?
A
result of urinary retention
caused by bladder outlet
obstruction, inability to
fully empty the bladder
due to detrusor
underactivity
↓ bladder contractility
due to medications such as
ACEi, antimuscarinics,
CCBs, opioids, hypnotics.
24
Q
what are the symptoms of UI?
A
- leaking urine when:
coughing, sneezing, laughing, exercising - ↑ urinary frequency & urgency
- difficulty to start passing urine
- feeling of incomplete bladder emptying
25
what causes UI?
caused by weak pelvic floor or an overactive bladder.
- common & more prevalent in women
- likely under-reported due to embarrassment - patient may try to limit daily fluid intake or purchase
incontinence pads before speaking to a HCP
--> identify red flags: blood w/o UTI symptoms? (= overactive bladder syndrome)
--> should be referred to GP for diagnosis
26
what OTC products can help w UI?
improve QoL w products
- absorbent pads and pants
- bed and chair protection
- catheter and penile sheaths
- skincare and hygiene products
- specially adapted clothing/swimwear
27
what self care advice should be given?
- reduce alcohol, fizzy drink, caffeine intake (stimulate bladder)
- stay hydrated but not too much
- lose weight if obese
- smoking cessation
- pelvic floor exercises - gP can refer for training trial
- change pads regularly
28
what POMs are used to treat incontinence?
oxybutynin, tolterodine, mirabegron (if antimuscarinic contraindicated), duloxetine
29
what other Tx is available?
self catheterisation
intermittent self-catheterisation (ISC) - recommended! inserted several times a day to drain urine,
indwelling catheter (3 monthly change), suprapubic catheter (4-12 weekly change)
risk? UTI
mitigation? hydrate, avoid bends in catheter, keep urinary bag below catheter to avoid overflow
30
when is emergency hormonal contraception offered?
when any woman who does not wish to conceive has UPSI on any day of her menstrual cycle
(highest risk of pregnancy is 6 days before + during ovulation but can happen at any stage)
31
what emergency contraception options are available?
copper intrauterine device (most effective)
ulipristal (EllaOne)
levonorgestrel (Levonelle)
32
how do Cu-IUDs work?
Cu affects sperm mobility, reducing opportunity for fertilisation; prevents implantation
small T shaped device inserted into uterus, within 5 days of UPSI
- no impact of BMI
33
what are s/e associated w Cu-IUDs?
heavier periods, spotting between periods, discomfort during sex, perforation of uterus, painful, risk of infection
34
how does ulipristal work?
selective progesterone receptor modulator = blocks normal function of progesterone
= delays/prevents ovulation (release of egg)
1st line for UPSI within 90-120 hrs
single dose, sooner it is taken, more effective it will be
35
what are s/e associated w ulipristal?
n+v, headaches (see BNF)
--> if vomiting within 2 hrs of dose, return!
excreted into breastmilk
metabolised by CYP3A4 therefore efficacy could be reduced by enzyme inducers
36
what is a key consideration for ulipristal?
INTERFERES with regular
contraception - need to
wait 5 days to take
regular contraception
if EllaOne is taken:
patient will need additional
contraception (e.g. condoms) if they are to have sex
more in BNF (COC)
37
how does levonorgestrel work?
synthetic progesterone - delays/prevents ovulation
single dose
effective within 3 days of UPSI
sooner it is taken = more effective it is
higher BMI (above 26) can impact effectiveness - ulipristal or may need double dose
38
what are s/e associated w levonorgestrel?
n+v, headaches (see BNF)
--> if vomiting within 2 hrs of dose, return!
severe HI = contraindication
metabolised by CYP3A4 therefore efficacy could be reduced by enzyme inducers
39
what is a key consideration w levonorgestrel?
does not interfere w regular contraception therefore restart immediately
need to use condoms or abstain from sex
40
when do you supply?
take Pt to consultation room (chaperone?) - confidentiality
full history, BMI, preference
no safeguarding issues
for under 16s - can have it w/o parental consent but under 13s...child protection referral needed
41
can you get EHC for free?
yes
sexual health or genitourinary Medicine (GUM) clinics
GP practices
NHS walk-in centres and minor injury units
pharmacies (local enhanced services)
42
what oral contraceptives are available OTC?
combined oral contraceptive
progesterone only (desogestrel)
43
what are the main components of COCs?
ethinylestradiol (oestrogen) + a progestogen (e.g. levonorgestrel, norethisterone, drospirenone)
44
what should be assessed before supplying a COC?
full medical history, BP, BMI, age, smoking status,
personal/family history of VTE, stroke, migraine
45
name 3 contraindications to supplying COC
migraine w aura
history of VTE or clotting disorders
BMI >35 or uncontrolled HTN
46
what tool helps pharmacists assess COC safety?
UKMEC criteria (UK Medical Eligibility Criteria for Contraceptive Use)
47
what safeguarding measures should be taken for under 16s?
assess Fraser competence and consider safeguarding concerns, including signs of abuse or coercion
48
how should COCs be taken?
one tablet daily for 21 days followed by a 7-day break (or taken continuously depending on regimen)
49
what s/e are associated w COC?
nausea, breast tenderness, mood changes, headaches, breakthrough bleeding (especially in first few months)
50
what are the missed pill rules for COCs?
1 missed pill: >24 hours late: take ASAP, continue as normal
2 missed pills: take ASAP, may need condoms for 7 days + EHC if unprotected sex occurred
51
what lifestyle/health advice should be included in counselling?
monitor for signs of VTE (leg pain/swelling, chest pain, SOB)
smoking cessation
encourage STI testing if needed
maintain healthy weight and BP
52
can COCs be used to manage non-contraceptive issues?
yes - COCs can help with acne, PMS, cycle regulation, dysmenorrhoea, and menorrhagia
53
when should a patient be referred instead of supplied with a COC?
if they have risk factors such as migraines with aura, smoking + age >35, uncontrolled HTN, or history of VTE
54
what age group can safely use OTC desogestrel?
women ≥18 years; supply to under 18s is based on clinical judgment and safeguarding
55
what should you assess before supplying desogestrel OTC?
medical history, current medications, sexual history, contraindications, safeguarding concerns
56
name 3 clinical scenarios where referral is required before supplying desogestrel
history of breast cancer, active liver disease, uncontrolled HTN
57
what tool can pharmacists use to assess suitability of OTC desogestrel?
Hana or Lovima Pharmacy Supply Aid Checklist + RPS decision flowchart
58
what CYP enzyme impacts desogestrel efficacy?
CYP3A4 (watch for inducers like carbamazepine, phenytoin, rifampicin)
59
how does desogestrel interact with EllaOne (ulipristal)?
desogestrel and EllaOne can reduce each other’s efficacy - wait 5 days post-EllaOne to start POP
60
how should desogestrel POP be taken?
one tablet daily at the same time every day without a break
61
what’s the missed pill window for desogestrel?
>12 hours = missed pill → not protected
62
what to advise if a pill is taken >12 hours late?
take it as soon as remembered, use condoms for 7 days, consider EHC if unprotected sex occurred
63
what s/e are associated w desogestrel?
irregular bleeding, mood changes, nausea, breast tenderness, headaches (see BNF)
64
what should you do if patient has vomiting/diarrhoea after taking the pill?
if it was less than 3 hrs after taking the pill then take another ASAP then carry on as normal
65
what health advice should be included in the counselling?
STI prevention (condom use), breast exams, cervical screening, healthy lifestyle (diet, smoking, alcohol, BP)
66
what adv do COCs have over POPs?
longer missed pill window - slightly more flexible w timing (check BNF for 'missed pill' on specific preparations)
67
what should you do for repeat supply?
reassess medical suitability, ask about side effects, changes in health or meds, and provide counselling
repeat supply up to 12 months
women <18 years: limit to 3 months’ supply
68
what is dysmenorrhoea?
painful menstruation, typically involving abdominal cramps
69
what causes primary dysmenorrhoea?
prostaglandin overproduction or uterine sensitivity = over-contraction and reduced blood supply = pain
70
when is peak incidence?
17-25
can start 6-12 months after menarche
71
when should dysmenorrhoea be referred?
no improvement after 3–6 months or signs of secondary causes
72
what causes secondary dysmenorrhoea?
underlying medical condition such as PID
more likely in women over 30
73
what are symptoms of dysmenorrhoea?
cramping lower abdominal pain, usually starting 1–2 days before or at the start of menstruation, sometimes with nausea, fatigue, or headaches
74
how do symptoms of secondary dysmenorrhoea differ?
pain may begin earlier, last longer, or worsen over time; may also include heavy bleeding, dyspareunia, or non-cyclical pain
75
what is first line Tx for primary dysmenorrhoea?
NSAIDs (ibuprofen, naproxen)
76
why are NSAIDs effective for dysmenorrhoea?
they inhibit prostaglandin synthesis, reducing uterine contractions and pain
can be used in combo w paracetamol
aspirin - not as effective as NSAIDs
77
what are alternative options if NSAIDs are contraindicated or not effective?
COC (alt first line if woman does not wish to conceive)
TENS machine
78
what advice should you give when recommending NSAIDs for dysmenorrhoea?
take w or after food; start before pain begins if predictable; ensure no history of gastric ulcers or asthma
79
when should a patient with dysmenorrhoea be referred?
symptoms not improving after 3–6 months of NSAID/COC use
suspected secondary causes (e.g. endometriosis)
severe pain interfering with daily life
unusual bleeding or pelvic symptoms
80
what self care advice can support dysmenorrhoea relief?
regular exercise
relaxation techniques
heat pads
adequate hydration
avoiding caffeine/alcohol around menstruation
81
what is menorrhagia?
excessive or prolonged menstrual bleeding, lasting >7 days or with blood loss ≥80ml per cycle.
82
what causes menorrhagia?
often no underlying pathology (primary/idiopathic)
or secondary to conditions like:
uterine fibroids
endometriosis
coagulation disorders
thyroid dysfunction
IUD use
83
what are typical signs of menorrhagia?
heavy bleeding soaking through pads/tampons every 1–2 hours
passing large clots (≥2.5cm)
periods lasting >7 days
symptoms of iron deficiency anaemia: fatigue, dizziness, pallor
84
what are the Tx options?
1st line: levonorgestrel releasing IUS
then tranexamic acid or NSAIDs (unlicensed)
see BNF
85
what self care advice should be offered?
keep a menstrual diary
iron-rich foods or supplements to prevent anaemia
plan around heavy days with extra protection and rest
stay hydrated and nourished
86
what is premenstrual syndrome?
a group of physical and emotional symptoms that many women experience in the days leading up to their menstrual period
87
what causes PMS?
thought to result from abnormal sensitivity to fluctuating sex hormones, particularly progesterone, affecting neurotransmitters like serotonin and GABA
88
what are the physical symptoms of PMS?
bloating, breast tenderness, headaches, fatigue, changes in appetite
89
what are the emotional/behavioural symptoms of PMS?
irritability, mood swings, anxiety, low mood, crying spells, poor concentration
90
what are risk factors associated w PMS?
presence of ovulatory menstrual cycles
family history
mood disorders e.g. depression
smoking
alcohol
weight gain
stress
91
what lifestyle changes can help manage PMS?
regular exercise, reducing caffeine/alcohol, stress management, sleep hygiene, and a healthy diet
92
what supplements are sometimes used for PMS?
vitamin B6 (max 100mg/day), calcium, magnesium
--> limited evidence
93
what pharmacological treatments are used for PMS?
simple analgesia - paracetamol, NSAIDs
COC (especially with drospirenone like Yasmin - use is continuous rather than cyclical)
SSRIs (e.g. fluoxetine, sertraline) - either continuously or during luteal phase
CBT (Cognitive Behavioural Therapy)
94
when should PMS be referred?
concerns about self harm, depression, anxiety
symptoms not improving
severe symptoms - suspected PMDD = severe PMS (5 distinct psychological symptoms in luteal phase)
luteal phase: 14 day period before menstruation
95
what are uterine fibroids?
benign (non-cancerous) smooth muscle tumours of the myometrium (uterine wall)
96
what hormones influence fibroid growth?
oestrogen and progesterone - fibroids tend to shrink after menopause due to hormone decline
97
what are risk factors for fibroids?
early menarche, family history, obesity, nulliparity (never given birth), high oestrogen states (e.g. pregnancy, HRT)
seen in women of reproductive age
incidence higher in black and asian women (racism
98
what are common symptoms of uterine fibroids?
heavy or prolonged periods (menorrhagia)
pelvic pain or pressure
abdominal bloating
urinary frequency or retention
constipation
pain during sex (dyspareunia)
fertility problems or pregnancy complications
99
what OTC/POM options are used for symptom relief in fibroids?
NSAIDs (e.g. ibuprofen) for pain
tranexamic acid to reduce bleeding
COC or POP to regulate/limit bleeding
100
what hormonal therapies can shrink fibroids?
GnRH analogues (e.g. goserelin) – used short term to shrink fibroids pre-surgery
101
when should you refer a patient with suspected fibroids?
severe symptoms (e.g. heavy bleeding, pressure symptoms)
fertility concerns
suspected malignancy or rapid growth
102
what questions should you ask a patient presenting with heavy periods or pelvic pressure?
duration and severity of bleeding
presence of clots or anaemia symptoms
abdominal/pelvic pain
bladder/bowel changes
impact on daily life or sex
103
what lifestyle support can be offered?
iron-rich diet or supplements if anaemic
support with period tracking
advice on pain relief and when to seek medical help
104
what is endometriosis?
chronic condition where endometrial-like tissue grows outside the uterus, causing inflammation, pain, and scarring
105
where is endometriotic tissue commonly found?
pelvis (ovaries, fallopian tubes, bladder, bowel), but it can occur almost anywhere in the body
106
what causes endometriosis?
exact cause unknown; theories include:
retrograde menstruation
genetic predisposition
immune system dysfunction
107
what are the symptoms of endometriosis?
severe dysmenorrhoea
chronic pelvic pain
dyspareunia (pain during sex)
dyschezia (painful bowel movements)
infertility
fatigue
108
how does the pain pattern differ from primary dysmenorrhoea?
pain is often cyclical but may become chronic, start earlier, and last longer than menstrual bleeding
109
what is the goal of Tx in endometriosis?
to relieve symptoms, preserve fertility, and improve quality of life - no current cure
110
what is the first-line pharmacological treatment?
NSAIDs for pain relief
hormonal treatments to suppress menstruation:
COC (cyclic or continuous)
POP
LNG-IUS (e.g. Mirena)
injectables (e.g. Depo-Provera)
111
what key considerations should you include when counselling a patient with suspected endometriosis?
track and record symptoms (use a pain diary)
encourage early referral for diagnosis (laparoscopy = gold standard)
explain that it’s a chronic but manageable condition
validate their experience - symptoms are real and not just "bad periods"
112
when should you refer a patient with period pain for further investigation?
if symptoms are severe, progressively worsening, or not responding to first-line treatments after 3–6 months
if there's dyspareunia, bowel/bladder pain, or infertility concerns
113
what lifestyle support can help manage endometriosis symptoms?
regular low-impact exercise
heat therapy (e.g. hot water bottles)
CBT or mental health support for chronic pain
anti-inflammatory diet (some find benefit)
114
what is PCOS?
endocrine disorder impacting the way ovaries work
immature follicles accumulate in ovaries OR a high level of male hormone can prevent the ovary from releasing an egg = hormonal imbalances
115
what causes PCOS?
multifactorial - involving genetic, hormonal, and insulin resistance components
116
what hormonal imbalances are typical in PCOS?
↑ LH
↑ androgens (which are converted to testosterone)
low/normal FSH
insulin resistance (↑ insulin levels)
117
what are symptoms of PCOS?
irregular or absent periods
hirsutism (excess hair growth)
acne
scalp hair thinning (androgenic alopecia)
weight gain/obesity
subfertility or infertility
118
what metabolic risks are associated with PCOS?
T2DM, CVD, metabolic syndrome, endometrial hyperplasia/cancer (due to unopposed oestrogen)
119
what is the first-line management approach for PCOS?
lifestyle changes: diet, exercise, weight loss - even 5% weight loss can restore ovulation
120
what medications can regulate menstrual cycles in PCOS?
COC (regulates periods, reduces androgens, protects endometrium)
POP (if COCP contraindicated - but doesn’t treat androgens)
LNG-IUS for endometrial protection
121
what treatments are used for hirsutism and acne?
COC with anti-androgenic progestogens (e.g. drospirenone)
topical retinoid treatments
122
what can be used for insulin resistance or fertility?
metformin (unlicensed for PCOS) – improves insulin sensitivity
clomifene or letrozole for ovulation induction (prescribed in specialist care)
123
what key lifestyle advice should be given to patients with PCOS?
aim for healthy weight/BMI
follow a balanced, low-GI diet
engage in regular physical activity
monitor blood glucose and CVD
124
what long-term monitoring is recommended for PCOS?
regular glucose/HbA1c checks
monitor lipids, BP, weight
ensure endometrial protection if cycles are irregular
women with PCOS are at increased risk of depression, anxiety, and body image concerns - signpost to support services as needed
125
what is menopause?
cessation of menstrual periods and reproductive years
126
when does it occur?
between ages 45–55; average age in the UK is 51
early = before 40
127
what causes menopause?
natural decline in oestrogen production due to reduced ovarian follicle activity
128
what hormonal changes occur during menopause
↓ oestrogen
↑ FSH and LH (due to loss of negative feedback)
129
what is the difference between perimenopause and menopause?
perimenopause = transitional phase with fluctuating hormones/symptoms
menopause = no periods for 12 months
postmenopause = time after menopause
130
what are the most common vasomotor symptoms of menopause?
hot flushes
night sweats
sleep disturbances
131
what are common genitourinary symptoms of menopause?
vaginal dryness
pain during sex (dyspareunia)
recurrent UTIs
urinary urgency/incontinence
132
what psychological symptoms may occur?
mood swings
low mood
anxiety
brain fog
memory issues
133
what long-term health risks increase after menopause?
osteoporosis, CVD, weight gain, vaginal atrophy and incontinence
134
what is the most effective treatment for vasomotor symptoms of menopause?
HRT
if the patient has a uterus, combined HRT needed to protect the endometrium
oestrogen-only HRT only for those w/o uterus (post-hysterectomy)
135
what are the main forms of HRT?
tablets
patches
gels
vaginal creams/pessaries/rings
136
what is Gina and how is it used?
Gina 10mcg estradiol vaginal tablets - OTC treatment for vaginal atrophy (thinning, drying of vaginal wall)
dose: 1 tab daily for 2 weeks, then twice weekly maintenance
first OTC HRT product in the UK (licensed for women ≥50 years who are postmenopausal for ≥1 year)
137
what should patients be advised when starting HRT?
benefits may take a few weeks
common s/e: breast tenderness, nausea, bloating, breakthrough bleeding
discuss risks vs benefits (VTE, breast cancer, stroke risk in older women)
138
when should a patient be referred before starting HRT?
undiagnosed vaginal bleeding
personal/family history of breast or endometrial cancer, liver disease or high VTE risk
liver disease: oestrogens are primarily metabolised by hepatic enzymes, so hepatic impairment = ↑ exposure + s/e
139
what self-care/lifestyle advice should be offered?
wear breathable fabrics
reduce triggers: spicy food, caffeine, alcohol
regular exercise and strength training, control weight, sleep in cool room, regular bedtime,
balanced calcium and vitamin D-rich diet
use vaginal moisturisers/lubricants for dryness, CBT or mindfulness for mood symptoms
