Women's Health and Contraception Flashcards
Health Promotion
process of enabling people to increase control over, and to improve, their health
HPV Vaccine
initiated in 2006
Gardisil
Cervarix
Gardisil 9
should be offered to girls and boys ages 11-12 yo through age 26 for women
2-3 dose series
Breast Cancer Screening
clinical breast exam: evidence has not supported the benefit
mammogram annually starting at age 45 (sooner if family hx of early breast ca, do screening 10 years before age of diagnosis of first degree relative)
MRI for younger women at high risk of breast cancer d/t fam hx or gene mutations
Cervical Cancer Screening
start at age 21
21-29: every 3 years
30+: every 5 years w/ HPV test
Colonoscopy
every 10 years starting at age 45
BG Testing
every 3 years after age 45
Cholesterol
frequency based on health hx
Stages of Menopause
Perimenopause: years preceding menopause wehn woman has menopausal signs and symptoms, can last 2-10 years
Menopause: occurs 12 months afte last menstrual period, avg age 50-52
Postmenopause: the time after menopause
Menopause Management
Tx sx and discomforts
Lifestyle changes: adequate sleep, healthy diet, exercise, avoid caffeine/alcohol/smoking
Alternative medicine: phytoestrogens, herbal supplements, acupuncture, biofeedback, hypnosis
Menopausal hormone therapy (HT): estrogen only for women who don’t have uterus or estrogen/progesterone therapy
Hormone Replacement Therapy (HRT)
- estrogen therapy
- progesterone therapy
- ET is never given alone to woman w/ uterus
Risk of HRT: thrombosis and breast cancer
Benefits of HRT: reduce osteoporotic fractures
Prevention of Osteoporosis
- adequate calcium intake
- vitamin D
- estrogen
- regular weight bearing exercise
- stop smoking
- moderate alcohol intake
Tx of Osteoporosis
- bisphosphonates (first thing on empty stomach)
- selective estrogen receptor modulators
- salmon calcitonin
- parathyroid hormone activates bone formation
- ultra-low dose estrogen patches
Fertility Awareness-Based Methods
need regular menstrual cycles
takes into account sper can live up to 2-7 days and the ovum 1-3 days, max fertility for the woman occurs ~5days prior to ovulation
requires several months of tracking first before using
Situational Contraceptives
Abstinence
Coitus Interruptus
Douching
Spermicides
MOA: destroy sperm by disrupting cell membrane
Advantages: availability, no systemic effects
Disadvantages: minimally effective alone, use w/ barrier method increases effectiveness, not effective against STIs, increased risk of HIV since has negative effect on integrity of vaginal cells
Vaginal Sponge
soft, absorbent pillow-shaped device that has spermicide in it, has a cupped area to fit against cervix and a loop on it to remove it
wet sponge, then place in vagina against cervix
spermicide is released up to 24 hours, must be left in place for 6hrs after intercourse then discarded
multiple acts of intercourse is ok
has equal effectiveness as a diaphragm for nullips
Barrier Methods
MOA: prevent transport of sperm to ovum, immobilize sperm or are lethal against them
Advantages: availability, non-hormonal, some STI protection, minimal SE
Disadvantages: possible lack of spontaneity, possible irritation, proper use and paying attention, risk of breakage, cost factor for some
Pt needs to be aware of s/sx of TSS (high fever, sore throat, vomiting, and/or diarrhea, faintness, weakness, muscle aches, and a rash)
Diaphragm
- used w/ spermicide
- women is fitted for it and given Rx
- not recommended if woman has hx recurrent UTI or hx of TSS
- can be placed 6hrs ahead and NEEDS to be left in place 6-8hrs after intercourse
- proper storage and care needed
Intrauterine Contraceptives
exact MOA is not clearly understood but basically a spermicidal intrauterine environment
do not cause ectopic pregnancy of PID
Advantages: high rate of effectiveness, continuous contraceptive protection, relatively inexpensive over time
IUD Contraindications
current pregnancy current STI or pelvic infection undiagnosed bleeding disorder abnormal uterine shape caution w/ multiple sexual partners
After IUD insertion
check for strings regularly, usually after menses
follow up exam 4-8 wks after insertion
call provider if you experience:
- exposure to STI
- late period, abnormal bleeding
- dyspareunia or pelvic pain
- s/sx of infection
- missing strings
remove ASAP if pregnancy occurs
COC
combined oral contraceptive
MOA: inhibit ovulation, create an atrophic endometrium, thicken cervical mucus
Methods of administration: day 1 start (no back up required), sunday start or quick start (back up required for 7 days)
COC Education
contact healthcare provider if: -become depressed -develop a breast lump -become jaundiced -experience "ACHES" Abdominal pain Chest pain Headache Eye changes Severe leg pain
Progestin Only Methods
good for breastfeeding moms, patients that have a contraindication to using estrogen
SE: amenorrhea or irregular bleeding
Postcoital Emergency Contraception
emergency contraceptive (EC): available OTC w/o Rx
- may cause n/v
- initial w/in 72 hours of unprotected intercourse, may work up to 5 days!
Plan B: progestin only contraceptive
- more effective than combined postcoital EC
- initiate w/in 72 hours of unprotected intercourse
Copper IUD: place w/in 7 days of unprotected intercourse may reduce risk of pregnancy by up to 99%
Sterilization
permanent birth control
operative: vasectomy, tubal ligation
Medical Pregnancy Termination
mifepristone/misoprostol: first 10 wks of pregnancy
- mifepristone blocks progesterone
- misoprostol: causes uterus to contract
methotrexate (chemotherapy agent):
- first 7 weeks of pregnancy
- stops cell division
Surgical Pregnancy Termination
first trimester: safest time to perform, vacuum aspiration for up to 8 wks, dilation/suction curettage up to 13wks
second trimester: medical induction, dilation and evacuation
risk: perforation to the uterus, cervical lacerations, hemorrhage, retained products of conception and infection
