Women's Health and Pregnancy Flashcards
What are oocytes and what is significant about them at birth?
Oocytes are cells in the ovary that may undergo meiotic division to form an ovum. Women are born with a set number of oocytes.
What is amenorrhea and what can cause it?
Amenorrhea is the absence of menstruation; it can be due to genetic or acquired causes, such as primary ovarian failure
Explain the hormonal feedback mechanisms in menstruation.
Gonadotrophin-releasing hormone (GnRH) is secreted from the hypothalamus, which activates the pituitary to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH and LH stimulate production of sex hormones from the follicular cells of the ovaries: 17-β estradiol (estrogen) and progesterone.
What are the diagnostic criteria for Polycystic Ovary Syndrome (PCOS)?
PCOS is diagnosed when 2+ of these features are present:
1) Irregular periods (i.e., irregular ovulation)
2) Excess androgen (may cause physical signs such as excess facial or body hair), 3) Polycystic ovaries (enlarged ovaries with multiple fluid-filled sacs that surround the eggs)
What symptoms or complications can PCOS cause?
Can cause difficulties getting pregnant, weight gain, acne, thinning hair, and is associated with later development of type 2 diabetes and high cholesterol
What is endometriosis?
Endometriosis occurs when cells similar to those in the uterine lining grow in other parts of the body
List the symptoms of endometriosis.
Symptoms include: pelvic pain, painful periods that interfere with everyday life, heavy menstrual bleeding, pain during or after sex, painful bowel movements, pain when urinating, difficulty getting pregnant, and fatigue with one or more of the above symptoms
List the different types of female contraception mentioned in the lecture.
Combined pill (progesterone and estrogen)
Mini pill (progesterone-only)
Intrauterine device (copper coil)
Intrauterine system (hormonal coil - local release of progesterone)
Contraceptive implant
Contraceptive injection
Condoms
Diaphragm (cap)
Cycle tracking
What is an important consideration when prescribing dental antibiotics to patients on the pill?
When prescribing dental antibiotics, if they cause nausea or vomiting, this can render the pill ineffective and patients need to be warned of this
What endocrine changes occur during pregnancy?
Increased estrogen and progesterone
Increased salt and water retention due to increased renin secretion from kidneys
Reduced insulin sensitivity (can get gestational diabetes)
Early increase in human chorionic gonadotropin
Placenta releases additional thyrotropin-releasing hormone > ↑ thyroid-stimulating hormone, ↑ prolactin
Thyroid hormone production ↑ 50%, free T3 and T4 due to ↑ thyroid-binding globulin (aids brain development and thyroid function of fetus)
Pituitary gland ↑ ~135%; Prolactin ↑ 10x to allow breast tissue development and milk production
What hematological changes occur during pregnancy?
Plasma volume increased by 45%, causing dilution so hemoglobin falls (protects against hemorrhage at birth)
Increased production of RCs, WCs, platelets
Increased consumption makes platelets normal/low on testing
Increased WC can mask infection on tests
Clotting factor production increases
Fibrinolysis increases
Increased system sensitivity with increased DVT risk (up to 5x more likely)
What cardiovascular changes occur during pregnancy?
↑ heart rate (~25%), stroke volume, cardiac output
Relaxation of vascular smooth muscle - ↓ peripheral resistance; ↓ systolic and diastolic blood pressure, lowest point 20-24 weeks
Vascular compression by uterus (vena cava and aorta)
Difficulty with venous return when supine
What respiratory changes occur during pregnancy?
Resting position of diaphragm shifts up 5cm; ↓ expiratory reserve volume; ↑ tidal volume, 30-50%, due to progesterone
What gastrointestinal changes occur during pregnancy?
GORD (Gastro-Oesophageal Reflux Disease) is common
Progesterone can lead to ↓ lower esophageal sphincter resting muscle tone, delayed gastric emptying, increased small bowel transit time; Also directly caused by compression
What happens at the first midwife appointment (“booking visit”) during pregnancy?
Usually occurs at 8-10 weeks and includes: height and weight measurement, blood pressure check, urine sample, information about antenatal care, local services, and where to give birth
When do the standard ultrasound scans occur during pregnancy?
Dating/booking scan at 11-14 weeks; Mid-pregnancy scan at 18-21 weeks
How is menopause clinically diagnosed?
Clinical diagnosis, based on absence of menses for 12 months
What happens to hormone production as women enter their 40s?
As the supply of oocytes depletes during early 40s, production of progesterone, estradiol, and testosterone begins to decline
What is the predominant estrogen before menopause?
estradiol
What are the normal serum estradiol levels during the menstrual cycle?
Serum estradiol levels vary throughout the menstrual cycle but average about 367 picomol/L (100 picograms/mL)
What becomes the dominant estrogen after menopause?
After menopause, estrone becomes the dominant estrogen, derived from estradiol metabolism in the liver and peripheral conversion of androstenedione in adipose tissue
What symptoms of menopause are closely related to decreasing estradiol levels?
Symptoms such as hot flushes and urogenital atrophy are closely related to decreasing estradiol levels
Define surgical menopause.
Surgical menopause is the permanent cessation of ovarian function, brought on by removal of both ovaries
Define perimenopause.
Perimenopause includes the years before and after cessation of menses in someone who ovulates
At what age is menopause considered premature?
40
What urogenital changes occur during menopause?
Vaginal epithelial thinning
Decreased secretions (vaginal dryness)
Reduction in vaginal elasticity
Increase in pH of vaginal fluid
Symptoms include dryness, itching, discharge, painful intercourse
Urinary symptoms include increased frequency and leakage (often under-reported and under-treated)
How does menopause affect bone health?
Average decline in bone density of 10-12% in the spine and hip; Increased risk of fractures with activity of daily living or falls; Bone resorption accelerates
Why must progestin be co-administered with estrogen for women with an intact uterus?
To protect against endometrial hyperplasia and cancer
What symptoms is estrogen therapy initiated for in menopause management?
Hot flushes (vasomotor symptoms), night sweats, and urogenital symptoms
What forms of HRT are available?
Oral combined pill
Transdermal patches (thought to be associated with lower risk of stroke and venous thromboembolism than oral administration)
Metered dose sprays
Gel formulation
What scientific factor contributes to healthcare disparities for women?
Study of human biology defaults to the male body
How do heart attacks differ between men and women?
There are differences in symptoms, age at onset, effective treatments, and overall outcome
What issue exists with troponin blood tests for diagnosing myocardial infarction?
They are often not reported against sex-specific thresholds
What has research shown about the gender differences in pain burden and mortality?
Research has shown that women have more pain burden (morbidity) but men have more mortality
What biological factors influence gender differences in pain?
Sex hormones, genetics, immune function, brain/spinal cord modulation
What actions can healthcare professionals take to address healthcare disparities?
1) Recognize this is everyone’s problem
2) Acknowledge the privileged position in healthcare
3) Take day-to-day actions to redress the balance
4) Be aware of social and cultural differences
5) Be aware of (sub)conscious biases
6) Encourage diversity
7) Involve patients and family in decision making
