Women's Health/Cancer Flashcards
Progesterone
Thickens and prepares uterus for receiving a fertilized ovum
Follicle stimulating hormone (FSH)
responsible for stimulating the ovaries to secrete estrogen
Luteinizing hormone (LH)
responsible for stimulating progesterone release
Gonadotropin releasing hormone (GnRH)
From hypothalamus, affects the rate of FSH and LH release
Proleferative phase
Day 1-13
Beginning of cycle (just after menstruation)
FSH output increases and estrogen secretion is stimulated
This causes the endometrium to become more vascular and thicken
Secretory phase
Day 14-28
LH output increases, ovulation occurs
In a womens health hx, data should be collected about:
Menstrual hx (menarche, duration, cramps?) Pregnancies (#?) Exposure to meds Dysmenorrhea Sx of vaginitis Bowel problems Sexual hx (STI's, abuse?)
Pap smear
Cervix is examined, obtained by rotating a small spatula at the os, followed by a cervical brush rotated in the os
Recommended age for a pap smear
18, or when they become sexually active, regardless of age
Benefits of hormonal contraceptives
Prevents pregnancy Decreased cramps and bleeding Regular bleeding cycle Decreased incidence of anemia Decreased acne Protection from uterine and ovarian cancer Decreased incidence of ectopic pregnancy Decreased incidence of pelvic infection
Risks of hormonal contraceptives
Bothersome side effects Nausea Weight gain Mood changes Small increased risk of developing blood clots, stroke or heart attack No protection from STI's
Do’s and Don’t of a pap smear
Best time to schedule is at least 5 days after your period stops. Don’t use tampons, birth control foams/jellies or vaginal creams 2-3 days before the test. Do not douche. Do not have sex for 2 days before the test
Transdermal contraceptives
Release estrogen and progestin continuously. Changed every week for 3 weeks, no patch is used during the 4th week. Risks are similar to those of oral contraceptives. May be applied to the torse, chest, arms, or thighs. Should not be applied to breasts.
Oral contraceptives
Stops the release of FSH, prevents ovulation.
Vaginal contraceptives
Releases estrogen and progestin, inserted in vagina for 3 weeks and then removed, results in lower hormone blood levels than oral contraceptives, does not require fitting.
Concerns for vaginal contraceptives
Fear of migrating
Uncomfortable
Noticed by partner
Injectable contraceptives (Depo)
IM inj every 3 months, inhibits ovulation
Advantages of Depo
Reduction of menorrhagia, dysmenorrhea, and anemia. May reduce the risk of pelvic infection, and endometrial cancer
Disadvantages of Depo
Irregular bleeding Bloathing Headaches Hair loss Decreased libido Changes in weight
Intrauterine device
Small plastic device, T-shaped, inserted into uterine cavity, causes a local inflammatory reaction that prevents fertilization
Advantages of IUD
Effectiveness over a long period of time
reduction of pt error
Disadvantages
Excessive bleeding Cramps Backaches Infection Risk of tubal pregnancy Displacement of device Rarely, proliferation of cervix or uterus
Examples of mechanical barriers
Diaphragm
Cervical cap
Female condom
Spermicides
Diaphragm
Round, flexible ring with a latex rubber cup. Spermicidal jelly coats it. inserted deep into the vagina, covering the cervix. Must be sized and properly fitted
How long should the diaphragm be placed
Remain in place for at least 6 hours after intercourse, no more than 12 after.
Disadvantages of diaphgram
Toxic shock syndrome
Allergic reactions to latex
Increased risk for UTI
Cervical cap
Covers only the cervix, used with spermicide, requires fitting
Advantage of cervical cap
May be left in place for 2 days after sex, may cause cervical irritation
Ectopic Pregnancy
Leading cause of pregnancy related death in 1st trimester. Occurs when fertilized ovum becomes implanted on any tissue other than uterine lining. (Fallopian tube, ovary, abdomen, cervix) Most commonly occurs in fallopian tube.
Causes of ectopic pregnancy
Salpingitis Pertitubal adhesions Structural abnormalities Previous ectopic pregnancy Previous tubal surgery Multiple previous abortions
Methotrexate
Stops pregnancy from progressing by interfering with DNA synthesis and the multiplication of cells, it interrupts early, small, unruptured, ectopic pregnancies
Side effects of methotrexate
Abdominal cramping Renal/hepatic damage Allergic reaction NSAIDS enhance metho toxicity Folic acid lowers efficacy
Menopause
Permanent cessation of menses, associated with declining ovarian function. Occurs in women between the ages of 48 and 55
S/S of menopause
Irregular menses Breast tenderness Hot flashes Night sweats Increased bone loss Thinning of pubic hair Shrinkage of labia vaginal secretions decrease Fatigue Dizziness Weight gain Sleep disturbances
During menopause, some women report dyspareunia, this is due to
Vaginal secretions decrease, causes vaginal pH to rise. This predisposes women to bacterial infections. Water based lubricants are recommended.
Assessment for women on HRT
Assess for pain/redness in legs
Any S/S of DVT and pulmonary embolism
Chest pain
SOB, tenderness
Candidiasis
Yeast infection
S/S of candidiasis
Vaginal discharge that causes itching (thick cottage like)
pH is 4.5 or less
Management of candidiasis
Antifungal agents
Vaginal creams
Bacterial vaginosis
Overgrowth of anaerobic baceria. Risk factors include douching after menses, smoking, multiple sex partners
S/S of bacterial vaginosis
Can occur throughout the menstrual cycle. Most sx are not noticed. Fishlike oder after intercourse Yellow white discharge, pH greater than 4.7.
Management of bacterial vaginosis
Flagyl bid for one week, vaginal gel or cream
Trichomoniasis
Protozoan that causes a common STI called trich. May be transmitted thru a asymptomatic carrier.
S/S of trichomoniases
Thin, frothy, yellow discharge
Vulvitis
Inspection with speculum shows cervical erythema, and multiple small petechiea (strawberry spots)
Management of trichmoniases
Most effective: Metronidazole or tinidazole
Both partners receive one time dose.
HPV
most common STI, can be asymptomatic , can be found in lesions of the skin, cervix, vagina, anus, penis, and oral cavity. Most common strains are 6, and 11
Management of HPV
Treatment of external warts: topical creams
Cryotherapy
Laser therapy
Herpes Type 2
Lifelong viral infection that causes herpetic lesions on the external genitalia. Recurrences can be associated with sunburns, stress, dental work, or inadequate rest or poor nutrition
Manifestations of Herpes type 2
Itching Pain, redness Swelling Flu like sx Malaise Enlarged lymph nodes in the groin Minor temperature Muscle aches Lesions last 4-15days before crusting over
Management of herpes type 2
No cure, treatment aimed at relieving sx Antiviral agents (Valtrex, Acyclovir, Famvir) Analgesics for pain Increase fluid intake Sitz baths Barrier methods during sex
Chlamydia and Gonorrhea (often coexist)
Chlamydia shows no sx but cervical discharge, dyspareunia, dysuria, and bleeding.
Gonorrhea shows no sx, may develop into PID w/o treatment
Management of chlamydia and gonorrhea
Doxycycline, Azithromycin
Ampicillin, amoxicillin
Pregnant women with chlamydia are treated with _______, not with _____
Erythromycin
Tetracycline
Abnormal findings in a breast inspection
Dimpling of flattening of nipple
Edema, redness
Nipple inversion
Ulceration, rashes, nipple discharge
BSE is best performed after
Menses (day 5 to 7, counting the first day of menses as day 1 for premenopausal women)
Once monthly for postmenopausal
Annual mammography should begin at age
40
Risk factors for breast cancer
Age Personal and family hx of breast CA Exposure to radiation Obesity Alcohol intake Genetic mutation (BRCA1 and BRCA2) Hormonal factors (early menarche, late menopause, late age at 1st full term pregnancy, HRT)
Nonsurgical treatment of breast cancer
Raiation therapy
Chemotherapy
Hormonal therapy
