women's health (unit 3) Flashcards
menarche
- avg. age 12.5 yrs
* irregular and scant
menstrual cycle
- 28 day duration
* 1st day of period=1st day of cycle
leading causes of death in women
- heart dz
- cancer
- cerebrovascular dz
- pneumonia, influenza
- chronic lung dz
education prior to pelvic exam
- schedule b/t periods
- don’t douch or have sex 48 hr
- no vag. meds, sprays, etc
- empty bladder
Papanicolaou (Pap) test
- screening for cancer
- speculum, spatula, and brush used to collect cells
- first @ 21 y/o
- qyr to 30
bimanual examination
- purpose is to palpate size, position, and consistency of uterus and cervix
- any ovarian tumors found are advanced
breast exams
•yearly by MD •monthly by self •mammogram yearly afte 40 •q2yrs after 50 *lawn mower starting at axilla
inspection during breast exam
- texture/color
- nipple position
- symmetrical movement
- dimpling or masses
palpation during breast exam
- lymph nodes
* while sitting and lying
fibroadenoma
- benign breast disorder
- firm hard, feely mobile mass (NOT cancer)
- DONT change w/ cycle
- teens/20s
fibrocystic changes***
- benign breast disorder
- bilateral pain/tenderness
- occurs prior to menopause
- CHANGES during cycle
- tx: OTC pain meds (NSAIDs); no caffeine
ductal ectasia
- benign breast disorder
- ducts become distended and filled
- irregular mass
- enlarged axillary nodes
- nipple retraction and d/c
- occurs near menopause
intraductal papilloma
- benign breast disorder
- d/c from nipple
- occurs near menopause
high risk of breast cancer
- personal/fam hx of breast CA
- hx of uterine/ovarian/colon CA
- > 50 y/o
- nulliparity or AMA
- early menarche/late menopause
- lifestyle factors
invasive breast cancer
•when tumor growth expands into tissue surrounding duct
metastasis
- cells are spread from tumor by both blood and lymph
* common end sites are lungs, liver, bones
inflammatory breast cancer
- blocks lymph vessels in breast skin
- Peau de’ orange
- aggressive
- dx by biopsy
breast cancer dx
- fine needle biopsy
* incisional biopsy (lumpectomy)
lumpectomy
- breast cancer tx
* lump and surrounding tissue are removed
simple mastectomy
•entire breast removed
modified radical mastectomy
•entire breast and surrounding lymph nodes removed
lumpectomy/mastectomy post-op
*prevent lymph edema
•no venipuncture/BP on affected arm
•arm above heart in RR
•exercise arms
breast cancer tx adjuvant therapies
•radiation
•chemo
•hormones (SERMs)
*depends on age and stage of CA
tamoxifen
•hormone breast CA adjuvant therapy •only works on estrogen receptive tumors •blocks estrogen in body •SE: similar to menopause *SERM- selective estrogen receptor modulator
candidiasis
•vaginal infection r/t moniliasis or yeast •pH < 4.5 •white, thick, curdy, no odor d/c •itching •not sexually transmitted *recurrent yeast r/t HIV+
candidiasis med tx
- Monistat
- gyne-lotrimin
- mycostatin
- diflucan
- vagistat
- terazol
bacterial vaginosis
- malodorous, profuse dc that is thin gray/white or yellow/green
- pH >5
- not sexually transmitted
- refrain from sex until cured
bacterial vaginosis med tx
- metronidazole
* clinda cream
gonorrhea
- green d/c, dyspareunia, dysuria
* abx tx
chlamydia
- yellow d/c
- asymptomatic in women
- can lead to infertility or PID if no tx
- tx: abx
trichomoniasis
- thin malodorous green/yellow d/c
- itching, redness, edema
- strawberry cervix
- looks like sperm
- tx: metronidazole
syphilis
- painless chancre (male ID)
- primary, secondary, tertiary stages
- VDRL or RPR
- tx: PCN ONLY
herpes
- blisters, severe vulvular pain, dyspareunia
- no cure
- tx: acyclovir (anti-viral)
immunioquid
•immune system stimulant to get body to fight itself
human papilloma virus
- genital warts
- strong association w/ cervical cancer
- tx: remove wart via TCA
is HIV/AIDs sexually transmitted?
•yes
is hep B or C sexually transmitted
•yes
is GBS sexually transmitted
- no
* not exclusively transmitted by blood/body fld.
pelvic inflammatory dz (PID)
- infection of upper genital tract usually d/t “silent” STD
- abd pain, cervical motion tenderness, fever, N/V, anorexia
- tx:
toxic shock syndrome
- fatal cndt. caused by staph aureus
- can lead to hypovolemia, hypotension, and shock
- s/sx: fever, flu-like, hypotension, rash
toxic shock syndrome tx
- fluid
- vasopressor drugs
- antimicrobials
toxic shock prevention
- hand washing before tampon/diaphragm
- change tampon q4hr
- no diaphragm during menses
- remove diaphragm as directed
causes of menstrual disorders
- PG complications
- anatomic lesions
- drug-induced bleeding
- systemic d/o
- failure to ovulate
menstrual d/o management
- treat cause
- treat any anemia
- surgery- D&C, hyst, laser ablation
normal amnt of bleeding after menopause
NONE!!
primary amenorrhea
- menarche after 16
* menarche 1 yr later than mom and same age as sister
secondary amenorrhea
- absence of menstruation of 3 cycles after regular cycles established
- most common cause is PG
amenorrhea tx
- PG test
- treat underlying cause
- nutritional counseling
- hormone replacement
- ovulation stimulation
- periodic progesterone
polycystic ovarian syndrome (PCOS)
- endocrine d/o r/t imbalance of male/female hormones
- cysts in ovaries
- s/sx: infertility, acne, thining hair, hirsutism, inulin resistance, irregular/absent cycles
mittelschemerz
•pelvic pain that occurs with ovulation
primary dysmenorrhea
- menstrual pain w/o pathology
- occurs hrs from start of menses
- spasmotic, colicky
- most common in nulliparous
secondary dysmenorrhea
•menstrual pain that occurs b/c of dz process -fibroids -endometriosis -PID •tx: OCPs, NSAIDs
endometriosis
- development of endometrial implants outside uterus
- implants enlarge/stretch, causing pain
- cause unkn
- often causes infertility b/c of tube or ovary occluding/strangling
- dx by laparoscopy
endometriosis tx
- hormone supression
- ablation
- hysterectomy
premenstrual syndrom (PMS)
•s/sx must be cyclic and recur after luteal phase
•s/sx free during follicular phase
•s/sx severe and interfere w/ life
*etiology unkn
physical s/sx PMS
- edema
- wt gain
- bloating
- hot flashes
- constipation
- HA
- acne
- breast pain
behavioral s/sx PMS
- anxiety
- depression
- irritability
- mood swings
- aggressive
- inc. appetite
- fatigue
- insomnia
PMS management
- good nutrition
- vit. B
- avoid caffeine, simple sugars, salt, etoh
- stress management
- exercise
- adequate sleep
Premenstrual dysphoric disorder (PMDD)
- severe PMS
* high r/o suicide
infertility
•inability to conceive after 1 yr of unprotected intercourse
•d/t delayed childbearing or physiological factors
-male responsible 40% of time
female infertility causes
- ovulatory d/o***
- abnormal tubes/cervix
- repeated PG loss
repeated PG loss causes
- fetal chromosomal abnormalities
- cervix/uterus abnormals
- endocrine abnormalities
- immune abnormalities
- infection
- environmental factors
male infertility causes
- infection
- ED
- seminal fld./sperm abnormal (pH)
- environmental
- ejaculation probs.
infertility tx
- treat cause (thyroid d/o, etc)
- artificial insemination
- invitro fertilization
- sperm/ovum donation
- meds: Clomid
basal body temperature and ovulation
•increases and stays higher if PG
menopause
- end of menses
- avg. age 51
- can be induced/created artificially
artificial induction of menopause
•surgical removal of ovaries
•destruction of ovaries by radiation
*s/sx more severe than natural
body changes of menopause
- cessation of estrogen/progesterone production
- vag. atrophy/dryness
- forgetful, diff. concentrating, insomnia, BA, HA, depression
- mood swings
- hot flashes
- bladder/urethra atrophy
why hot flashes
•dec. endogenous estrogen
*most common reason women seek care
why insomnia during menopasue
•lack of estrogen on hypothalamus
uterine leiomyomas
- benign uterine tumors
- may cause bleeding, anemia, pressure
- tx: myomectomy, hyst, GnRH agonists
ovarian cysts
- benign tumors of ovary
- luteal are painful
- tx: OCPs, U/S, surgery
endometrial cancer key s/sx
•bleeding after menopause
cervical cancer almost always caused by
•HPV
most effective and safest method of contraception
abstinence
basal body temperature method of contraception
- natural family planning method
- temp drops prior to ovulation and then rises for several days after
- several months of graphs
calendar (rhythm) method of contraception
- natural family planning
* record menstrual cycles for 6-8 months to ID shortest/longest
billings method of contraception
- natural family planning
* based on cervical mucus changes through cycle
barrier contraceptive methods
•Diaphragm
•cervical cap
•condoms (male/female)
*some reduce risk of STDs
diaphragm
- requires fitting by provider
- DOESNT protect against STDs
- used with spermicidal jelly
- insert 6 hrs a and leave in place 6-8 hrs p sex
- don’t use if hx of UTI
- replace q2-3yr or 10 lb wt change
- r/o toxic shock
cervical cap
- rubber cup w/ firm round rim
- filled w/ spermicide prior to insertion
- place 30 min a sex
- leave in for 6-8 hrs p sex
- 48 hr protection
- DOESNT protect against STD
spermicides
•used 15-30 min a intercourse
•reapply w/ each encounter & q1h
•DOESNT protect against STDs
*use with other method for best results
male condom
- oldest form of contraception
- protects against HIV and some STDs
- use w/ spermicide -> 99% effective
- easy to break
female condom
- traps sperm in sheath placed in uterus
- placed 8 hrs prior to sex
- may prevents STDs better than male
- more expensive than male
coitus interruptus
•withdrawal method of contraception
•ejaculate deposited away form vag.
•DOESNT protect against STDs
*REMEMBER preejaculate can contain sperm
intrauterine device
- interferes w/ sperm transport to tubes
- lasts 1-8 yrs
- DOESNT protect against STDs
- medicated w/ copper or progesterone
- contraindicated in PID, STD, nullparous
PAINS
*IUD warning signs Period late, abn, spotting Abdominal pain, pain w/ sex Infection exposure/discharge Not feeling well (fever, chills) String missing
combined oral contraceptives (COC)
- combo of estrogen (estradiol) and progesterone (many kinds)
- suppresses ovulation***
- thickened cervical mucus
- effects endometrial lining
COC advantages
- dec. menstrual s/sx
- treats menstrual irreg.
- lighter cycle
- improves acne
- manipulates cycle
- dec. # cycles
- enhanced sexual enjoyment
- dec. r/o cancer, cysts, PID, etc
Beyaz & Safryal
•new COC that adds folic acid, which remains consistent for 20 wks after discontinuation
Natazia
•new estrogen w/ diff. timing and only 2 placebo pills
Lo loestrin Fe
•lowest estrogen to date and 2 day placebo pills (Fe tablets)
COC disadvantages
- spotting during beginning of tx
- missed period/amenorrhea
- depression, anxiety, irritability, fatigue
- inc. r/o adenocarcinoma cervical cancer
- N/V, hunger, HA, HTN, wt gain
- inc. r/o DVT, MI, stroke*** (lower if don’t smoke, have HTN, or migraines)
Seasonale
- tricycle regimen
- 63 active pills in a row, then 7 days off
- ALL monophasic (one dose of hormones every day)
Lybrel
- continuous contraception
- advantageous if menstrual complications, migraines, epilepsy, etc
- dec. r/o breast cancer
what meds decrease COC effectiveness
- ampicillin
- doxycycline
- tetracycline
ACHES
*COC s/sx needing MD contact Abdominal pain (severe) Chest pain, cough, SOB HA, dizziness/weakness/numbness Eye problems Severe leg pain *DONT just stop pill
combined vaginal contraceptive
- vaginal ring
- once a month BC inserted by pt
- releases hormones that are absorbed thru vaginal canal
- same drugs as pill
combined topical contraceptive
- patch changed weekly
- placed on abd/upper torso/butt/upper arm (NOT breast)
- lots of complications
- not effective in > 195 lbs
progestin-only pill (mini-pill)
•contraception of choice for lactating moms b/c doesn’t effect milk
•works by changing endometrium and cervical mucous
•best if > 40 y/o
•DOESNT protect against STDs
*must take at same time everyday
implanon
•long-acting progestational agent •prevents PG for 3 yrs •device implanted under skin -prevents ovulation -cervical mucous -thins endo •reversible
depo-provera
•oil-based long acting progesterone •admin q12wk •injection •prevents ectopic PG •may take 10 months to get PG after discontinue •r/o dec. bone density and wt gain -reverses after d/c
when is postcoital contraception used
•woman had unprotected intercourse •failed method (ex: condom break) •rape •intermittent isolated intercourse *89% chance no PG *ineffective if already PG (NOT abortion)
Postcoital (emergency) contraception side effects
- N/V
* menstrual changes
medical abortion
•RU-486
•misoprostal
-blocks folic acid and causes uterine cramping
•methotrexate (antineoplastic)
female sterilization
•surgery to ligate, clip, or destroy part of fallopian tube
•ovulation still occurs, but ovum absorbed
•must be > 21 y/o
•used if for sure don’t want kids or for medical purposes
•r/o ectopic PG
*NOT STD protection
Essure
•non-surgical female sterilization •coil in place of fallopian tube •natural scarring (after 3 months) -need BC during (no IUD) •MUST have 3 month confirm test •r/o ectopic PG
male sterilization
•must use alt. contraception for 3 months
•fertility after reversal is 50%
*NOT STD protection
most likely spot to have atypical (cervical cancer) cells
- transformation zone
* changing from cervical cells to endocervical cells
abnormal cell characteristics
- no or multiple nucleus
- macro/micro-nucleus
- cell wall abnormality
Peau de’ orange
- abnormal breast tissue texture
* indicative of inflammatory aggressive breast cancer
why is AMA or no PG higher risk for breast cancer
- no break for hormones
* connected to estrogen receptive breast cancer tumors
when can’t take ANY type of COC…
- over 35 and smoke, HTN, migraine
* have had previous thrombolytic complication
when to start COC
•day after menstrual cycle starts
what to do if have COC side effects
- call MD
* DONT stop abruptly
