WOMENS HEALTH Flashcards
ACCURASTELY DESCRIBE WITH THE RESPECTIVE AGES THE STAGES OF WOMEN
EARLY REPRODUCTIVE
PEAK REPRODUCTIVE
LATE REPRODUCTITVE
EARLY PREMENOPAUSE
LATE PREMENOPAUSE
EARLY POSTMENOPAUSE
LATE POST MENOPAUSE
ANSWER IS ON SLIDE 4 OF WOMENS HEALTH SLIDE
https://docs.google.com/presentation/d/1JEqmPXnOZAJT3GKE96nZ6Az4LUSbrDhJ/edit?usp=sharing&ouid=114563836080248606659&rtpof=true&sd=true
WHAT IS Endometriosis
Chronic oestrogen-dependent condition characterised by the growth of endometrial tissue in sites other than the uterine cavity
STATE FACTS ABOUT Endometriosis
Endometriosis has a much higher prevalence in infertile women, estimated as between 25% and 40%
Endometriosis is found almost exclusively in women of reproductive age, with diagnosis usually during a woman’s 30s. It is uncommon in the under-20s
WHAT ARE THE CAUSES OF Endometriosis
Retrograde menstruation Genetic predisposition Lymphatic or circulatory spread Immune dysfunction Environmental causes Metaplasia
WHAT ARE THE SYMPTOMS OF Endometriosis
Symptoms – dependent on area affected
Dysmenorrhoea Dyspareunia (painful sexual intercourse) Cyclical/chronic pelvic pain Subfertility Bloating, lethargy, constipation Worsen prior to/during menstruation
WHAT ARE Endometriosis Treatments AND THINGS TO CONSIDER
Consider the following…
Nature of symptoms
Severity of symptoms
Need for future fertility
Treatments
Hormone treatments
Pain relief
Surgery
WHAT ARE THE HORMONE TREATMENTS FOR ENDOMETRIOSIS
Combined oral contraceptive Mirena coil Progestogens GnRH analogues Testosterone derivatives Danazol Gestrinone
WHAT ARE THE Pain Relief TREATMENT FOR ENDOMETRIOSIS
Heat/comfort Analgesia/NSAIDs/Codeine Physiotherapy Pain modifiers TENS machines Pain clinics
GIVE A Brief Overview OF Female Genital Mutilation
The World Health Organization (WHO) defines it as ‘all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons’.
Widely practised in more than 29 countries throughout Africa, SE Asia and the Middle East for many reasons:
Honour
Unmarriageable
Tradition
WHAT ARE THE TYPES OF FEMALE
Type 1: this is the partial or total removal of the clitoral glans (the external and visible part of the clitoris, which is a sensitive part of the female genitals), and/or the prepuce/ clitoral hood (the fold of skin surrounding the clitoral glans).
Type 2: this is the partial or total removal of the clitoral glans and the labia minora (the inner folds of the vulva), with or without removal of the labia majora (the outer folds of skin of the vulva).
Type 3: Also known as infibulation, this is the narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora, or labia majora, sometimes through stitching, with or without removal of the clitoral prepuce/clitoral hood and glans.
WHAT IS Vaginal Dryness
Lack of oestrogen can cause a thinning and reduction in elasticity of the vaginal walls and a reduction in the glands which produce lubricating mucus.
Common in post-menopausal women
Associated with hormonal contraceptive use, cigarette smoking, radiation therapy or chemotherapy
WHAT ARE THE SYMPTOMS OF Vaginal Dryness
Pain during sexual intercourse
Inflamed vulva causing discomfort
Itch/scratch/inflammation cycle
Urinary problems due to possible thinning/weakening of tissues around the neck of the bladder
what are the treatment for Vaginal Dryness
OTC – lubricating gels e.g. ReplensMD and Sylk – non-hormonal, drug free bio-adhesive moisturiser
OTC – water-based lubricant K-Y Jelly work for several hours
Avoid douching, perfumed soaps and bath products (irritants)
HRT or Hormone based vaginal gels
what are the risk factors for breast cancer
and known protective factors
Age, ethnic group (lower in South Asian women), previous history of breast cancer, significant family history, early menarche, late menopause, not having children or having children when older, HRT, history of benign breast disease, having dense breast tissue, high alcohol intake, being overweight post-menopause, being tall, history of early cancer, exposure to radiation
Bejng active, breastfeeding, having a healthy diet
Some drugs may have a prophylactic effect, eg, tamoxifen, aspirin
what are the rusk factors for Endometrial cancer
and known protective factors
Age, being overweight high fat diet, not having children, menstrual disturbance,
early menarche, late menopause, history of endometrial hyperplasia (thickening of the endometrium), history of polycystic ovary disease, family history, tamoxifen, HRT
what are the risk factors for Ovarian cancer
and known protective factors
Family history, history of breast cancer, being infertile, using fertility drugs, HRT, being overweight being tall, history of endometriosis, smoking
Contraceptive pills, having children, breastfeeding, hysterectomy, surgical sterilisation, aspirin
what are the risk factors for Cervical cancer
and known protective factors
Human papilloma virus (HPV) infection, history of other sexually-transmitted infections, smoking, a weakened immune system, contraceptive pills, poor personal hygiene, having children young, having multiple pregnancies, genetics
HPV vaccine
explain Dysmenorrhoea
cyclical, lower abdominal or pelvic pain, which may also radiate to the back and thighs, occurring before or during menstruation, or both
Primary dysmenorrhoea
Secondary dysmenorrhoea
Careful questioning and age consideration will help differentiate between the two
what are symptom of primary Dysmenorrhoea
Most severe from day before until 48 hrs after begin of menstrual flow
Pain plus headache, constipation, nausea, vomiting, diarrhoea, dizziness
Most common in younger females
what are symptom of secondary Dysmenorrhoea
Later onset (over 30 years old) Pain lasts throughout menstrual cycle Plus dyspareunia, intermenstrual bleeding, post-coital bleeding Causes: Endometriosis Fibroids Pelvic inflammatory disease Ovarian cysts/tumours Copper IUD
what are the treatment options for Dysmenorrhoea – Period Pain
Analgesia – paracetamol, ibuprofen, feminax plus ( naproxen), aspirin
Contraception
(Childbirth)
Age
what additional advise do you give for Dysmenorrhoea – Period Pain
Heat therapies – massage, warm baths, hot water bottles
Exercise
Relaxation techniques
TENS
Lifestyle
REFER if light-headed, very tired – blood test to check iron levels, pelvic examination?
state facts about Menorrhagia (Heavy Periods)
Average blood loss during a period is 30-40mls
9/10 women lose less than 80ml
Heavy blood loss is considered to be 60ml or more per cycle
Diagnosed via pelvic examination, followed by a blood test to check for anaemia#
Listen out for tell tale symptoms:
Using unusually high number of sanitary products
Flooding through to bedding or underwear
Using tampons and towels
what are the causes of Menorrhagia (Heavy Periods)
Polycystic Ovarian Syndrome (PCOS) Fibroids Pelvic Inflammatory disease Endometriosis Hypothyroidism
Von Willebrand’s disease (blood clotting disorder) Anti-coagulants IUD Bleeding after a C-Section/vaginal birth (don’t use tampons for 6 weeks it might be a Signs of infection
what are the treatment options for Menorrhagia (Heavy Periods)
1st line Mirena Coil
2nd line NSAID mefenamic acid/tranexamic acid/COC
3rd line Norethisterone 5mg tablets day 5 to 26/medroxyprogesterone
surgery
Hysterectomy – Most effective treatment
state facts about Bacterial Vaginosis
Caused by an overgrowth of anaerobic organisms in the vagina. The most common organisms include Gardnerella vaginalis, Prevotella spp., Mycoplasma hominis, and Mobiluncus spp.
They replace lactobacilli, which are the dominant bacteria present in the normal vagina.
The pH increases from less than 4.5 to as high as 6.
BV is not thought to be sexually transmitted (it can occur in virgins); however, sexual activity has been linked to development of the infection.
Most common in women of reproductive age
what are the risk factors of Bacterial Vaginosis
New sexual partner.
Other sexually transmitted infections (STIs).
Ethnicity (more common in women of Afro-Caribbean descent).
Presence of a copper intrauterine contraceptive device (IUCD).
Vaginal douching.
Bubble baths.
Receptive oral sex.
Smoking.
how do you protect against Bacterial Vaginosis
Combined oral contraceptive pill (oestrogen encourages lactobacilli).
Condoms.
Circumcised partner
what are the presenting complaints of Bacterial Vaginosis
Offensive, fishy-smelling vaginal discharge without soreness or irritation.
Approximately half of all women infected are asymptomatic.
On examination there is usually a thin layer of white discharge covering the vaginal wall.
what is the differential diagnosis of Bacterial Vaginosis
Other vaginal infections – e.g. candida, trichomoniasis, STIs
Other benign causes of vaginal discharge – e.g. physiological discharge, chemical irritants, foreign body, pregnancy, cervical ectropion.
Tumours of the vulva, vagina, cervix, or endometrium.
Postmenopausal vaginal discharge due to atrophic vaginitis.
Vaginal discharge after gynaecological surgery
what are the treatment options for Bacterial Vaginosis
Antibiotics. Metronidazole is the most common and preferred antibiotic treatment for BV. …
Further treatment. For some women, the first course of treatment doesn’t treat BV effectively.
Vaginal pH correction treatments.
Referral to a specialist.
what additional advise would you give someone with Bacterial Vaginosis
Use water and an emollient to wash with Avoid perfumed soaps, bubble bath or shower gel, antiseptic bath additive Avoid douching Have showers instead of baths Don’t use vaginal deodourants
state facts about osteoporosis
Characterized by a loss in bone density, increased bone fragility, high risk of fracture
Bone mass density peaks early-mid 30s then starts to decline
Bone mass density declines more rapidly during the menopause due to loss of oestrogens (responsible for laying down calcium into the bone matrix)
osteoporosis is asymptomatic and the condition usually presents only after first bone fracture
what questions should you ask when considering someone with osteoporosis
Ask a set of questions when deciding on the various treatment options for a patient with Osteoporosis: Is bone sparing treatment required? Is calcium intake adequate? Is the patient male of female? Is the patient in premature menopause? Lifestyle
what is the treatment for Osteoporosis
- Bisphosphonates e.g. alendronate, risedronate
- HRT
- Raloxifene
- Tibolone (hormone therapy)
- Calcium & Vitamin D
what is the mechanism of action for the treatment for Osteoporosis
- inhibits the action of osteoclasts
- oestrogen replacement
- SERM
- STEAR
- deposition of bone mineral
