Womens Health Flashcards
What does follicular stimulating hormone (FSH) do?
- Spurs follicle development and causes estrogen surge
*peaks on 14th day, triggers ovulation and locate release
What does estrogen and progesterone do to the uterus?
- The endometrium will thicken for an embryo
What happens to the uterus when estrogen and progesterone is low during the menstrual cycle?
- The blood sloughs off the lining causing spotting
What does progesterone do to the cervical mucus?
- Will thicken the cervical mucus and body temperature will increase
What does estrogen do to luteinizing hormone (LH) and follicular stimulating hormone (FSH)
- Estrogen causes LH and FSH to surge
What does the surge of LH and FSH do?
- Causes the oocyte (egg) to release from the ovary into the fallopian tube
*egg lives here for 24 hours once released
What do you need to trigger ovulation?
LH and FSH
What is the MOA of hormonal contraceptives?
- They will inhibit production of FSH and LH to prevent ovulation
- They alter cervical mucus, inhibiting sperm from penetrating egg
What are the different types of hormonal contraceptions /
- Combined oral contraceptives (COCs)
*Estrogen + Progestin - Progestin only
- Non-oral combined hormonal
What do combined hormonal contraceptives contain? (COCs)
- Estrogen ethinyl estradiol (EE) and a progestin
What are the different formulations of combination oral contraceptives?
- Monophasic
*Same dose of estrogen and progestin throughout the pack - Biphasic, triphasic, and quadriphasic
*mimic estrogen and progesterone levels during menstrual cycle
What does Lo mean for combined oral contraceptives?
<35mcg estrogen, which means there is less estrogen to cause less estrogenic side effects
What does Fe mean? For combined oral contraceptives
An iron supplement is included
What does 24 mean for combined oral contraceptives
There is a shorter placebo time (EX 24 active + 4 placebo = 28 d cycle)
What is Lo loestrin Fe?
This combined oral contraceptive is the lowest dosed estrogen on the market
*10 mg
What will extended cycle COCs have? (Period every 3 months)
- There will be >21 days of active hormone
*will minimize blood loss
*may improve menstruation-related problems (dysmenorrhea)
*eliminated withdrawal bleeding
What type of pills are recommended for extended cycling?
- Monophasic pills (same dose of estrogen and progestin throughout the pack)
*there is an increased risk for breakthrough bleeding with others
What would women do prior to the development of extended cycle COCs?
- Women on standard 21/7 days packs could choose to “skip a period” by not taking the placebo pills
What are the progestin only oral contraceptives?
- Mini pills
*Errin
*camilla
*Nora BE - Norethindrone 35mcg
How can progestin only OC be taken?
- Taken daily with no placebo or pill free interval
- Can start on any day of the cycle, just keep timing consistent
How long does it take for progestin only OC to start working?
- Works within 48 hours
*If you miss a dose >3 hours use an alternative contraception for the next 48 hours
How do hormonal contraceptive primarily work by?
Inhibiting the production of LH and FSH
*inhibiting them will prevent ovulating by altering cervical mucus. Which will prevent the sperm from reaching the egg
What hormones are contained within a combined hormonal contraceptive?
- Progestin
- Estradiol (Estrogen)
What are the synthetic estrogens?
- Ethinyl estradiol
- Mestranol
- Estradiol valerate
What is primary amenorrhea?
Absence of spontaneous menstruation by 15 years old thereafter
What is secondary amenorrhea?
- Prior normal menses and absence of menses for 90+ days
OR - Irregular menses and absent for 6+ months
What are the common causes of secondary amenorrhea?
- Pregnancy
- MC for women in competitive sports
What do you need to rule out when a patient presents with amenorrhea?
- Pregnancy (get and hCG)
What is primary dysmenorrhea
Painful menstruation
1. There is excess prostaglandin and leukotriene levels which CREATES uterine cramping
When is the onset of dysmenorrhea?
- Within 2 years of menarche
- Peaks late teens/ early 20s
When does primary dysmenorrhea occur?
- During menses
What is secondary dysmenorrhea?
- There is an underlying pathology
*endometriosis, PID, etc - It is less related to first day of flow
What is the first-line treatment of dysmenorrhea?
- NSAIDS just before menses or with onset continue for 2-3 days (take with food)
- If a class of NSAIDS doesn’t work switch to another one
*Ibuprofen for naproxen - Oral contraceptives
How are oral contraceptives used to treat dysmenorrhea?
- It will reduce ovulation which will decrease uterine prostaglandin levels and menstrual flow
What can be used in adjunct and alternative forms of treatment for dysmenorrhea?
Adjunct: Heat and regular exercise
Alternative: Vitamin B, magnesium, acupuncture
What forms of therapies may help a 17 year old patient living with dysmenorrhea for whom lifestyle changes have not proved helpful?
OTC ibuprofen
What is Premenstrual syndrome? (PMS)
- Happens about 1-2 weeks prior to menses (luteal phase) and 1-2 days after onset
- There will be mood alteration and psychological effects
What is premenstraul dysphoric disorder PMDD?
- PMS that is so severe enough to cause dysfunction in daily living
What are the MC Affective signs and symptoms of PMS?
- Irritability
- Depression
- Anxiety
What are the MC physical signs and symptoms of PMS?
- Fluid retention (bloating)
- Headache
- Breast pain
What are the treatment options for PMS?
First-line: Non drug therapies (life-style changes)
Second-line: NSAIDS
Third-line: Prescription drug therapy (OC)
What type of lifestyle modification may be helpful in the treatment of PMS?
1, caffeine reduction
2. Salt restrictions
3. Low dairy
4. Low-fat
What is the preferred OC for treatment of PMS?
- Monophasic products preferred
Can SSRIs be used for treatment of PMS?
Yes
*sertraline
*Fluoxetine
**start during lateral phase
What to use for PMS when SSRIs do not relieve symptoms?
Anxiolytics
*Alprazolam
*Buspirone
What are the adverse reactions of NSAIDS (PMS treatment)
- Stomach upset (take with food)
- Bleeding
- GI ulcer
- Worsening HTN
- Hyperkalemia
6.Impaired renal function
What are some (rare) serious reactions of NSAIDS (PMS treatment)
- Skin reaction
- Stevens Johnson Syndrome (disorder of the skin and mucous membranes)
- Risk of stroke/thrombotic events
What does vitamin B6 100mg do for PMS?
- May improve symptoms (breast tenderness, depression )
- Do NOT recommend doses over 100mg/day
*can cause peripheral neuropathy
What does vitamin E 400 IU daily X 3 cycles do for PMS?
- May help mood, reduce anxiety, food cravings, and breast pain
What are other Vitamins/mineral supplements that can be used to treat PMS?
- Calcium carbonate 1000-1200mg of elemental calcium daily
- Magnesium 360 mg/day
What is an appropriate first line treatment for clinical dysmenorrhea in a patient with a history of a GI bleed 6 months ago?
- Loestrin 24 Fe
What therapy can help an 18 year old patient living with PMS characterized by underlying symptoms of anxiety around menstruation?
- Vitamin E
- Sertraline
What population of women is endometriosis common in?
- Nulliparous women
*A woman who has never given birth either by choice or for any other reason
What is the first-line treatment of endometriosis?
- Hormonal contraceptives +/- oral NSAIDS
What type of Hormonal contraceptives are used for endometriosis?
- Combined or progestin only
*reduce dysmenorrhea and heavy bleeding
What are alternative forms of treatment after the first-line/ (endometriosis)
- Progestins
- Danazol
- GnRH-a
What are the rules for starting an combined oral contraceptive?
Menstrual start
*within the first 5 days of menstruation (effective immediately)
Random start
*If the COC is started on any other days than the first 5 days of bleeding it will take 7 days to work
What are the first-line treatments for a patient presenting with dysmenorrhea, dyschezia (difficulty pooping), intermittent spotting, pelvic pain, and infertility and all the s/Sx point to endometriosis?
- Estrogen + progestin
- Progestin only
What are the treatment options for menopause?
- Estrogen-progestin products
*most effective for vasomotor symptoms is systemic hormone therapy with estrogen - Formulation consideration
*transdermal, local (topical) and low-dose oral estrogen products
*Lower risk of VTE
What are the SE of estrogen?
- Mood changes
- Vaginal bleeding
- Bloating and breast tenderness
What are the treatment options for local vaginal symptoms of Menopause?
- Local estrogen is preferred
*lubrication
*astroglide
What are most estrogen effective for?
Vasomotor Sx
*women with a uterus they need to use estrogen with progesterone
What does unopposed estrogen increase the risk of?
Endometrial cancer
What are the BBB for estrogen
- VTE
- Stroke
- Dementia
- Breast cancer
When is it okay to use hormone therapy for healthy symptomatic women (Menopause)
- When the women are within 10 years of menopause
- <60 years old
- no contraindications
*if there are risk factors use non-hormonal tx
*SSRI, SNRI, gabapentin, pregabalin
What are the common hormone therapy products for local symptoms of menopause
- 17 Beta Estradiol
- Conjugated equine estrogens
What are common hormone therapy products when there are systemic symptoms of menopause
- 17 beta estradiol
- Estradiol
- Conjugated Equine Estrogens
- Medroxyprogesterone
- Micronized progesterone
What are the BBB of systemic hormone therapy for menopause?
- Endometrial cancer
- Dementia >65
- Increased risk of stroke and VTE
- Breast cancer
*weight gain (SE)
What are the CI of systemic hormone therapy for menopause?
- Estrogen- containing products
- Undiagnosed uterine bleeding
- Active VTE
- Pregnancy
When is Paroextine used for menopause?
- During moderate-severe vasomotor symptoms
*takes about 4 weeks to see effects
BBB: suicide risk
SE: Sexual (increased/decreased libido)
What is Ospemifene (menopause treatment)
- Oral estrogen agonist/antagonist for dyspareunia
- 60mg PO with food
- Short term for moderate-severe symptoms of menopause
- Avoid in women with severe hepatic impairment
