Womens Health

Question 1

10.1 EHC

Answer 1

Uses:
• unprotected sex
• contraceptive failure
• advanced supply
referral:
• >5 days since - needs IUD
• changes to period
• severe liver dysfunction
• interacting medicines e.g.
enzyme inducers
OTC product:

Levonelle ONE STEP -
-16+
-Within 72 hours
-Can take more than one in the same cycle
- Avoid in - severe liver impairment, ectopic pregnancies risk, crowns
- OK in breastfeeding
- Regular contraception is okay
- interaction - cyclosporine

EllaONE - Ulipristal
- women of child bearing age - this includes 16+
- within 120
- contraindicated - cannot take more than once in the same cycle
- avoid in - severe liver impairment, asthma , on steroids
- breastfeeding - not recommended for 1 week - express and discard
- reduced efficacy of regular contraception - use condom until next period

advice:
• take asap for greater efficacy
• vomit within 3 hours - need replacement dose
• use barrier method until next period
• abdominal bleeding at period - see GP
• delayed period - see GP >5 days for
levonelle, >7 days for ellaone
• severe abdominal pain - see GP

Question 2

10.2 cystitis

Answer 2

symptoms:
• dysuria - pain
• urinary frequency and urgency
• incomplete bladder emptying
• dark, cloudy, strong smelling urine

Referral:
• women under 16 or over 70

• men and children
• recurrent attacks >2 in last 6 months
or 3 episodes in a year
• duration >48 hours
• severe symptoms
• flank pain
• systemic symptoms
• blood in urine
• abnormal discharge
• medication ADR - allopurinol • pregnancy
• diabetes
• immunocompromised
OTC product:
treat mild symptoms present for <48 hours for 2 days only:
• alkalinising agent - potassium/sodium
citrate interactions:
• potassium citrate: contrainidicated in hyperkalaemia
• sodium citrate: hypertension, heart
disease, pregnancy, kidney disease, lithium
advice:
• cranberry juice
• drink large quantities of water
• urinate after sex
• front to back
• do not hold urine in
• avoid soaps etc
• wear cotton underwear
• avoid tight jeans and trousers

Question 3

10.3 menorragia

Answer 3

symptoms:
• heavy periods
referral:
• intermenstrual bleeding
• under 18 or over 45

OTC failure - 3 cycles with no
improvement
• renal failure
• medication ADR - warfarin/
anticoagulants
• family endometrial cancer
• active VTE
• thrombophilia
• pregnancy or breastfeeding
• obesity
• diabetes
• tamoxifen
• COC
• pcos
• history of VTE
OTC product:
• tranexamic acid (anti-fibrinolytic) licensing:
• 18-45 years with 21-35 day regular
menstrual cycle dose:
• 1g TDS for 4 days or QDS if heavy side effects:
• nausea, vomiting, diarrhoea, visual
disturbances or thromboembolic event
advice:
• change towels every 6 hours
• change tampons ever 2 hours

Question 4

10.4 period pain

Answer 4

symptoms:
• lower abdominal cramps

back pain, N/V, diarrhoea, fatigue

referral:
• pain increases on onset of menses
• women >30 years with new or worsening
pain
• vaginal bleeding post menopause
• taking oral contraceptive
• intermenstrual bleeding and pain
• pain with late period
• presence of fever

OTC product: • NSAIDs
1. ibuprofen 12+
2. POM to P - naproxen
licensing: primary dysmenorrhoea dose: 500mg initially then 250mg 6-8 hours later if needed
• max 3 days in one month
• swallow whole with or after food cautions:
• asthma
contraindications:
• GI events
• HF
• stroke
• anticoagulants
• pregnancy
advice:
• hot water bottle
• exercise
• acupunture
• dietary supplements
• tens machine

Question 5

10.5 vaginal thrush

Answer 5

symptoms:
• itching and soreness - burning • discharge - like cottage cheese • pain during intercour

Referral

nder 16 or over 60
• OTC failure >7 days
• first episode
• recurrent attacks >2 in last 6 months • abnormal discharge
• spotting
• pain
• sores, ulcers, blisters • STIs

• abnormal vaginal bleeding
• medication ADR - abx, COC
predisposed:
• pregnancy
• diabetes
• immunocompromised
OTC product: treat infection:
• clotrimazole pessary/interanl cream -
immediate relief, administer pessary
at night
• oral fluconazole - single dose, takes
12-24 hours for symptom relief
Treat symptoms:
• external cream - for vulval symptoms
and to treat sexual partners penis to
prevent re-infection
• licensing: women 16-60 years/ when
with symptoms of penile thrush
advice:
• wear cotton underwear and loose
clothing
• avoid perfumed soaps
• wipe front to back
• change sanitary pads regularly