Womens health Flashcards
bacterial vaginosis:
discharge
thin, watery, off-white or discolored, “fishy” discharge
bacterial vaginosis:
symptoms
vaginal irritation, dysuria, and itching
bacterial vaginosis:
vaginal pH
increased
trichomoniasis:
discharge
copious, malodorous, yellow-green, frothy discharge
trichomoniasis:
symptoms
pruritus, vaginal irritation, and dysuria
trichomoniasis:
vaginal pH
increased
vulvovaginal candidiasis:
discharge
thick, white, odorless, “cottage cheese” discharge
vulvovaginal candidiasis:
symptoms
erythema, itching, and vulvar edema
vulvovaginal candidiasis:
vaginal pH
normal
exclusions for self care of VVC
- first vulvovaginal episode
- recurrent VVC (more than three infections per year or an infection in the past 2 months)
- pregnancy
- girls < 12 years
- fever or pain in the pelvic area, lower abdomen, back or shoulder
- corticosteroids, antineoplastic
- diabetes, HIV infection
products to treat VVC
clotrimazole, miconazole, or tioconazole
duration of treatment VVC
1 to 7 days
ADE of VVC antifungals
vulvovaginal burning, itching, and irritation
DDI of VVC antifungals
miconazole and warfarin
symptom relief of VVC
sodium bicarbonate sitz bath, tea tree oil, gentian violet, boric acid, benzocaine + resorcinol
sodium bicarbonate sitz bath
provides symptom relief, potentially sooner than antifungal relief
tea tree oil
allergic dermatitis risk, antibacterial and antifungal properties
gentian violet
used in resistant VVC, soak tampon in dye and insert (1-2 applications per day up to five days), very messy
boric acid
used in resistant infections, used 1-2 times daily for 14 days, do not use in pregnancy
vagisil cream
can provide relief of itching, but use should be reserved for limited time
exclusions for atrophic vaginitis
- symptoms of severe vaginal dryness, severe dyspareunia, or bleeding
- symptoms that are not localized
- vaginal dryness or dyspareunia not relieved by use of personal lubricants
treatment of atrophic vaginitis
water-soluble vaginal lubricants
examples of lubricants
astroglide, KY jelly, replens
use of lubricants
regularly if symptoms primarily chronic, about 2 teaspoons externally and internally, do not use petroleum jelly products
primary dysmenorrhea:
age at onset
typically several years after menarche, often girls age 13-17
primary dysmenorrhea:
menses
regular with normal blood loss
primary dysmenorrhea:
pattern and duration of pain
onset just prior to onset of menses; lasts 2-3 days
primary dysmenorrhea:
response to NSAID
yes
primary dysmenorrhea:
other symptoms
fatigue, headache, nausea, backache, irritability
secondary dysmenorrhea:
age at onset
mid to late 20’s or older, usually patients in 30’s and 40’s
secondary dysmenorrhea:
menses
irregular and heavy
secondary dysmenorrhea:
pattern and duration of pain
varies; pain outside of menses
secondary dysmenorrhea:
response to NSAID
no
secondary dysmenorrhea:
other symptoms
varies, but may include dyspareunia and pelvic tenderness
exclusions for dysmenorrhea
- severe dysmenorrhea or menorrhagia
- symptoms inconsistent with primary dysmenorrhea
- history of PID, infertility, irregular menstrual cycles, endometriosis, ovarian cysts
- use of IUD
- allergy to aspirin or NSAIDs
- use of warfarin, heparin, or lithium
- active GI disease
- bleeding disorder
first line treatment for dysmenorrhea
NSAIDS
ibuprofen dosage for dysmenorrhea
200-400mg ever 4-6 hours
naproxen dosage for dysmenorrhea
220-440mg initially; then 220mg every 8-12 hours
other treatments for dysmenorrhea
aspirin, apap, omega-3 fatty acids, vitamin D
aspirin
effective for mild symptoms but may increase menstrual flow
APAP
effective for mild symptoms, even high doses of 4 grams are less effective than ibuprofen
omega-3 fatty acids
lead to decreased production of pro-inflammatory cytokines
vitamin D
600 IU daily decreases production of prostaglandins
non pharm treatment of dysmenorrhea
topical heat, sleep, regular exercise, and avoid tobacco smoke
exclusions for treatment of PMS
- severe PMS or PMDD
- uncertain pattern of symptoms
- onset of symptoms coincident with use of oral contraceptives or hormones
- contraindications in caffeine/pamabrom with theophylline, MAOI, PUD, insomnia, ammonium chloride
non pharm treatment of PMS
aerobic exercise, dietary modifications, and stress management
pharm treatment for PMS
pyridoxine, calcium + vitamin D, magnesium, NSAIDS, diuretics
pyridoxine
improved mood symptoms, limit dose to 100mg daily
calcium + vitamin D
improvement in mood and physical symptoms, may be initial treatment, calcium = 600 mg BID
magnesium
may improve irritability, 310-360 mg daily, may cause diarrhea
NSAIDs
help with physical symptoms
diuretics approved for
bloating, water retention, weight gain, swelling, and the feeling of fullness
approved diuretics
caffeine, pamabrom, and ammonium chloride
caffeine
considered safe and effective at doses of 100-200 mg every 3-4 hours
pamabrom
derivative of theophylline, most common agent in OTC medications, up to 50 mg four times daily
ammonium chloride
up to 3g/day in 3 idvided doses for no more than 6 days, contraindicated in renal or liver impairment