Women's Health

Front 1

Estrogen

(Synthesis, Therapeutic uses(2), benefits(3), and adverse effects(5))

Back 1

1. Produced by developing follicles in the ovaries, corpus luteum, and placenta.

2. Contraception and HRT

3. Decrease risk of osteoporosis, maintain urinary tract health, and decrease LDLs.

4. CV: Thromboembolism, GI: nausea, GYN: increase risk of endometrial cancer when used alone, Breast Cancer: increased risk when combined with progesterone, Teratogenic: cause uterine/vaginal cancer in female infants

Front 2

Progesterone

(Synthesis, Therapeutic uses (5) and adverse effects(3)

Back 2

1. Produced by ovaries and placenta to help maintain pregnancy.

2. Contraception, HRT, DUB, amenorrhea, palliative for endometrial cancer

3. GYN: Break through bleeding and sore breasts, Breast Cancer: increased risk when taken with estrogen, Teratogenic: cause birth defects if taken in high doses during first four weeks of pregnancy

Front 3

Menopause related therapies

(Approved indications for HRT(3) and 4 types)

Back 3

Use only if needed in the lowest effective dose for the shortest time necessary!!!

Indications:

1. Moderate to severe vasomotor symptoms

2. Vulvar/vaginal atrophy

3. Prevention of postmenopausal osteoporosis

Types:

1. Estrogen only: only if post hysterectomy

2. Estrogen progesterone combo therapy: if uterus still intact

3. Topical vaginal estrogen: helps with vaginal atrophy and UTI prevention

4. Alternative/ non-hormonal therapies: hot flash journal, other drugs, diet and exercise

Front 4

Menopause

(Definition, age of onset, s/sx-6)

Back 4

1. Cessation of menses. Ovaries stop producing estrogen and progesterone.

2. Usually occurs between 45 and 55, with 52 being the most common age of last period in the US.

3. Signs and symptoms include: hot flashes(vasomotor symptoms), loss of libido, tiredness, vaginal dryness and atrophy, mood swings, and irregular bleeding.

Front 5

Conjugated Estrogen only HRT

ET- Premarin

Back 5

1. Only if s/p hysterectomy due to increase in chance of endometrial cancer

2. Important to bone, vagina, and bladder health

3. Helps alleviate hot flashes and vaginal atrophy

4. PO, IM, patch, topical cream

5. Produced from pregnant mares urine.

Front 6

Combined estrogen and Progesterone HRT

EPT- Prempro

Back 6

1. Only use if pt. still has uterus.

2. Counteracts the adverse affects that estrogen only treatment has on the endometrium, but possible increased risk of breast cancer and cardiovascular disease, doesn't decrease risk of MI. Breakthrough bleeding may occur. Most common complaint breast discomfort.

3. Helps with vasomotor symptoms and vaginal lubrication, decreases chance of colon cancer, hip fractures and UTIs.

4. Usually PO

Front 7

Transdermal Patches

Back 7

1. Follow directions on package!

2. Do not apply a patch to the same area within a week, avoid places it may be rubbed off, avoid areas that are dry, cracked, open, oily, or (sometimes) exposed to sunlight.

3. If a patch falls off and cannot be reapplied, apply a new patch to a different area and then replace that patch when next change is scheduled

Front 8

Alternative therapies

Back 8

1. Medications- SSRIs(fluoxetine, paroxetine), Gabapenton (Neurontin), Clonidine

2. Keep a hot flash journal and avoid triggers

3. Diet ( avoid/limit caffeine, alcohol, sugar, salt), exercise, and sleep

Front 9

Contraceptives

(Most common? Most effective?)

Back 9

1. Sterilization is the most common birth control method for both men and women.

2. Most effective are sterilization, depo, and IUDs. Second patches and oral(when used properly.

Front 10

2 types of oral contraceptives

Back 10

1. Progestin only

2. Combined oral contraceptives- estrogen and progestin

Front 11

Combined Oral Contraceptive(COCs)

(Effectiveness, Adverse effects, Contraindications)

Back 11

21 hormone days and 7 inactive days

1. 99.7% effective when used properly in woman of normal weight. 92% effective (less effective) in obese women when used properly.

2. Less than the risk of getting pregnant- common side effects are H/A, N/V, and thromboembolism

3. Smokers (especially those >35 y.o.), breastfeeding mothers, hx of CV disease, hx of blood clots, pregnancy, breast cancer, abnormal vaginal bleeding.

Front 12

COC risks-6

Back 12

1. 58% of first cycles after d/c COC are ovulatory. Penicillin decreases effectiveness- use additional contraception for remainder of cycle.

2. Risk of thromboembolism-- Increased with smoking, obesity, and family hx. Discontinue use 4 weeks prior to any type of surgery!

3. Gallbladder disease and stones

4. Myocardial infarction/ Stroke-- Factor V. Leiden mutation has increase risk

5.Migraines (hormone shift- also can treat them)

6. Breast Cancer (maybe)

7. Bone Health (users under 18 may gain less BMD)

Front 13

Progestin only contraceptives (POCs)

(Effectiveness, recommended population, adverse reactions, contraindications)

Back 13

28 day hormone cycles

1. Effectiveness depends--don't always suppress ovulation, but thicken cervical mucous and alter endometrium. Ectopic pregnancies occur in 6 to 10% of users.

2. Older women, smokers, breastfeeding mothers, other medical problems.

3. Free of estrogen’s side effects (clotting,h/a, n/v). Irregular periods, breakthrough bleeding (spotting) common.

4. Pregnancy

Front 14

Missed Doses?

Back 14

1. What type of oc?

2a. COC

1 missed- take asap, 2 missed- take 2 a day for 2 days, 3 missed- restart cycle after 7 days and use barrier for at least 2 weeks

2b. POC

1missed- take asap, 2 missed- take 2nd asap and discard extra, 3 missed- stop taking and restart with next menses

Front 15

Transdermal contraception

Back 15

1. Decreased efficiency in women over 90 kg

2. Similar effects/ side effects as OCs

3. Higher estrogen levels

Front 16

Vaginal ring

Back 16

1. Reliable removal bleeding

2. If removed for more than 3 hours chances of contraception are high- barrier method needed for 7 days

3. 99% effective

Front 17

Mirena (Levonorgestrol)

Back 17

1. Hormonal IUD

2. Little to no bleeding often no periods and just spotting

3. Highly effective- spermicidal, thickens cervical mucus, thins endometrium

4. Good for 5 years

Front 18

Para-guard or copper T

Back 18

1. Highly effective and safe

2. Good for 10 years

3. Heavier than normal periods

4. Prevents implantation

Front 19

Adverse effect and Contraindications of IUDs

Back 19

1. PID- if a woman does not use barrier protection and has multiple partners

2. Pregnancy

3. Bleeding common in first three months

4. Expulsion common in first year 2-10%

Front 20

Depo-Provera (Depot medroxyprogesterone acetate)

Back 20

1. IM or deep SQ shot every 12 weeks (3 months). If a dose is missed give pregnancy test, ensure use of barrier protection for 2 weeks, repeat HCG test and then administer only if both preg. tests were negative.

2. Slightly less effective in heavier women.

3. Causes reversible decrease in BMD for first couple years.

4. Irregular bleeding, headaches, and weight gain.

Front 21

Emergency contraception

Back 21

1. Yuzpe: take a bunch of OCs, look up on internet first, nausea, cramping, must be done within 72 hours, sooner the better.

2. Plan B: high levels of progestin(only), less nausea, behind the counter, will not terminate existing pregnancy, must be done within 72 hours, sooer the better.

3. IUD: implant within 5 days!