GU Exam 2 (women's health)

How long is a women’s menstrual cycle?

on average 28 days but can vary

T/F A woman can get pregnant on any day of her monthly cycle

False

When in a cycle is a woman fertile?

the days leading up to ovulation and the day of ovulation itself

During a woman’s fertile window, how long can sperm survive in a women’s body after sex?

up to 5 days

How long does a women’s egg survive after she has ovulated?

24 hrs

How is it possible for sex before ovulation to lead to pregnancy?

because sperm can survive for several days in the woman’s body

Which hormones does Clearblue Advanced Digital Ovulation Test detect?

estrogen and luteinizing hormone (LH)

Typically how many fertile days does the Clearblue Advanced Digital Ovulation test identify each cycle?

4 or more

How many ovulation tests can typically identify 4 or more fertile days each cycle?

ONLY Clearblue Advanced Digital Ovulation Test

What is the average menstrual cycle length?

28 days

What is the mean age of menarche?

12 years

How long does menstruation occur?

on average 5 ± 2 days

In which phase of the menstrual cycle does estrogen and progesterone decrease and FSH increases?

follicular phase

What happens during the follicular phase of the menstrual cycle?

lining of uterus sheds, estrogen and progesterone decrease, FSH increases

In which phase of the menstrual cycle does LH & FSH surge, estrogen decreases and progesterone increases?

ovulatory phase

What happens during the ovulatory phase of the menstrual cycle?

Egg release; surge in LH and FSH; decrease in estrogen; increase in progesterone

In which phase of the menstrual cycle does LH and FSH decrease and progesterone increases?

luteal phase

What happens during the luteal phase of the menstrual cycle?

estrogen and progesterone cause thickening of urterine wall to prepare for possible fertilization; LH and FSH are decreased

Where does fertilization occur?

fallopian tube

How long after ovulation can hCG be detected?

8-9 days

Where does implantation occur?

uterine cavity

How long does pregnancy last?

280 days, 40 wks or 9 months

How is pregnancy measured?

time period from first day of last menstrual period to birth

What produces gonadotropin-releasing hormone (GnRH)?

hypothalamus

What hormone acts on the pituitary to make gonadotropins?

GnRH

What hormones are considered gonadotropins in women?

FSH and LH

What is the effect of LH in menstrual cycle?

stimulates ovulation

What is the effect of FSH in menstrual cycle?

stimulates egg development and release of estrogen

What hormone signals the hypothalamus to stop producing GnRH?

estradiol

Which hormone signals the pituitary to stop producing LH?

progesterone

What is the major metabolite of progesterone in the urine and presence of it in urine confirms ovulation?

pregnanediol 3 glucuronide (PdG)

What is the hormone that all ovulation kits measure?

LH

What is the hormone produced in placental cells during pregnancy?

human chorionic gonadotropin (hCG)

When in pregnancy does the placenta begin to produce its own steroid hormones?

20 wks gestation

When is hCG detectable in urine after conception?

11-14 days

When does hCG peak in pregnancy?

8-11 weeks

How long will hCG remain elevated following a pregnancy loss?

4-6 weeks

What are some patient counseling points for taking a urine pregnancy test at home?

use 1st morning urine and don’t drink before hand, follow instructions on test and if negative and NO menstruation occurs repeat in a few days; if positive seek medical care

Pregnancy test: Qualitative =

OTC measures whether hCG is present

pregnancy test: Quantitative =

lab-based measures how much hCG is present

What value of hCG in lab-based pregnancy test = definitive pregnancy

>25 mIU/mL

test’s ability to designate an individual with a disease as positive (true positive) =

sensitivity

a test’s ability to designate an individual who does not have a disease as negative (true negative) =

specificity

Dysmenorrhea =

painful menses

secondary dysmenorrhea is due to _____ and are NOT candidates for self treatment

pelvic pathology

Which patient population has the highest prevalence of dysmenorrhea?

adolescents

When does dysmenorrhea develop?

within 6-12 months of menarche

Dysmenorrhea ONLY occurs during ______ cycles

ovulatory

What are some risk factors for dysmenorrhea?

early menarche (<12), longer cycles, heavy flow, nulliparity, <30 yr

What are some non-pharm options for dysmenorrhea?

heating pad, regular exercise, dietary changes

What is the pharmacology target in dysmenorrhea?

NSAIDs

How often is OTC ibuprofen dosed?

every 4 hrs

What is the max dose of OTC naproxen?

3 tablets (2 tablets at onset and 1 every 12 hrs)

When to start OTC NSAIDs for dysmenorrhea?

at symptom onset, NO benefit to take prophylactically

How often should NSAIDs be taken for dysmenorrhea?

take as scheduled, NOT PRN for 1st 48-72 hrs of menses

What are some exclusions to self-care for Dysmenorrhea?

hx of PID, infertility, irregular menstrual cycles, endometriosis, ovarian cysts, use of IUD

benign, muscular tumors that grow on the uterine wall cause swelling in the abdomen

fibroids

endometrium grows outside of the uterus (ovaries, fallopian tubes, and pelvic tissue)

endometriosis

affective and somatic symptoms during the luteal phase of the menstrual cycle

premenstrual syndrome (PMS)

more severe PMS symptoms =

premenstrual dysmorphic disorder (PMDD)

What are some potential causes of PMS and PMDD?

cyclic changes in estrogen & progesterone, alternation of RAAS system

What are some affective symptoms in PMS and PMDD?

angry outbursts, anxiety, depression, difficulty concentrating, confusion, irritability

What are some somatic symptoms in PMS & PMDD?

abdominal bloating, breast swelling/tenderness, headache, muscle/joint pain, swelling of extremities, weight gain, constipation or diarrhea

What is involved in the diagnosis of PMS?

At least one psychological symptom and one physical symptom

What is involved in the diagnosis of PMDD?

at least 5 symptoms and one must be affective lability, irritability, depression, or anxiety

What are some exclusions for self-treatment for PMS/PMDD?

severe symptoms, timing unrelated to menstrual cycle, symptoms related to CHC/HT, CI to OTC meds

What are some non-pharm options for PMS/PMDD?

exercise; avoiding caffeine, salt, sugar; adequate sleep; stress relief; smoking cessation

What are a few vitamins/supplements that may be useful in PMS/PMDD?

calcium carbonate, magnesium, vitamin B6, St. John’s Wort, evening primrose oil, Gingko biloba

When should NSAIDs be taken for OTC tx of PMS/PMDD?

take one week prior to and during 1st several days of menses

Which xanthine diuretics are useful as OTC tx of PMS/PMDD?

pamabrom and caffeine

When to take OTC pamabrom for PMS/PMDD?

5-6 days before menses

What are the components of Midol Complete?

acetaminophen, caffeine, pyrilamine maleate

What are the components of Midol Long Lasting Relief?

acetaminophen 650 mg

What are the components of Pamprin Multi-System (blue box)?

acetaminophen, pamabrom, pyrilamine maleate

What are the components of PamprinMax Pain & Energy (Pink Box)?

acetaminophen, aspirin, caffeine

What are the 1st line prescription medications for PMS/PMDD?

SSRIs and SNRIs

What is the brand name for fluoxetine FDA approved for PMDD?

Sarafem

What SNRI is used in PMS/PMDD?

venlafaxine

How are SSRIs and SNRIs dosed for PMS/PMDD?

dosed continuously or in the luteal phase (starting daily dose 14 days prior to menstruation through to first full day of menses and repeat with each new cycle)

Which serotenergic agent is NOT effective in PMS/PMDD?

bupropion

What is the drug class of Leuprolide?

GnRH agonists

What are the benefits of using leuprolide in PMS/PMDD?

improves emotional symptoms and bloating/breast tenderness

What is the last line agent used in PMS/PMDD?

leuprolide

What are the disadvantges of leuprolide in PMS/PMDD?

monthly IM injection, hypoestrogen effects and expensive

What are the types of CHC used to suppress ovulation in PMS/PMDD?

monophasic oral, continuous cycle, monophasic & triphasic

Which oral CHC is FDA approved for PMDD?

20 mcg EE + 3 mg drospirenone

Which CHC improves PMDD symptoms?

90 mcg levonorgestrol + 20 mcg EE

Which CHC reduces physical symptoms in PMS?

monophasic and triphasic CHC