NUA 7710: Women's Health Week 5

What type of inheritance pattern is associated with BRCA mutations?

Autosomal Dominant

Name some cancer risks associated with BRCA mutations.

Premenopausal epithelial ovarian cancer, Fallopian tube cancer, Primary peritoneal cancer, Breast cancer at age <50, Breast cancer in males

What are some ways to modify the risk of cancer in individuals with BRCA mutations?

Bilateral salpingo-oophorectomy, oral contraceptive use, age <30 at first live birth, breastfeeding, tubal ligation

benign condition of the breast

fibroid adenoma

What is a fibroid adenoma?

A benign mass of the breast that is estrogen-stimulated, firm, rubbery, and mobile.

What are the characteristics of a fibroid adenoma?

Smooth, macrolobulated, usually homogenous, hypoechoic, wider than tall.

What is a Skene duct cyst?

A benign, fluid-filled sac that develops near the urethra.

Where are Skene's duct cysts located?

Anterior and lateral in location, along the labia minora.

What can cause pain in Skene duct cysts?

Either tense tissue or infection due to occlusion of Skene's gland.

What are vaginal septa?

Transverse septa within the vagina.

How do vaginal septa typically present in adolescents?

As amenorrhea or dysmenorrhea post menarche.

What are the symptoms associated with vaginal septa?

Low abdominal pain, vaginal pain, cramping without blood loss.

What is the typical location of Gartner's cyst in males?

Epididymis

Where are Gartner's cysts usually found in women?

Lateral vagina usually proximal ⅔'s

How do Gartner's cysts appear in terms of size?

Usually 1 to 3 cm in diameter

What is the characteristic appearance of some Gartner's cysts?

Membranous or palpable as soft, subtle distortions through an otherwise normal appearing vaginal mucosa

What is the significance of T-scores in osteoporosis diagnosis?

T-scores help classify bone density as normal, osteopenia, osteoporosis, or severe osteoporosis based on specific values.

What are the recommended screening criteria for DEXA scans?

Screening is recommended for females aged 65 and older, younger females with osteoporosis risks, individuals with fractures after age 50, and those with medical conditions or medications linked to bone loss.

What are the key laboratory tests recommended for osteoporosis evaluation?

CBC, albumin, calcium (adjusted for albumin), renal function tests, phosphorus, magnesium, liver function tests, 25 (OH)-vitamin D, and parathyroid hormone (PTH) are initial tests, with additional tests as needed.

How does the FRAX tool assist in osteoporosis management?

The FRAX tool considers 11 risk factors to help decide on medication therapy initiation, especially for individuals with osteopenia.

What are the lifestyle recommendations for managing osteoporosis?

Recommendations include calcium intake (1000-1300 mg/day for women), vitamin D supplementation (800-1000 IU/day), exercise, smoking cessation, and fall prevention strategies.

What is lochia and how long does it last postpartum?

Lochia changes color in the first few weeks postpartum; active bleeding stops in the first week but a white discharge may continue for up to 6 weeks after delivery.

When may ovulation start after delivery and what precautions should be taken?

Ovulation may start as soon as 3 weeks after delivery. The client needs to be aware and use a form of birth control. Clearance by the provider is required prior to intercourse after a vaginal delivery.

What is involution in the context of postpartum recovery?

Involution is the process of the return to nonpregnancy size and function of reproductive organs. The uterine fundus typically regresses at a rate of one fingerbreadth a day.

How can engorgement be managed postpartum?

Suggest the client feed the baby every two or three hours to help reduce and prevent further engorgement. Cold compresses can be applied to the breasts to reduce engorgement for non-breastfeeding clients.

What is the treatment for candidal infection on the nipples postpartum?

The treatment involves applying an antifungal cream to the nipples following feedings and providing the infant with oral nystatin.

How can nipple pain be managed postpartum?

Suggest drying the nipples following feedings to help manage nipple pain.

What happens to stretch marks postpartum?

Stretch marks gradually fade to silvery lines but do not disappear completely.

How does darkened pigmentation on the abdomen, face, and nipples change postpartum?

Darkened pigmentation gradually fades as estrogen and progesterone levels decrease.

Abnormal uterine bleeding

bleeding between menses; includes infrequent, excessive, prolonged, or postmenopausal bleeding

Diagnostics for AUB

•Diagnostic testing

•Ultrasonography and MRI

•Biopsy and dilation and curettage (D&C)

•Hysteroscopy

Causes of amennorhea

•Hypothalamic disorders

•Pituitary disorders

•Ovarian disorders

•Polycystic ovary syndrome

•Uterine causes

•Hidden menstruation

Diagnostic studies for amenorrhea

•Serum prolactin

•Thyroid stimulating hormone (TSH)

•Follicle stimulating hormone (FSH)

•Progestational challenge test

•Step two and three...appropriate referral

PMS (premenstrual syndrome)

Nervous tension, mood swings, headaches, bloating, irritability prior to menstruation

PMDD (premenstrual dysphoric disorder)

Group of symptoms similar to but more severe than PMS, including severe mood disturbances. Must be diagnosed by a psychiatrist.

What are the first-line treatments for PMDD?

Selective serotonin reuptake inhibitors (SSRIs) and hormonal treatments such as combined oral contraceptives

What are the treatment options for severe cases of PMDD?

Ovulation suppression with GnRH agonists or surgical options

How is PMS managed?

Treatment may involve lifestyle modifications, dietary supplements (e.g., calcium, vitamin B6), and pharmacologic options such as SSRIs or combined oral contraceptives, but the approach is generally less aggressive than for PMDD

COEIN: nonstructural causes

Coagulopathy (AUB-C)

Ovulatory dysfunction (AUB-O)

Endometrial (AUB-E)

Iatrogenic (AUB-I)

Not yet classified (AUB-N)

What are the common symptoms of PCOS?

Weight gain, insulin resistance, facial hair, obesity

What hormonal imbalance is typically seen in PCOS?

High LH/FSH ratio in blood

What physical characteristics are associated with PCOS?

Enlarged ovaries with small cysts on the outer edges

What population is PCOS most common in?

Young women (teens to twenties)

What type of gland is the breast classified as?

An enlarged, modified sweat gland.

What is the Tail of Spence?

The tail of the breast that extends into the armpit.

What are Montgomery tubercles?

Sebaceous glands on the surface of the areola that help lubricate the nipple during lactation.

How many lobes are typically found in a breast?

12-18 lobes.

What hormonal changes stimulate breast development at puberty?

Estrogen stimulates growth.

What is Tanner Stage 1 of breast development?

Elevation of the nipple with no palpable tissue or pigmentation of the areola.

What occurs in Tanner Stage 2 of breast development?

Glandular tissue under the areola and nipple; the breast projects as a single mound.

What is the significance of Tanner Stage 5?

The breast assumes a smooth contour with no projection of the areola.

When do breasts typically finish developing?

After the first pregnancy.

What is the optimal time for self-breast examination in the menstrual cycle?

Days 3-10 after menses.

What is the recommended frequency for clinical breast examinations (CBE) for women aged 20-39?

Every 3 years.

What percentage of masses are detected during a clinical breast examination?

3-45% of masses missed by mammography.

What is the gold standard for breast cancer screening?

Mammogram.

What does a Birads score of 0 indicate?

Negative findings.

What is the purpose of a biopsy in breast assessment?

To sample tissue for diagnosis of a suspicious mass.

What is a fine needle aspiration (FNA)?

A procedure to aspirate the contents of a mass.

What is the role of MRI in breast imaging?

Adjunct to standard breast imaging; may help rule out multifocal disease.

What factors may indicate the need for MRI screening?

BRCA1/2 mutation, high lifetime risk of breast cancer, or indeterminate findings after conventional workup.

What is a common issue with mammograms in dense breast tissue?

Higher false positive rates.

What should be documented during a breast examination?

Current mammogram results and details of the breast exam.

What is the impact of hormone replacement therapy (HRT) on postmenopausal breasts?

It influences the regression of stromal and epithelial tissue, replaced by adipose tissue.

What is the purpose of a surgical biopsy?

To remove a larger portion of a mass for diagnosis, not for cancer treatment.

What is premature thelarche?

Abnormal breast development occurring before the typical age.

What condition is characterized by the congenital absence of breast tissue?

Amastia

What is gigantomastia?

Overgrowth of breast tissue.

What is polythelia?

Accessory nipple tissue that can occur anywhere along the milk line.

What is the primary goal of elective breast surgery?

To either reduce or augment the size of breast tissue.

What is mastopexy?

A breast lift procedure used to improve breast position.

What are common treatments for breast pain (mastalgia)?

Ice, heat, NSAIDs, and supportive bras.

What is mastitis?

An infection of the breast tissue, commonly occurring in lactating women.

What is galactorrhea?

Lactation in a non-lactating woman, often requiring prolactin level testing.

What is the most common cause of bloody nipple discharge?

Intraductal papilloma, which is a benign condition.

What are the risk factors for breast cancer?

Being female, age, family history, reproductive factors, and obesity.

What is the Gail model used for?

Breast cancer risk assessment.

What lifestyle changes can help reduce breast cancer risk?

Reducing alcohol intake, increasing exercise, and losing excess weight.

What is the average age of menopause?

51 years old, with a range of 41-55 years.

What is perimenopause?

The stage encompassing 2-10 years before the final menstruation period.

What physiological changes occur during menopause?

Decline in follicle production, estrogen, and progesterone, leading to the cessation of menstruation.

What is the significance of HPV in relation to non-neoplastic changes?

HPV dysplasia can cause non-neoplastic changes in the cervix, vagina, and vulva.

What is the function of the Bartholian's gland?

To provide lubrication to the vaginal opening.

What is the clinical management process for vaginal health?

Determine etiology, perform clinical assessment, and execute a management plan.

What are the common types of benign breast masses?

Fibroadenomas, cysts, lipomas, and papillomas.

What is the recommended follow-up for women over 30 after breast surgery?

A pre-op mammogram and follow-up mammogram 6 months post-surgery.

What is the role of vaccination in cervical health?

Vaccination is crucial for the prevention of HPV-related dysplasia.

What is the importance of a thorough examination in cases of nipple discharge?

To determine if the discharge is spontaneous or induced and assess for malignancy.

What is the duration of postmenopause?

The period of 5 years following menopause.

What are some health risks associated with postmenopause?

Increased risk for heart disease, bone loss, diabetes, obesity, and various types of cancer.

What hormonal changes occur during postmenopause?

Decline in estrogen and progesterone levels, leaving their receptors unbound.

What are common symptoms of postmenopause?

Vaginal dryness, hot flashes, mood changes, sleep problems, and cognitive issues.

What is the role of testosterone in postmenopause?

Production of testosterone continues even after menopause.

How does smoking affect the timing of menopause?

Smoking can lead to an earlier onset of menopause by about 1.5 years.

What is Genitourinary Syndrome of Menopause (GSM)?

A decrease in estrogen resulting in vulvovaginal atrophy, leading to vaginal dryness and urinary issues.

What factors can influence the timing of menopause?

Genetics, ethnicity, obesity, fibroids, and lifestyle factors such as exercise and smoking.

What are the common psychological effects of postmenopause?

Mood changes, irritability, and cognitive difficulties.

What dietary changes can help manage postmenopausal symptoms?

Avoiding caffeine, sugar, alcohol, and spicy foods, and increasing water intake.

What is the significance of FSH levels in postmenopause?

High FSH levels indicate elevated testosterone levels and hormonal changes.

What are some self-management strategies for postmenopausal women?

Regular exercise, dietary changes, stress management techniques, and environmental adjustments.