Well-Woman Assessment and care

Taking a sexual history

Explain purpose of interview

Direct eye contact unless culturally unacceptable

Ask-open ended questions

proceed from easier to more difficult topics

Clarify terminology

Use teachable moments to educate

Breasts

Skin changes

dimpling

symmetry

Scars

tenderness

Discharge

massess

characterisitcs of nipple/aerola

Mammography

ages 40-44:

• women should be offered to start annual mammograms if they wish

Age 45-54

• annual checks are recommended

Ages 55-74

• mammograms every 2 urs or annual mammograms if preferred

Ages 75+

• Discuss with healthcare provider

GI

External genitalia

perineum

vaginal mucosa

cervix

• inflammation, tenderness, discharge, bleeding, ulcers, nodules, masses

  • G

Speculum

allows visualization of cervix

allows collections of specimens

Pap Test

vaginal wall examination

Pap Test

screens for cervical cancer and other conditions by collecting and examining cells from the cervix

Cervical cancer

• a pap test can detect precancerous and cancerous cells in teh cervix

HPV

• Check for HPV

Other conditions

• Infections, infallmation, and other non-cancerous growths like polyps or cysts

Pap test 2

Women ages 21-29 should have a test every 2-3 years

Woman aged 30-65 years should have pap test and an HPV test every 5 years

no screening under <21 years

may stop cervical cancer screening after the age of 65 yrs if they meet specific requirements related to recent screening results

Colposcopy

provider uses a colposcope with a high-powered lens to look at the cervix and detect changes

Acetic acid often applied as it turns abnormal cells a white color

Biopsy collected when necessary

Coposcopies scheduled with abnormal pap, unexplained vaginal bleeding, cervical polyps

LEEP procedure

Uses a thin, heated wire loop to remove abnormal tissue or cells from the cervix

Performed to diagnose cervical dysplasia

• often after abnormal findings from colp

Can weaken cervix, increasing risk for preterm birth in future pregnancies

Menopause

absence of menstraution x 12 months

age of onset influenced by

• overall health

• weight and nutiriton

• lifestyle and culture

• genetics

Per-menopause changes

years leading up to menopause

• reproductive system changes

• thinning, dryness of vaginal mucosa

• vaginal PH rises

• pubic hair turns grey

• labia shrink, lose pigment

• pelvic fascia, muscles atrophy

• breasts loose denisty

• sexual function declines

• hot flashses

• periods are irregular

Peri-menopause pt 2

changes in reproductive system

anovulation

irregular menstration, amenorrhea

FSH levels rise

Estrogen decreases

Endometirum thins, myometrium, fallopian tubes and ovaries atrophy

Osteoporosis

Prevention is primary goal

height at every visit

bone mineral density

DEXA scan

Recommended

• all postmenupausal women >65

• postmenopausal women with fractures

• postmenopausal women <65 with at least one risk factor

Osteoporosis prevention and treatment

adequate calcium intake

vitamin D supplement

Estrogen replacement

Treatment

• hormone replacement therapy

• estrogen

• progesterone

• bisphosphonates

• selective estrogen

• calcitonin

Amenorrhea

the abesence of a menstrual flow

Primary Amenorrhea

absence of both menarche and secondary sexual characterisitcs by age 13 yrs

absence of menses by age 16 in the presence of normal growth and secondary sex characterisitcs

can be genetic or hormonal

Secondary ammenorrha

Absence of menstrual periods for three or more months in women who previously had regular cycles

can be hormonal, thyroid, severe weightt loss/malnutrition, excessive exercise, medication use, uterine abnormailites, chronic stress

Dysmenorrhea

pain during or shortly before menstration

symptoms last hours to days

differentiate as

Primary: normal natural response

Secondary: response to an underlying condition

primary Dysmenorrhea

associated with the ovulatory cycles

prostaglandin release

pain usually begins at the onset of menstration and lasts 8-48 hrs

decreases with age

treatment

• heat

• back massage

• NSAIDS

• oral contraceptives

Secondary Dysmenorrhea

Diagnosis

• pelvic exam

• ultrasound

• d and c dilation

• endometrial biopsy

• laparscopy

premenstrual syndrome

complex, poorly understood

symptoms during luteal phase

fluid retention

emotional behavior changes

breast tenderness

premenstrual cravings

headache

fatigue

Premenstrual dysphoric disorder

more severe variant of PMS

symptoms present one week before period

interfere with ability to work/personal relationships

NSAIDS: Prostiglandin inhibitors

• decrease prostiglandin, decrease cramps

Managment of PMS and PMDD

detailed history

daily log of symptoms/mood

education

diet and exercise

avoid caffeine, alcohol, smoking, red meat, salt,sugar

counseling

Endometriosis

presence and growht of endometrial tissue outside of the uterus

Tissue grows during proliferative and secretory phase

• can be influenced by hormones

• suppress estrogen

Bleeds after menstruation= inflammation

Endometriosis symptoms

pelvic pain

dysmenorrhea that is severe

chronic non-cyclic pain

dyspareunia (painful intercouse)

diarrhea/constipation

pain with exercise

Endometriosis treatment

medical

• suppress estrogen production

  • GnRH agonist

  • danazol

  • combined COCs

surgical

• laparoscopy

• total abdominal hysterectomy

Oligomenorrhea

infrequent menstruation

Hypomenorrhea

scant blood byt normal intervals

menorrhagiea

excessive bleeding

metrorrhagia

bleeding between periods

dysfunctional uterine bleeding

bleeding without a cause

Abnormal uterine bleeding

without a cuase

Uterine leiomyomas

fibriods

common cause of menorrhagia

benign tumors of smooth muscle of uterus

can interfere with reproduction

myomectomy

• cut through uterus to remove firbiod, higher risk of uterine rupture, high survillence, delievery at 37 weeks