Women's health quiz 1

Copper IUD emergency contraceptive

Use within 5 days of unprotected sex

Most effective, provides ongoing contraception

Ulipristal acetate emergency contraceptive

Use asap within 5 days

More effective than LNG during days 3-5

• May be more effective in obese patients

Levonorgestrel (plan B) emergency contraceptive

Use asap within 5 days

Available without RX

Combined estrogen-progestin emergency contraceptive

Use within 5 days

Less effective, more nausea

What are progestrin-only pills best for?

• Can’t use estrogen

• Breast feeding

• Rapid reversibility

What is the mechanism of progestin-only pills

Thicken cervical mucus, suppress endometrium

What are the 2 types of progestrin-only pills

Norethindrone/norgestrel (missed dose at 3 hours), Drospirenone (missed at 24 hours)

How often is depot medroxyprogesterone acetate administered

Every 3 months injection

MOA of Depot medroxyprogesterone acetate

Suppress ovulation, thicken cervical mucus, produce endometrial atrophy

Major consideration of depot

Delayed return to ovulation after discontinuation, weight gain, reversible reduction in bone density

What is and how long does etonogestrel implant last

Progestin rod in upper rod, 5 years

MOA of etonogestrel implant

suppress ovulation, thicken cervical mucus

Types of IUD

Copper, levonorgestrel-releasing

Advantages of IUD

Reversible, rapid return to fertility after removal

How long does levonorgestrel (mirena) last

3-8 years

MOA of levonorgestrel iud

thickens cervical mucus, suppresses endometrium, impairs sperm transport and function, ovulation may continue in many cycles

Who should avoid levonorgestrel iud

Current breast cancer

MOA of copper iud

Local inflammatory response that impairs sperm motility and viability, preventing fertilization

Who should avoid copper IUD

Wilson’s disease/copper allergy

Considerations for Copper IUD

Menstrual bleeding and cramping may increase, most noticeable early in use

What are the contraindications of IUDs

Known pregnancy, cervicitis, G/C, malignancy, unexplained uterine bleeding

What 3 criteria need to be met for Lactational amenorrhea

1.) less than 6 months post-partum

2.) Amenorrheic

3.) Fully/near fully breast feeding

Broad ligament key function

Peritoneal fold that drapes over and supports the uterus, fallopian tubes, and ovaries

Not a true load-bearing ligament

Round ligament function

Helps maintain uterine anteversion

Cardinal ligament

Major support of cervix and upper vagina (CONTAINS UTERINE ARTERY)

Uterosacral ligament

Posterior support from cervix/uterus to sacrum

Important apical support structure

Ovarian ligament

Connects ovary to uterus

Anchors ovary medially

Suspensory ligament of ovary (infundibulopelvic ligament)

Suspends ovary from lateral pelvic wall

Contains ovarian artery, vein, lymphatics, and nerves

What are the 3 uterine wall layers

Endometrium, myometrium and perimetrium

What does the endometrium do

Inner hormone responsive lining (menstruation, implantation)

What does the myometrium do

Smooth muscle layer (labor contractions, dysmenorrhea)

What does the perimetrium do

Outer serosal layer (external covering)

Ovarian lymph node drain

Para-aortic

Vulva lymph node drainage

Superficial inguinal nodes

Pudendal nerve

s2-S4, perineal sensation and sphincter control

What is the location of the bartholin glands

Posterolateral vestibule (4 and 8 oclock)

What is the function of the bartholin glands

Mucus lubrication

What is the location of the skene glands

Paraurethral (near urethral opening)

Skene glands fxn

Urethral lubrication

Ectocervix epithelium

Stratified squamous epithelium

Endocervix epithelium

Columnar glandular epithelium

Transformation zone

Junction where squamous and columnar epithelium meet

Uterine blood supply

Uterine artery (branch of internal iliac artery)

Ovarian and fallopian tube blood supply

Ovarian artery (direct branch of abdominal aorta)

Vagina blood supply

Vaginal artery (internal iliac artery)

External genitalia and perineal blood supply

Internal pudendal artery

Painless unilateral posterior vestibular mass

Bartholin cyst

Painful tender fluctuant mass

Bartholin abscess

Itching, irritation, discharge

Vulvovaginitis

Burning/itching after irritant exposure

Contact dermatitis

Pruritis, thin white plaques

Lichen sclerosus

Persistent lesion, ulcer, mass, pruritis

Vulvar cancer

Cyclic pelvic pain, primary amenorrhea, bulging bluish hymen

Imperforate hymen