Unit 2 - Preconception & Conception

What is women’s health?

The branch of medicine focused on the diagnosis and treatment of diseases and conditions that affect a woman’s physical and emotional well-being

What age range falls under the women’s health definition?

Adolescence through older age

What issues are important for women’s health in adolescence?

• Menarche

• HPV

• Vaccination

• Establishing Preventative Care Habits Early

What issues are important for women’s health in reproductive years?

• Menstrual Health

• Contraception

• Pregnancy

• Fertility Care Needs

What issues are important for women’s health during their midlife or older years?

• Menopause

  • Hot Flashes

  • Bone Loss

  • Rising Cardiovascular Risk

What is the average age of onset for menopause?

51

OB/Gyn physicians focus on what area of women’s health?

Pregnancy and reproductive care

Perinatologists focus on what area of women’s health?

High-risk pregnancy care

Nurse midwives focus on what area of women’s health?

Labor, delivery, and postpartum

Urogynecologists focus on what area of women’s health?

Pelvic floor and bladder disorders

Which healthcare providers focus on breast, cervical, and uterine cancers?

Specialized radiologists and oncologists

What are other healthcare providers involved in women’s health?

• Specialized general surgeons

• PAs

• PCPs

• NPs

• And others

What are examples of preventative care and screening used in women’s health?

• Pelvic and Breast Exams

• Pap Smear and HPV Testing

• STI Screening

• Age-Appropriate Immunizations

• Breast Cancer Screening → Mammogram

• Bone Density Testing

What can be impacted during times of hormonal transitions for women?

Mood and mental health

When are mood and mental health most often impacted by changes in hormones for women?

• Puberty

• Postpartum

• Perimenopause

How many women report symptoms of postpartum depression according to the CDC?

1 in 8 women

What is an example of a mood disorder affecting women that is widely under diagnosed and under treated?

Perinatal mood disorders → mood disorders during pregnancy and immediately after

What are women diagnosed with at roughly twice the rate of men?

Depression and anxiety

How many women experience either physical violence, sexual violence, or stalking by an intimate partner in their lifetime?

1 in 4 women

What kind of screening is a standard part of women’s health and prenatal visits?

Intimate Partner Violence (IPV)

What is associated with IPV?

Worse pregnancy outcomes → including preterm birth and low birthweight

What is reproductive coercion?

interfering with contraception and pregnancy decisions

Is reproductive coercion a recognized form of abuse?

Yes, it is

What are autoimmune diseases?

When the immune system attacks the body’s own tissue

What population is disproportionately affected by autoimmune diseases?

Women

What percentage of people diagnosed with an autoimmune disease are women?

80%

What are examples of autoimmune diseases that disproportionately affect women?

• Multiple Sclerosis → ~2-3x more common in women

• Lupus → ~9x more common in women

• Hashimoto’s Thyroidits

What are current social determinants affecting women’s health?

• Research underfunding

• Access barriers

• Life spent in poor health

• History of exclusion

What percentage of global research and development funding goes to women’s health?

Only 5% → with only 1% going to conditions beyond cancer

What are examples of things that can cause access barriers in women’s health?

• Insurance gaps

• Rural healthcare deserts

• Limited specialist access

Women spend what percentage more of their life in poor health or disability than men?

25%, even though women live longer on average

What is the history of exclusion for women discussing?

A lack of women of childbearing age in drug trials pre-1993, when a law required inclusionW

What is endometriosis?

Endometrium-like tissue that grows outside of the uterus, causing the chronic inflammation and scar tissue

Where does endometriosis often occur?

Growths often occur in the pelvic region, but can appear elsewhere in the body

How many women are affected by endometriosis?

10% of reproductive age women (~190 million people)

How is endometriosis diagnosed?

Potentially through ultrasound, MRI, or laparoscopic surgery

What is the average time needed to be diagnosed with endometriosis?

4-12 years

What are symptoms of endometriosis?

• Severe pain during menstruation

• Heavy menstrual bleeding

• Chronic pelvic pain

• Infertility

• Abdominal bloating and nausea

What are treatment options for endometriosis?

• NSAIDs for pain relief

• Hormonal therapies (contraceptives, GnRH analogues)

• Surgery to remove lesions or scar tissue

• Physiotherapy and cognitive behavioral therapy

What is the broader impact of endometriosis?

• 25-30% of women with infertility have endometriosis

• Lost income from missed work or school

• Worsened by stigma that normalizes period pain

• Diagnosis and treatment access limited in LMICs

What is PCOS/PMOS?

A hormonal disorder in which higher-than-normal androgen levels disrupt ovulation, leading to irregular periods, potential infertility, and other symptoms

Does PCOS/PMOS persist beyond reproductive years?

Yes, it is a chronic metabolic condition that persists

What percentage of women are diagnosed globally with PCOS/PMOS?

~10-13% → but up to 70% of affected women remain undiagnosed

What are symptoms of PCOS/PMOS?

• Irregular periods

• Abnormal hair growth

• Acne

• Obesity

• Patches of dark skin

• Cysts

• Skin tags

• Thinning hair

What are the main causes of PCOS/PMOS?

• Higher level of androgens

• Insulin resistance

• Low-grade inflammation

What treatments exist for PCOS/PMOS?

• Lifestyle changes (diet, physical activity)

• Combined oral contraceptives

• Medicines to include ovulation

• IVF for fertility when needed

What are the long-term health risks associated with PCOS/PMOS?

• Type 2 diabetes and insulin resistance

• Cardiovascular diseases and hypertension

• Endometrial hyperplasia or cancer

• Anxiety, depression, and body image concerns

What is the core mechanism of endometriosis?

Ectopic endometrial tissue and inflammation

What is the core mechanism of PCOS/PMOS?

Excess androgens and anovulation

What is the hallmark symptom of endometriosis?

Pelvic Pain

What is the hallmark symptom for PCOS/PMOS?

Irregular cycles

What are shared themes between endometriosis and PCOS/PMOS?

• Global access gaps → diagnosis and treatment is limited in low- to middle-income countries

• Normalized pain → Period pain and irregular cycles are often dismissed, delaying care-seeking and diagnosis

• Structural inequities → SDOH and structural racism shape who receives timely, quality care

• Mental health burden → both conditions are linked to anxiety, depression, and reduced quality of life

Where do eggs mature?

In an ovary

What path does an egg follow when released during ovulaion?

It is released from the ovary and then traveling through the fallopian tube towards the utuerus

Why does the lining of the uterus thicken?

To potentially support a pregnancy

What is the average length of the menstrual cycle?

21 to 35 days

What are the four phases of menstruation?

• Menstrual Phase

• Follicular Phase

• Ovulation

• Luteal Phase

What happens in the menstrual phase?

The uterine lining sheds as menstrual blood (period starts)

What happens in the follicular phase?

The lining of the uterus begins to thicken again

What happens during ovulation?

Midway through the cycle, an egg is released from an ovary

What happens during the luteal phase?

If there is no pregnancy, the cycle ends and menstruation begins again

How many women and girls menstruate wordlwide?

2.1 billion women and girls

How many women and girls experience pain during menstrual bleeding?

2 in 3

What percentage of schools worldwide provide menstrual health education?

39% of schools

Why does menstruation matter?

• Menstrual health is more than hygiene - it includes access to accurate information, affordable menstrual materials, and freedom from stigma

• Concerns about heavy or painful bleeding deserve to be evaluated, since they could signal conditions like endometriosis and PMOS

• If you are not having a regular cycle, this could mean issues with ovulation

Where are sperm produced?

In the testes

Where do sperm mature?

In the epididymis

What is the path of sperm during ejaculation?

Through the vas deferens → mix with fluid from the prostrate → exit through the urethra

What is the basic timeline of conception?

Ovulation → Egg Travels → Sperm Meets Egg → Fertilization → Implantation

Where does the egg travel during conception?

Into the fallopian tubes where it can be fertilized

Where do sperm and egg meet?

Sperm travels through the cervix and uterus towards the fallopian tube

Where does the fertilized egg travel and implant?

In the uterine lining

How long after ovulation can an egg be fertilized?

12-24 hours

How long can sperm survive in the reproductive tract?

For several days

Is preconception health important for likelihood of conception and overall health of the pregnancy?

Yes, it can get the body ready for a healthy pregnancy

What are the recommendations for women to get healthy before pregnancy?

• Talk to a healthcare provider

• Get 400 mcg of folic acid daily

• Stop alcohol, smoking, and certain drugs

• Reach and maintain a healthy weight

• Avoid toxic substances and contaminants

• Learn your family health history

• Prioritize your mental health

What are recommendations for men to get healthy before pregnancy?

• Avoid smoking, alcohol, and drug use

• Maintain a healthy weight and stay active

• Manage chronic health conditions

• Limit heat and toxin exposure

• See a healthcare provider

• Support your partner’s plan

How many women of reproductive age are their with a need for family planning?

1.1 billion women

• 874 million using a contraceptive method

• 164 million have an unmet need for contraception

What are common barriers for accessing family planning?

• Limited method availability

• Cost, age, income, or marital-status restrictions; need for partner consent in some settings

• Fear of side effects, misinformation, and social, cultural, or religious concerns

• Variable quality of counseling, or provider bias toward or away from certain methods

What are the categories of different family planning methods/

• Fertility Awareness/NFP

• Barrier Methods

• Hormonal Methods

• Intrauterine Devices

• Permanent Methods

What are fertility awareness/natural family planning (NFP) family planning methods?

Identifying the fertile window each cycle, then avoiding intercourse or using a barrier method during fertile days

What are examples of NFP/fertility awareness methods?

• Calendar/Rhythm Method

• Cervical Mucus (Billings/Ovulation Method)

• Standard Days Method

• Basal Body Temperature (BBT)

• Symptothermal Method

• Fertility Monitors/Apps

What is the calendar/rhythm method?

Predicts fertile days from the length of past cycles

What is the cervical mucus (billings/ovulation method)?

Tracks changes in cervical mucus texture across the cycle

What is the standard days method?

Avoids days 8-19 of a cycle (apps/beads aid tracking)

What is the basal body temperature (BBT) method?

Daily waking temperature rises slightly after ovulation

What is the symptothermal method?

Combines BBT, mucus, and other signs for greater accuracy

What is the fertility monitors/apps method?

Hormone test strips or algorithms estimate fertile days

What is the first year failure rate for all FABMs with typical uee?

24%

What are barrier methods?

They physically or chemically block sperm from reaching an egg; most are used only at the time of intercourse and do not require a prescription (except from the diaphragm and cervical cap)

What are examples of barrier methods?

• Male (external) Condom

• Diaphragm/Cervical Cap

• Spermicide (alone)

• Female (internal) Condom

• Contraceptive Sponge

• Pull-Out Method (she doesn’t consider this a real barrier method)

What are hormonal methods of family planning?

Oral contraceptives are pills taken daily to prevent pregancy

What are examples of hormonal methods of family planning?

• Combined Pill (COC)

• Progestin-Only Pill (Mini-Pill)

What is the combined pill method of family planning?

Works by preventing ovulation through low doses of two hormones (estrogen and progestin)

What is the progestin-only pill method of family planning?

Works by thickening cervical mucus and contains only progestin (no estrogen)

What are examples of hormonal implant and injection methods of family planning?

• Contraceptive Implant

• Injectable

What is the contraceptive implant method of hormonal family planning?

A matchstick-sized rod placed under the skin of the upper arm that releases progestin

What is the injectable method of hormonal family planning?

Progestin injection is given every 3 months

What is an intrauterine device?

Both types are inserted and removed by a clinician and are among the most effective reversible methods available (w/ a first-year typical-use failure rate below 1%)

What are the two types of intrauterine devices?

• Copper IUD

• Hormonal (Levonorgestral) IUD