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Purpose of menstrual cycle?
o To prepare for pregnancy- need egg and environment to get fertilize
What hormones at the starting of the menstrual cycle?
o GNRH- FOLLICULAR PHASE (follicle)- after bleeding has stopped Comes from hypothalamus
o FSH- Then pituritary- follicle stimulates hormone- ovaries have immature folliclce which
can mature into an egg. This then stimulates into the ovaries to allow the eggs to mature
o Slight decrease in estrogen which cause increase in LH
 LH spike/surge cause ovulation to happen
nd
o 2 phase- gluteal phase
 Dominant hormone is the progesterone- comes from corpus luteum- capsule that
mature egg was in.
 SAOURCE OF PROGESTRONE IS FOUND IN THE GLUTEAL PHASE
 Estrogen keeps coming form corpus luteum until egg is fertilized or will die off
where there is no estrogen
o
o How long can sperm last? 5-6 days
PAP SMEAR
o Purpose- to detect abnormalities in the cervix- screening for cervical cancer
o Typical screening recommendation? Age should a reproductive person have this? AT 21
regardless of being sexually active
o Take sample form the cervix to look for abnormalities then take a certain test to look for
HPV
o Pelvic to screen for STIs
o CBE and Breast self-example
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Purpose
How to conduct- start under the axillary and not take hands off so don’t miss area
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Mammogram-start getting at 40-45, can be earlier if there’s history
Osteoporosis
 Who is at risk?
o Lifestyle changes- weight, increasing vitamin D
Anorexia and bulimia
o Know the difference between the two
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Amenorrhea- absence of menses
o Primary
 Someone who hasn’t gotten period by age 15, regardless of sexual characteristics
 Cause- related
 to endocrine disorder and treating it
o Secondary
 Someone who has had menses before and all of sudden do not
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1st question to ask- is if they’re pregnant? If not/rule out/long term amenorrhea,
then look at endocrine issue
 Gynecological disorders- fibroids, endometriosis, PID, PICO
 PICO- ovarian syndrome is an ENDOCRINE issue related to
 Hyperinsulinemia
 Endometriosis- abnormal growth of then endometrial lining outside of
the endometrial wall (intermenstrual bleeding- bleeding in between the
cycle)- HAVE EXTRA SPOTTING IN BEWTEEN
 Fibroid- heavier. Pain bleeding d/t abnormal noncancerous growth in the
uterus.
Dysmenorrhea- PAINFUL MENSES
o Primary
 Discomfort comes from the release of
 NO PATHOLOGU
 Management0- treat whatever discomfort is occurring like aspirin
o Secondary
o Causes- related to other gynecological problems- may have endometriosis or fibroids to
make cramping more painful
o Management-0 treat whatever the secondary is
Case Study- NOT CANDIDATE FOR IUD
o Varies type of IUD
o Hormonal Skylar 3yrs
 Myrana 5yrs
 Progesterone- cause the thickening of the cervical mucous that makes it harder
for sperm to penetrate into uterus to meet the sperm.
o Non-hormonal- copper
 Last for 10 year,
 How does it prevent pregnancy-copper makes for an environment not conducive
for implantation and doesn’t do anything for sperm
 Copper is the inhibitor for killing sperm
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Multiple partners
 History of PID, STIs
Recommend
 nexprodone for the arm
 nuvaring over CAP and IUD
 can get DEPO
Counsel
 Use it consistently
 Screening
 In addition to hormonal IUD, Explain the use of condom consistently
 Talk about barrier methods- at risk for STI
PILL
 Educate about the pill doesn’t give cancer
 History of clot- not recommend an estrogen and progesterone type of combo
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Case 2- IPV- partner speaking for her, not making eye contact, looking for permission from partner
signs of IPV and keeping in mind culture
o Ask if they feel safe
o Contraception options- any restrictions or contraindications to contraceptive method?
 On the surface- no issues or contraindicated based on health issue-assess more
info
 IUD may not be the best option
o STI screening- NO- NOT SEXUALLY ACTIVE BEFORE.
 Doesn’t need a PAP
 ASK about Gardasil (11-13 age) can be given up aging 26 in someone not sexually
active
o EX- chose to use the PATCH
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CASE 3
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Place it anywhere on the body and change it 3 weeks at the time
AVOID BREAST AREA, 4th week is the patch free week then have withdrawl bleed
and start over
Herpes simplex virus 2- gift that keeps on giving
Get tested if there’s an outbreak- DORMANT
NO CURE FOR HERPES- treating the outbreak
Most contagious time w/ former partner- 3-4 days before the outbreak happens
 Feelings of tingling
 Woman in vaginal area- fatigue, flu-like symptoms would be most contagious
time
 If there’s an active outbreak there’s still contagious and ow virus has ruptured,
and pain is at the highest and see lesions that are painful
Screening (others too)- for chlamydia, gonorrhea- can be asymptomatic- may have these
and not know it
 What screening have you had beside STI screening? PAP smear, when and what
was it? Past 21yrs. Normal PAP is every 2-3years
TX- provide comfort NOT A CURE
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CASE 4
o What do you suspect? STI-Trichomonas- “frothy” foul smelly discharge and green/yellow
o Treatment- flaggel 2g by PO (drugs and dosages be on the exam)- once screened
o Contraception options
 Still use condoms, STI to worry about
 Doesn’t have contraindication- TRICK is not contra for IUD or anything inserted in
the virgin
 When do you plan to conceive, long acting? Oral? Injectable?
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CASE 5
o Know if screen appropriately? PAP SMEAR history- every 2-3 years? Did they screen for
HPV pap smear? Mammogram? Could be entering perimenopause- where periods are
irregular- can be lighter, heavier, spaced out, vasomotor-hot flashes, night sweats
o Normal PAP looking for abnormal cells
o Menopause- absence of menses/no bleed or spotting for one year consecutively
 Increase risk for osteoporosis- estrogen helps with bone reabsorptions
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CASE 6
o Talk about syphilis- stages?
o How long with partner? Rash or lesions?
o Lesions
 Stage 1- PAINLESS, Tainker?-site of injury of Syphilis infection
 Why it may be missed, and overtime will heel itself
 Stage 2- wart, flat against perineum against the anus
 Rash on soles of feet, palm, hives but not itchy
 Stage 3
 Resolved but infection is festering
 Stage 4
 Neurological issue
o Treatment- PENICILLIN (DRUG OF CHOICE)
o Screening for CHLAMYDIA AND GONORRHEA are partners in crime
 Screen for other STIs
o Negative for syphilis but positive for Gono and chlamydia
 Treatment for Gono- IM injection- rosephline (both brand and generic name)
 Treatment for chlamydia- doxycycline or azithromycin
 Should be treated together
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o Doxycycline 100ml and azithromycin 1g
o Herpes-penicillin
o Trich- Flagel 2g
CASE 6
Options for permanent contraception
o Tube ligation or vasectomy
o IUD- 10yrs
o Natural family planning If using contraception, then using this to know when they’re fertile time is
 No barrier method
 Awareness of when fertile time is, using body’s natural cycle to determine when
to engage in intercourse
 Methods- calendar, temp increase= ovulation, changes in cervical mucus
 CONCEICE- HAVE INTERCOURSE DURING FERTILE TIME
o C- swelling in legs, no DVT
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A- after each menses
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C- how early to insert diaphragm prior to intercourse? 6hrs. Stay in 6hrs after intercourse.
Douches increase the chance of an infection, throws the PH balance off
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C- pill doesn’t protect STI
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D-If on oral then watch out for DVT and smoking increases risk
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B- warts related to syphilis-flat against cervix. Wart caused by HPV- clustered gray like warts.
D(trich), curdy is yeast infection
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A- virus, and others are bacteria
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B- cervical cancer
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