Podcast
Questions and Answers
What occurs during the menses phase of the menstrual cycle?
What occurs during the menses phase of the menstrual cycle?
What hormonal change marks the ovulation phase in the menstrual cycle?
What hormonal change marks the ovulation phase in the menstrual cycle?
During which phase does the uterine lining thicken due to rising estrogen levels?
During which phase does the uterine lining thicken due to rising estrogen levels?
How long does the luteal phase typically last in a 28-day menstrual cycle?
How long does the luteal phase typically last in a 28-day menstrual cycle?
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What is the recommended form of birth control for patients taking phenytoin?
What is the recommended form of birth control for patients taking phenytoin?
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What effect does phenytoin have on oral contraceptives?
What effect does phenytoin have on oral contraceptives?
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What hormone helps prepare the uterine lining for pregnancy during the luteal phase?
What hormone helps prepare the uterine lining for pregnancy during the luteal phase?
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Which statement about the menstrual cycle is false?
Which statement about the menstrual cycle is false?
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What is considered the gold standard for testing Trichomoniasis?
What is considered the gold standard for testing Trichomoniasis?
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Which of the following is a symptom of primary syphilis?
Which of the following is a symptom of primary syphilis?
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What is the first-line treatment for early stage syphilis?
What is the first-line treatment for early stage syphilis?
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Which SSRI is considered appropriate for treating depression during pregnancy?
Which SSRI is considered appropriate for treating depression during pregnancy?
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What is the recommended medication for managing diabetes in pregnant women?
What is the recommended medication for managing diabetes in pregnant women?
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What medication has the longest track record of safety for treating high blood pressure during pregnancy?
What medication has the longest track record of safety for treating high blood pressure during pregnancy?
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What condition is characterized by high blood pressure and protein in urine after the 20th week of pregnancy?
What condition is characterized by high blood pressure and protein in urine after the 20th week of pregnancy?
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Which of the following statements about Trichomoniasis is true?
Which of the following statements about Trichomoniasis is true?
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What is the ideal time frame for inserting Nexplanon relative to a woman's menstrual cycle?
What is the ideal time frame for inserting Nexplanon relative to a woman's menstrual cycle?
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How effective is Nexplanon in preventing pregnancy?
How effective is Nexplanon in preventing pregnancy?
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Which of the following is a possible side effect of Nexplanon?
Which of the following is a possible side effect of Nexplanon?
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What should you avoid doing three weeks prior to getting Nexplanon inserted?
What should you avoid doing three weeks prior to getting Nexplanon inserted?
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What is one of the initial actions to take if you experience severe bleeding after receiving Nexplanon?
What is one of the initial actions to take if you experience severe bleeding after receiving Nexplanon?
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What is the maximum duration for which the NuvaRing can contain hormones effectively?
What is the maximum duration for which the NuvaRing can contain hormones effectively?
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What should you inform your healthcare provider about before using Nexplanon?
What should you inform your healthcare provider about before using Nexplanon?
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Which of the following is NOT a reason to avoid using Nexplanon?
Which of the following is NOT a reason to avoid using Nexplanon?
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Which of the following is an advantage of using female condoms?
Which of the following is an advantage of using female condoms?
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Which contraceptive method is contraindicated during pregnancy?
Which contraceptive method is contraindicated during pregnancy?
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What is a common disadvantage of female condoms compared to male condoms?
What is a common disadvantage of female condoms compared to male condoms?
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What complication can arise from using IUDs during pregnancy?
What complication can arise from using IUDs during pregnancy?
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What is a disadvantage of combined oral contraceptives during perimenopause?
What is a disadvantage of combined oral contraceptives during perimenopause?
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What is a commonly reported issue with female condoms during intercourse?
What is a commonly reported issue with female condoms during intercourse?
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What should a woman do if she discovers she is pregnant while using hormonal birth control?
What should a woman do if she discovers she is pregnant while using hormonal birth control?
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Which of the following statements about SKYLA LNS is correct?
Which of the following statements about SKYLA LNS is correct?
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What is the function of oral antifungal medications like fluconazole?
What is the function of oral antifungal medications like fluconazole?
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What percentage of patients with an ectopic pregnancy may experience abdominal pain, vaginal bleeding, and amenorrhea?
What percentage of patients with an ectopic pregnancy may experience abdominal pain, vaginal bleeding, and amenorrhea?
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What type of medication is recommended for medical management of ectopic pregnancy in stable patients?
What type of medication is recommended for medical management of ectopic pregnancy in stable patients?
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Which of the following symptoms is NOT typically associated with endometriosis?
Which of the following symptoms is NOT typically associated with endometriosis?
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What diagnostic method is used to visually determine the location of an ectopic pregnancy?
What diagnostic method is used to visually determine the location of an ectopic pregnancy?
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Which symptom is considered an emergency in cases of ectopic pregnancy?
Which symptom is considered an emergency in cases of ectopic pregnancy?
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What percentage of reproductive age women and girls globally are affected by endometriosis?
What percentage of reproductive age women and girls globally are affected by endometriosis?
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Which of the following statements regarding endometriosis is accurate?
Which of the following statements regarding endometriosis is accurate?
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Study Notes
Trichomoniasis
- Most people with trichomoniasis have no symptoms.
- Treatment options include metronidazole 2 grams single dose, tinidazole 2 grams single dose, or metronidazole 500 milligrams twice a day for 7 days.
- The gold standard for testing is Affirm, which also checks for bacterial vaginosis and yeast infections. Wet mount testing is available but has low sensitivity.
Syphilis
- Syphilis is a systemic disease caused by Treponema pallidum.
- It is divided into stages: primary, secondary, tertiary, early latent, and late latent.
- Primary syphilis presents with ulcers or chancres at the infection site.
- Secondary syphilis is characterized by skin rashes and swollen lymph nodes.
- Tertiary syphilis represents advanced disease.
- Early latent stage occurs within the first year of infection.
- Late latent or unknown duration occurs after the first year.
- Testing for syphilis is done with Trep-pal test and RPR.
- A four-fold change in RPR titer (1:4 to 1:16) is considered significant.
- Treatment for primary, secondary, and early latent syphilis involves a single dose of benzathine penicillin G 2.4 million units IM.
- Late latent syphilis is treated with a total of 7.2 million units of benzathine penicillin G, administered in three doses of 2.4 million units IM at weekly intervals.
Medications Safe in Pregnancy
- Selective serotonin reuptake inhibitors (SSRIs) are commonly used for depression in pregnancy due to minimal side effects and extensive research.
- Examples include citalopram, escitalopram, fluoxetine, and sertraline.
- SSRIs can cause adaptation syndrome in newborns, similar to withdrawal symptoms.
- Insulin is the preferred treatment for diabetes in pregnancy as it effectively regulates blood glucose and does not cross the placenta, making it safe for the baby.
- Insulin can be administered via syringes, insulin pens, or insulin pumps, all of which are safe for pregnant women.
- Methyldopa, labetalol, and nifedipine are generally considered safe for managing high blood pressure in pregnancy.
Preeclampsia
- Preeclampsia is characterized by high blood pressure and protein in the urine developing after the 20th week of pregnancy.
Menstrual Cycle
- Menses Phase: The lining of the uterus sheds through the vagina if pregnancy hasn’t occurred. Most people bleed for 3-5 days.
- Follicular Phase: The lining of the uterus (endometrium) thickens, and follicles in the ovaries begin to grow.
- Ovulation: A surge in luteinizing hormone (LH) causes the ovary to release an egg.
- Luteal Phase: The egg travels through the fallopian tubes to the uterus. Progesterone levels rise to prepare the uterine lining for pregnancy. If fertilization occurs, it implants in the uterine wall. If not, the lining sheds during menstruation.
- Most people bleed for 3 to 5 days, but a period lasting only three days to as many as seven days is usually not a cause for worry.
Choosing Birth Control While on Phenytoin
- Phenytoin can significantly reduce the effectiveness of oral contraceptives due to its enzyme-inducing properties.
- A levonorgestrel-releasing intrauterine device (IUD) is often the preferred birth control option for patients taking phenytoin.
- Progestin-only options, such as injections (medroxyprogesterone acetate) or levonorgestrel IUDs, are less impacted by enzyme induction.
- Avoid oral contraceptives.
- Consult with your doctor to determine the best birth control method for your individual situation.
Nexplanon
- Get it inserted within five days of your period.
- If inserted later, use a condom or another contraceptive method for the first week.
- It begins working in seven days and is over 99% effective at preventing pregnancy.
- It can cause soreness, swelling, bruising, or discoloration at the insertion site for up to two weeks.
- Your period may change, with more or less bleeding, or you might have spotting between periods.
- It can be removed at any time during the three-year period.
- Pregnancy can occur as early as the first week after removal.
- Do not use Nexplanon if you are pregnant, have liver disease, or have certain cancers.
- Avoid unprotected sex for at least three weeks before your appointment.
- Inform your healthcare provider about all medications, vitamins, and herbal supplements you take. Some medications can reduce Nexplanon’s effectiveness.
- Contact your healthcare provider immediately if you experience bleeding that saturates a pad or more in an hour, pain not relieved by over-the-counter medications, redness or significant swelling at the injection site, fever greater than 100.4 degrees Fahrenheit, or any signs of pregnancy.
Vaginal Ring
- One NuvaRing provides enough hormones for up to 5 weeks.
- Several ring schedules are available, allowing you to choose whether to get a period or skip it.
- All schedules are effective at preventing pregnancy.
- It can be started within 5 days of your period. If started later, use another method for the first week.
Treatment for Painful Menstrual Cramps
- Nonsteroidal anti-inflammatory drugs (NSAIDs), oral contraceptives, heating pads, and transcutaneous electrical nerve stimulation (TENS) units can help manage painful menstrual cramps.
Female Condoms
-
Pros:
- Along with male condoms, it is the only form of birth control that significantly reduces the transmission of sexually transmitted diseases.
- It provides women with greater control over contraceptive use.
- It does not require a prescription.
- It is less likely to cause an allergic reaction or break compared to male condoms.
- It is small, easy to carry, and disposable.
-
Cons:
- More expensive than male condoms (approximately 5 times).
- The outer ring may be considered cumbersome.
- Typical use has a higher failure rate of approximately 21%.
- It may cause crackling or popping noises during intercourse.
Contraception During Pregnancy
- Hormonal birth control and intrauterine devices (IUDs) should not be used during pregnancy.
- Barrier methods like condoms are safe.
- Accidental use of hormonal birth control early in pregnancy has a low risk of birth defects or miscarriage, but it should be stopped immediately, and you should consult with your ob/gyn.
- IUDs can increase the risk of miscarriage and preterm birth. They should be removed if pregnancy occurs.
Contraception During Perimenopause
- Combined oral contraceptives, vaginal ring, and depot medroxyprogesterone acetate (DMPA) are not recommended for women over 50 due to the risk of blood clots.
- Progestin-only pills may not address perimenopause symptoms like hot flashes, night sweats, and mood disturbances.
- Diaphragms and cervical caps rely on vaginal wall support, which may be compromised during perimenopause.
SKYLA LNS
- Insertion is nonsurgical and can be done during a routine office visit.
- Provides continuous, highly effective birth control.
- You may experience pain, bleeding, or dizziness during and after placement.
Antifungal Medications for Yeast Infections
- Medications are available in oral and topical forms.
- Topical medications can be applied to the vaginal area or inserted into the vagina using an applicator.
- Common antifungal medications include miconazole (Monistat®) and terconazole.
Ectopic Pregnancy
- Fertilized egg implants outside of the uterus.
- 50% of patients with an ectopic pregnancy experience abdominal pain, vaginal bleeding, and amenorrhea.
- Other symptoms include nausea, breast fullness, dizziness, fever, weakness, flu-like symptoms, vomiting, syncope, and cardiac arrest.
- Emergency Symptoms: Abdominal rigidity, involuntary guarding, severe tenderness, and evidence of hypovolemic shock (orthostatic blood pressure changes, tachycardia).
- Diagnosis is made through serial beta HCG levels and ultrasound imaging to determine the location of the pregnancy.
- Treatment includes medical management with intramuscular methotrexate for hemodynamically stable patients (not FDA-approved but endorsed by the ACOG), which avoids surgery. HCG values must be less than 1500.
Endometriosis
- Affects approximately 10% (190 million) of reproductive-age women and girls globally.
- It is a chronic disease associated with severe pain during periods, sexual intercourse, bowel movements, and/or urination, chronic pelvic pain, abdominal bloating, nausea, fatigue, depression, anxiety, and infertility.
- There is no known cure, and treatment aims to control symptoms.
- Early diagnosis and effective treatment are important and limited in many settings, especially in low- and middle-income countries.
- Symptoms include severe pelvic pain, especially during menstruation, pain during sex or urination/defecation, difficulty getting pregnant, chronic pelvic pain, heavy bleeding during periods or in between periods, bloating or nausea, fatigue, depression, or anxiety.
- Symptoms often improve after menopause, but not always.
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