Women's Health Exam (updated SG) PDF

What are complications of PID (Pelvic Inflammatory Disease): Infertility PID can cause scarring and adhesions in the fallopian tubes, which can make it harder for sperm to reach an egg. The risk of infertility increases with the number of PID infections. Ectopic pregnancy PID can damage the fallopia...

What are complications of PID (Pelvic Inflammatory Disease): Infertility PID can cause scarring and adhesions in the fallopian tubes, which can make it harder for sperm to reach an egg. The risk of infertility increases with the number of PID infections. Ectopic pregnancy PID can damage the fallopian tubes, which can lead to an ectopic pregnancy, where the pregnancy occurs outside of the uterus. Ectopic pregnancies are not viable. Chronic pelvic pain About 25% of people with PID experience chronic pelvic pain, which is pain that doesn't go away. Abscesses PID can cause abscesses to form, which may require surgery to prevent them from bursting and causing more damage. If an abscess forms on the uterus or ovaries, those organs may need to be removed. Blocked fallopian tubes PID can cause scar tissue, adhesions, or abscesses that block the fallopian tubes. This makes it harder for sperm to reach an eg Symptoms and complications of Lichen sclerosis Irretraceable itching, unknown cause, often misdiagnosed for yeast infection or genital herpes Will see a white wrinkle appearing plaques or patches, the tissue is usually red around it To test: Punch biopsy, rule out coexisting vaginal infection Treatment: Ointment as opposed to cream Can affect the skin anywhere on the body, but it often affects the genital and anal areas. It can also affect the back, shoulders, upper arms, and breasts. Complications of lichen sclerosus include: Scarring and tightening of the skin, Increased risk of squamous cell skin cancer, and Depression. Lichen sclerosus is not contagious or a sexually transmitted disease. It can be treated with topical corticosteroids, phototherapy, and other treatments. In rare cases, surgery may be required. Lichen sclerosus is associated with other autoimmune conditions, such as thyroid disease, vitiligo, anemia, diabetes, and alopecia areata. It's more common in people who have a family member with lichen sclerosu Symptoms/characteristics and treatment of PCOS Common feature is hypersecretion of androgens. In adult women 2 of 3 must be present for diagnosis: Hyperandrogenism Oligo – ovulation or anovulation Polycystic ovaries on ultrasound Birth control for treating menstrual cramps, painful sex, abdominal cramps and back pain during menstruation: Hormonal birth control can help with menstrual cramps, painful sex, abdominal cramps, and back pain during menstruation: Birth control pills Pills that contain both estrogen and progestin can be more effective than placebos. Taking pills continuously or with fewer breaks may be better than taking them on a regular cycle. Progestin-only IUDs These IUDs can decrease period pain compared to copper IUDs or no treatment. Thinning the uterine lining Some types of birth control, like hormonal IUDs and progestin-only methods, thin the endometrial lining. This can reduce menstrual bleeding and cramping. Reducing prostaglandins Birth control pills can reduce the amount of prostaglandins, which can reduce blood flow and cramping. Premenstrual syndrome characteristics, treatment. and when does it occur: Premenstrual syndrome (PMS) is a collection of physical and emotional symptoms that many women experience in the week or two leading up to their menstrual period, often including breast tenderness, bloating, mood swings, irritability, fatigue, food cravings, headaches, and abdominal pain; symptoms usually improve once menstruation begins, and can be managed through lifestyle changes like exercise, a healthy diet, stress reduction, and sometimes medication depending on severity. Key characteristics of PMS: Physical symptoms: Breast tenderness, bloating, abdominal pain, headaches, backache, swelling in hands and feet, changes in appetite, constipation or diarrhea, acne Emotional symptoms: Mood swings, irritability, anxiety, depression, feeling overwhelmed, difficulty concentrating, increased sensitivity When does PMS occur? Symptoms typically start around ovulation (mid-cycle) and become most noticeable in the week or two before menstruation begins Symptoms of Oligomenorrhea, Primary amenorrhea, secondary amenorrhea: The primary symptom for all three conditions - Oligomenorrhea, primary amenorrhea, and secondary amenorrhea - is the absence or irregularity of menstrual periods; however, depending on the underlying cause, other symptoms may include: acne, excess facial hair, headaches, hot flashes, vaginal dryness, breast discharge, vision changes, pelvic pain, and changes in body hair growth due to hormonal imbalances. Oligomenorrhea: Irregular menstrual cycles with periods occurring less frequently than usual, often defined as fewer than 9 menstrual cycles per year or cycles longer than 35 days apart. Causes: Health conditions: Thyroid disorders, diabetes, eating disorders, pelvic inflammatory disease, polycystic ovarian syndrome, and tumors in the ovaries or adrenal glands Medications: Antipsychotics, antiepileptics, and hormonal contraceptives Lifestyle: Intense physical activity, stress, and nutritional changes Other factors: Structural abnormalities in the reproductive organs, congenital adrenal hyperplasia, and Prader-Willi syndrom Primary Amenorrhea: Complete absence of a menstrual period by the age of 16 in a person with normal sexual development. Secondary Amenorrhea: The sudden cessation of menstrual periods for several months in a person who previously had regular cycles PCOS is most common cause of Secondary Amenorrhea Characteristics, diagnostic test and treatment for bacterial vaginosis. How do you test for Bacterial Vaginosis: Most common is Gardnerella Vaginalis, vaginal fluid Ph>4.5 Gram Stain is the GOLD standard for diagnosis To be diagnosed, need at least three clinical criteria: Thin white discharge Clue cells Ph>4.5  Fishy odor with the “whiff test” Treatment: Metronidazole 500mg orally BID for 7 days, OR metronidazole gel 0.75% one full applicator (5g) intravaginally QD 5 days OR Clindamycin cream 2% one fill applicator (5g) intravaginally at bedtime for 5 days Symptoms of chlamydia: Chlamydia is the most common STI, highest rates under age 25, often asymptomatic, screen under age 25 annually, new sex partner, more than 1 partner, recent partner with STI If symptomatic: Burning upon urination, pain during sex, lower belly pain, abnormal, smelly discharge, bleeding between periods Treatment for Chlamydia: Doxycycline 100 mg orally 2 times/day for 7 days Alternative Regimens: Azithromycin 1 g orally in a single dose OR Levofloxacin 500 mg orally once daily for 7 day What testing is done for chlamydia? NAATS First urine of the day, vaginal/cervical swab Symptoms of Gonorrhea: Most women who get gonorrhea don’t have any symptoms. If they do, gonorrhea symptoms show up within about a week of being infected. These include: Pain or burning feeling when you pee Abnormal discharge from the vagina that may be yellowish or bloody Bleeding between periods Treatment for Gonorrhea: The recommended treatment for gonorrhea is a single intramuscular injection of 500 mg ceftriaxone. If ceftriaxone is not an option, a single 800 mg dose of cefixime can be used Testing for Gonorrhea: The most common gonorrhea testing method is a nucleic acid amplification test (NAAT). NAAT detects the genetic material of the Neisseria gonorrhoeae bacterium. You can get results from a urine or a swab sample. NAAT is the best test to detect the Neisseria gonorrhoeae bacterium because it doesn't grow well in culture Symptoms of genital warts Usually visually diagnosed Genital warts can appear as small or large bumps in the genital area, and can have the following symptoms: Appearance: Genital warts can be skin-colored or whitish-grey, and can be raised or flat. They can be smooth or bumpy, and sometimes appear in a cauliflower-like shape. Some warts can be so small and flat that they are not noticed right away. Pain: Genital warts are usually painless, but can sometimes cause itching, bleeding, burning, or pain. Other symptoms: Genital warts can also cause bleeding during sex. Genital warts can be diagnosed by a healthcare provider, who can perform a visual exam, a pelvic exam, or a colposcopy. A colposcopy uses a light and microscope to help find and biopsy abnormal areas in the cervix. A healthcare provider can also perform an HPV test to determine if you have a high-risk type of HPV. Genital warts can come back, even after treatment, but the body's immune system usually clears the virus from the body and the wart will eventually disappear Treatment for genital warts: Usually resolve in a year Patient applied Imiquimond 3.75% or 5% cream OR Podofilox 0.5% solution or gel, OR Sinecatechins 15% ointment OR Provider can perform Cryotherapy with liquid nitrogen or cyroprobe High risk HPV strains; HPV 16, HPV 18, HPV 31, HPV 33, and HPV 42 are examples of high-risk HPV types that can cause cancer. These HPV types can sometimes avoid the body's immune system, so the body can't get rid of the HPV. The infection can linger over time, causing damage to normal cells that can turn them into abnormal cells, which might later become cancer. In fact, high-risk HPV types are known to cause 6 different types of cancers What educational information would you provide to a patient with HSV-2 HSV-2 is genital herpes, it is a lifelong viral infection Many people have no symptoms while shedding the virus Testing includes PCR assays for HSV DNA or IGG testing which is often included in an STI panel Using a condom can reduce but not eliminate risk NO sex during prodromal/active lesions Tell HCP if pregnant Does NOT cause cancer Treatment for herpes PRIMARY treatment: Acyclovir 400mg TID 7-10 days *dose can vary SUPPRESIVE – Acyclovir 400mg BID or Valacylovir 500mg QD or 1gm Symptoms of Trichomoniasis: Trichomoniasis, also known as "trich", is a common sexually transmitted infection (STI) that can cause a number of symptoms in women, including: Vaginal discharge that is thin, frothy, and has a foul or fishy smell Itching or burning of the genitals or inner thighs Pain or discomfort when urinating or during sex Redness or swelling of the vulva or labia Symptoms can appear within 5 to 28 days of exposure, but some people don't develop symptoms until much later. Most people with trich don't have any symptoms Treatment for Trichomoniasis: Metronidazole 2g single dose OR tinidazole 2g single dose OR Metronidazole 500mg BID x 7 days Testing for Trichomonas: Wet mount -> low sensitivity Gold standard – Affirm (checks for BV, yeast, trich) Symptoms of Syphilis Systemics disease -> Treponema pallidum Divided into stages: Primary: ulcers or chancre at infection site Secondary: skin rashes; swollen lymph nodes Tertiary: advanced disease Early latent: 1st year Late latent or unknown duration: after 1st year Testing for Syphilis Trep-pal test and RPR RPR reported in titer w/fourfold change (1:4 to1:16) Treatment for Syphilis Treatment (primary, secondary, early latent) Benzathine penicillin G 2.4 million units IM in a single dose Treatment late latent Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals Medications safe to use in pregnancy: For depression: Selective serotonin reuptake inhibitors (SSRIs) These are often the first-line treatment for depression during pregnancy because they have minimal side effects and have been studied extensively. Some examples include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), and sertraline (Zoloft). However, SSRIs can cause adaptation syndrome in newborns, which is similar to withdrawal symptoms For diabetes: From the ADA: Insulin is the traditional first-choice drug for blood glucose control during pregnancy because it is the most effective for fine-tuning blood glucose and it doesn’t cross the placenta. Therefore, it is safe for the baby. Insulin can be injected with a syringe, an insulin pen, or through an insulin pump. All three methods are safe for pregnant women. For high blood pressure: Studies show that three blood pressure medications are generally safe for treating high blood pressure in most pregnancies: Methyldopa has the longest and most reassuring track record of safety in pregnancy. This medication relaxes the blood vessels, which lowers blood pressure. Labetalol slows your heart rate, which lets your heart relax. Nifedipine only needs to be taken once a day in the extended-release form. PRECLAMPISA AND ECLAMPSIA Preeclampsia: High blood pressure and protein in the urine that develops after the 20th week of pregnancy. Preeclampsia can reduce blood supply to the fetus, which can lead to complications like premature birth or problems for the baby after birth. Other symptoms include swelling in the hands, fingers, neck, or feet. Eclampsia Seizures or coma that develops in pregnant women with preeclampsia. Eclampsia is a rare but serious complication of preeclampsia that affects less than 3% of people with preeclampsia. Eclampsia requires immediate emergency medical care. Treatment for preeclampsia may include: Modified activity, like bed rest Hospitalization Medications to lower blood pressure Delivery of the baby Magnesium sulfate is given to prevent or stop seizures in women with preeclampsia or eclampsia. Preeclampsia and eclampsia can also damage the liver and blood cells, which can lead to HELLP syndrome. HELLP syndrome stands for: Hemolysis: Red blood cells break down Elevated liver enzymes: High levels of chemicals in the blood that indicate liver problems Low platelet counts: Not enough platelets to clot blood properly When should we screen for breast cancer in women 40 and over every two years for mammograms, but also encourage self exam and perform manual exam at every wellness visit When should we screen for osteoporosis: The U.S. Preventive Services Task Force (USPSTF) recommends that women get screened for osteoporosis at age 65 or older. Women between the ages of 50 and 64 should get screened if they have risk factors, such as a parent who broke their hip When should we do pap smear The U.S. Preventive Services Task Force (USPSTF) recommends that women ages 21 to 29 get a Pap test every three years to screen for cervical cancer. For women ages 30 to 65, the USPSTF recommends three screening options: A Pap test every three years An HPV test every five years A combination of a Pap test and an HPV test every five years The USPSTF recommends against screening women: Younger than 21 years old Older than 65 who have had adequate prior screening and are not at high risk for cervical cancer  Who have had a hysterectomy and removed their cervix, unless they have a history of cervical cancer or a high-grade precancerous lesion Who do not have a cervix Know phases of the menstrual cycle what are the four phases of the menstrual cycle? The rise and fall of your hormones trigger the steps in your menstrual cycle. Your hormones cause the organs of your reproductive tract to respond in certain ways. The specific events that occur during your menstrual cycle are: The menses phase: This phase begins on the first day of your period. It's when the lining of your uterus sheds through your vagina if pregnancy hasn’t occurred. Most people bleed for three to five days, but a period lasting only three days to as many as seven days is usually not a cause for worry. The follicular phase: This phase begins on the day you get your period and ends at ovulation (it overlaps with the menses phase and ends when you ovulate). During this time, the level of the hormone estrogen rises, which causes the lining of your uterus (the endometrium) to grow and thicken. In addition, another hormone — follicle-stimulating hormone (FSH) — causes follicles in your ovaries to grow. During days 10 to 14, one of the developing follicles will form a fully mature egg (ovum). Ovulation: This phase occurs roughly at about day 14 in a 28-day menstrual cycle. A sudden increase in another hormone — luteinizing hormone (LH) — causes your ovary to release its egg. This event is ovulation. The luteal phase: This phase lasts from about day 15 to day 28. Your egg leaves your ovary and begins to travel through your fallopian tubes to your uterus. The level of the hormone progesterone rises to help prepare your uterine lining for pregnancy. If the egg becomes fertilized by sperm and attaches itself to your uterine wall (implantation), you become pregnant. If pregnancy doesn’t occur, estrogen and progesterone levels drop and the thick lining of your uterus sheds during your period. What is the best birth control for a patient taking phenytoin? For a patient taking phenytoin, the best birth control option is typically a levonorgestrel-releasing intrauterine device (IUD), as phenytoin can significantly reduce the effectiveness of oral contraceptives due to its enzyme-inducing properties; therefore, a method not affected by liver metabolism is preferred. Key points about choosing birth control while on phenytoin: Avoid oral contraceptives: Phenytoin rapidly metabolizes the estrogen in oral birth control pills, making them significantly less effective.  Consider a progestin-only option: A good alternative is a progestin-only injection (like medroxyprogesterone acetate) or a levonorgestrel IUD, which are less impacted by enzyme induction. Consult your doctor: Always discuss your contraceptive needs with your healthcare provider to determine the best option based on your individual situation and medication regime What educational information would you provide for the Nexplanon When to get it inserted A healthcare professional can help you determine the best time to get Nexplanon inserted, which depends on whether you are currently using birth control. It's best to get it inserted within five days of your period. If it's inserted later, you should use a condom or other contraceptive method for the first week. How it works Nexplanon starts working in seven days. It's over 99% effective at preventing pregnancy. Side effects You might experience 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. Removing Nexplanon A healthcare professional can remove the implant at any time during the three-year period. You might become pregnant as early as the first week after removal. What to avoid You should not use Nexplanon if you are pregnant, have liver disease, or have certain cancers. You should also avoid unprotected sex for at least three weeks before your appointment. What to tell your healthcare provider Let your healthcare provider know about all medications you take, including vitamins and herbal supplements. Some medicines can make Nexplanon less effective. What to do if you have an issue Call your healthcare provider if you experience: Bleeding that fills a pad or more in an hour Pain that is not relieved with an over-the-counter pain reliever Redness or a large amount of swelling at the injection site  Fever greater than 100.4 degrees Fahrenheit Any signs of pregnancy What educational information would you provide for the vaginal ring One NuvaRing has enough hormones in it to last for up to 5 weeks. You have a few different options for ring schedules, and you can choose to get a period or choose to skip it. All of these schedules work just as well to prevent pregnancy. When can I start using the birth control ring? You can start using the birth control ring as soon as you get it — any day of the week, and anytime during your menstrual cycle. But depending on when you start the ring, you may need to use backup birth control (like condoms) for the first 7 days. If you put your first ring in within 5 days after your period starts, it will start working right away. For example, if you get your period Monday morning, you can start using the ring anytime until Saturday morning and be protected from pregnancy right away. If you start using the ring at any other time in your cycle, it needs to be in your vagina for 7 days before it will start protecting you from pregnancy. Use another method of birth control — like a condom — if you have vaginal sex during your first week on the ring. Starting the ring after pregnancy: You can get pregnant again shortly after being pregnant, so talk with your nurse or doctor about starting your birth control as soon as you can. You can start using the ring right after an abortion or miscarriage. In general, you can start using the ring 3 weeks after giving birth (but wait 3 weeks whether you're breastfeeding or not). Read more about breastfeeding and the ring. If you leave a NuvaRing out of your vagina for more than 2 days during the weeks you’re supposed to wear it, you won’t be protected from pregnancy. If your ring has been out of your vagina for too long, use a backup birth control method (like condoms) until the ring has been in your vagina for 7 days in a row. Don’t use lube that has oil or silicone in it while the ring is in your vagina. Water-based lubes are safe to use. Don’t use the birth control gel Phexxi with the birth control ring. What do I do if I want to get pregnant? If you decide you want to get pregnant, just take your ring out and throw it away. It’s possible to get pregnant right after you stop using the ring. It can take a few months for your period to go back to the cycle you had before you started using it. But it’s still possible to get pregnant during that time, even if your period isn’t regular or you haven’t gotten your period yet since you stopped using the ring.  Treatment for painful menstrual cramps NSAIDS, OCPs heating pad, TENS unit Advantages and disadvantages of the female condom The Pros include: Along with male condoms, it is the only form of birth control that has a significant reduction in the transmission of sexually transmitted diseases It keeps the control of contraceptive use in your hands You do not need a prescription Compared to the male condom it is less likely to cause an allergic reaction, and it is less likely to break Condoms are small, easy to carry, and disposable The Cons include: 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 be a distraction during intercourse because of crackling or popping noises Which birth control is contraindicated in pregnancy? Hormonal birth control and IUDs should not be used during pregnancy, but barrier methods like condoms are safe: Hormonal birth control While the risk of birth defects or miscarriage is low if you accidentally take hormonal birth control early in pregnancy, you should stop taking it and talk to your ob/gyn as soon as you find out you're pregnant. IUDs IUDs can increase the risk of miscarriage and preterm birth, and you should remove them if you become pregnant What contraceptive is contraindicated in perimenopause?  Combined oral contraceptives, vaginal ring, and depot medroxyprogesterone acetate (DMPA) These are not usually recommended for women over 50 due to the risk of blood clots. Progestin-only pills These pills may not address perimenopause symptoms like hot flashes, night sweats, and mood disturbances. Diaphragms and cervical caps These methods rely on vaginal wall support, which may be compromised during perimenopause What educational information would you provide for SKYLA LNS Getting an IUD is nonsurgical can take place during a routine office visit. Once in place, it provides continuous, highly effective birth control. You may experience pain, bleeding or dizziness during and after placement. If these symptoms do not go away within 30 minutes after placement, call your healthcare professional as Skyla may not have been placed correctly. Your healthcare professional will examine you to see if Skyla needs to be removed or replaced. Within 4 to 6 weeks, you should return for a follow-up visit to make sure that Skyla is in the right position. After that Skyla can be checked by your healthcare professional once a year as part of your routine exam. Skyla is an IUD that releases a low dose of hormones and is over 99% effective at preventing pregnancy for up to 3 years. Reversible and can be removed by your healthcare professional at any time if you change your mind, so you can try to get pregnant right away. About 3 out of 4 women who want to become pregnant will become pregnant sometime in the first year after Skyla is removed. You can still use tampons or menstrual cups: o Change tampons or menstrual cups with care to avoid pulling the threads of Skyla. If you think you may have pulled Skyla out of place, avoid intercourse or use a non-hormonal back-up birth control (such as condoms or spermicide), and contact your healthcare professional. You shouldn't be able to feel it o If you feel more than just the threads or if you cannot feel the threads, Skyla may not be in the right position and may not prevent pregnancy. Avoid intercourse or use non-hormonal back-up birth control (such as condoms or spermicide) and ask your healthcare professional to check that Skyla is still in the right place. You and your partner should not feel it during sex. Sometimes your partner may feel the threads. If this occurs, or if you or your partner experience pain during sex, talk with your healthcare professional. You should make sure Skyla is in place with a monthly thread check. Your healthcare professional can show you how.  Pain, bleeding or dizziness during and after placement. If these symptoms do not stop 30 minutes after placement, Skyla may not have been placed correctly. Your healthcare professional will examine you to see if Skyla needs to be removed or replaced. Changes in bleeding. You may have bleeding and spotting between menstrual periods, especially during the first 3–6 months. Sometimes the bleeding is heavier than usual at first. However, the bleeding usually becomes lighter than usual and may be irregular. Call your healthcare professional if the bleeding remains heavier than usual or increases after it has been light for a while. Missed menstrual periods. About 1 out of 16 women stop having periods after 1 year of Skyla use. If you have any concerns that you may be pregnant while using Skyla, do a urine pregnancy test and call your healthcare professional. If you do not have a period for 6 weeks during Skyla use, call your healthcare professional. When Skyla is removed, your menstrual periods should return. Cysts on the ovary. About 14 out of 100 women using Skyla develop a cyst on the ovary. These cysts usually disappear on their own in two to three months. However, cysts can cause pain and sometimes cysts will need surgery. When does ovulation occur during a normal cycle Day 14 Characteristics of a cystocele A cystocele, also known as a prolapsed bladder, is a pelvic organ prolapse that occurs when the muscles and ligaments that support the bladder weaken. Symptoms can include: Urinary symptoms: Frequent or urgent urination, difficulty starting urination, a slow urine stream, or a feeling of incomplete bladder emptying Pelvic symptoms: A feeling of fullness, heaviness, or pain in the pelvic area, or pressure in the vaginal area Constipation: Constipation or difficulty fully emptying the bowels Sexual symptoms: Pain or urinary leakage during sexual intercourse Other symptoms: Difficulty inserting tampons, or discomfort in the pelvic area when coughing, bending, jumping, or lifting Symptoms may worsen when standing, lifting heavy objects, coughing, or as the day progresses. Many women have a cystocele but don't experience symptoms. Some causes of a cystocele include: Family history of pelvic organ prolapse Conditions that affect connective tissues, such as Ehlers-Danlos syndrome Hysterectomy Straining during bowel movements or lifting heavy objects Long-term conditions that involve coughing Chronic constipation Characteristics of a rectocele A rectocele is a type of pelvic organ prolapse that occurs when the rectum bulges into the vaginal wall. Symptoms can include: A bulge or fullness in the vagina Difficulty having a bowel movement Tissue protruding from the vagina Discomfort during sexual intercourse A feeling of pressure in the pelvis Lower-abdominal or lower-back pain Symptoms that worsen when standing up and improve when lying down Slow or stopped urine flow Bladder or bowel urgency Incontinence or constipation A rectocele can be diagnosed with a pelvic exam and a digital rectal exam. Treatment options include medical management, surgical treatment, or biofeedback Characteristics of a uterine prolapse Uterine prolapse occurs when the uterus drops into the vaginal canal or protrudes from the vaginal opening. Symptoms include Pelvic pressure: A feeling of heaviness or pressure in the pelvis or vagina Vaginal bulging: Tissue may bulge into the vaginal canal or protrude from the vaginal opening Urinary issues: Leaking urine, urinary frequency, or incomplete bladder emptying Pain: Pain in the pelvis or lower back, or painful intercourse Constipation: Difficulty emptying the bowels Sexual difficulties: Painful or uncomfortable intercourse, or difficulty with arousal Vaginal bleeding: Abnormal vaginal bleeding Vaginal discharge: Increased vaginal discharge How to Avoid Your Uterine Prolapse Symptoms Worsening... Symptoms may be worse when standing, sitting, exercising, or lifting. The severity of the prolapse depends on the weakness of the pelvic support structures. Risk factors for uterine prolapse include: Being older Being obese Having had pelvic surgery Straining from chronic coughing, constipation, or heavy lifting Family history of pelvic organ prolapse or connective tissue conditions Having one or more vaginal births Giving birth to a large baby Treatments for uterine prolapse include lifestyle changes, vaginal pessaries, or surgery Symptoms and treatment of yeast infection There are several tell-tale signs of a vaginal yeast infection. These symptoms can include: An itchy or burning sensation in your vagina and vulva. A thick, white vaginal discharge with the consistency of cottage cheese. Redness and swelling of your vagina and vulva. Small cuts or tiny cracks in the skin of your vulva because of fragile skin in the area. A burning feeling when you pee. In some cases, another symptom of a vaginal yeast infection can be pain during sex. Antifungal medications work by fighting yeast overgrowth in your body. Medications are either oral (usually given in one dose of fluconazole by mouth) or topical (used daily for up to seven days). You may apply topical medications to your vaginal area or place them inside your vagina (suppository) using an applicator. Some common antifungal medications are miconazole (Monistat®) and terconazole. Ectopic pregnancy and best course of action for it: It is a fertilized egg outside of the uterus 50% of patients that have an ectopic pregnancy will have: Abdominal pain, vaginal bleeding, amenorrhea May also present with symptoms common to early pregnancy (nausea, breast fullness) Dizziness, fever, weakness, flu like symptoms, vomiting, syncope, cardiac arrest Any of the following sx are an EMERGENCY Abdominal rigidity, involuntary guarding, severe tenderness, evidence of hypovolemic shock (examples – orthostatic blood pressure changes, tachycardia) DIAGNOSIS – Serial beta Hcg , ultrasound imaging to visually determine location TREATMENT – medical management with intramuscular Methotrexate is an option for those who are hemodynamically stable – THIS IS NOT FDA APPROVED but has been endorsed by the ACOG, it avoids surgery, hcg values must be less than 1500 ENDOMETRIOSIS Endometriosis affects roughly 10% (190 million) of reproductive age women and girls globally. It is a chronic disease associated with severe, life-impacting pain during periods, sexual intercourse, bowel movements and/or urination, chronic pelvic pain, abdominal bloating, nausea, fatigue, and sometimes depression, anxiety, and infertility. There is currently no known cure for endometriosis and treatment is usually aimed at controlling symptoms. Access to early diagnosis and effective treatment of endometriosis is important, but is limited in many settings, including in low- and middle-income countries.. Symptoms Endometriosis often causes severe pain in the pelvis, especially during menstrual periods. Some people also have pain during sex or when using the bathroom. Some people have trouble getting pregnant. Pain may be most noticeable: during a period during or after sex when urinating or defecating. Some people also experience: chronic pelvic pain heavy bleeding during periods or between periods trouble getting pregnant bloating or nausea fatigue depression or anxiety. Symptoms often improve after menopause, but not always. Diagnosis A careful history of menstrual symptoms and chronic pelvic pain provides the basis for suspecting endometriosis. Although several screening tools and tests have been proposed and tested, none are currently validated to accurately identify or predict individuals or populations that are most likely to have the disease. Endometriosis can often present symptoms that mimic other conditions and contribute to a diagnostic delay. Ovarian endometrioma, adhesions and deep nodular forms of disease often require ultrasonography or magnetic resonance imaging (MRI) to detect. Histologic verification, usually following surgical/laparoscopic visualization, can be useful in confirming diagnosis, particularly for the most common superficial lesions. The need for histologic/laparoscopic confirmation should not prevent the commencement of empirical medical treatment. Treatment Treatments to manage endometriosis can vary based on the severity of symptoms and whether pregnancy is desired. No treatments cure the disease. A range of medications can help manage endometriosis and its symptoms. Non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics (painkillers) like ibuprofen and naproxen are often used to treat pain. Hormonal medicines like GnRH-analogues and contraceptive (birth control) methods can also help control pain. These methods include: pills hormonal intrauterine devices (IUDs) vaginal rings implants injections patches. These methods may not be suitable for those wanting to get pregnant. Fertility medicines and procedures are sometimes used for those having difficulty getting pregnant because of endometriosis. Surgery is sometimes used to remove endometriosis lesions, adhesions and scar tissues. Laparoscopic surgery (using a small camera to visualize inside the body) allows doctors to keep incisions small MENOPAUSE- how to diagnose, impact on hormone levels: Women typically notice the signs and symptoms of menopause without a formal diagnosis from their healthcare provider. A change in menstrual patterns and the appearance of hot flashes are usually the first signs. 12 months without a period. Although blood tests are not required, healthcare providers can run blood or urine tests to determine levels of the hormones estradiol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH).1,2 At menopause, the ovaries become less responsive to FSH and LH hormones, so the body makes more of these hormones to compensate. Estradiol and other hormones decrease around menopause as well. A healthcare provider can use the test results to tell if a woman is in menopause