Condoms and Awareness: Emergency?
Daphne of Bisset and the Duke of Hastings practiced this latin phrase with a 4% perfect use failure rate (which is also used by 15% of women in a 2016 survey)
coitus interruptus
According to the US Mec Guidelines, this POC is MOST concerning for patients that have diabetes with confirmed microvascular disease.
DMPA
Being late is OK with this combined hormonal contraceptive, which can be saved by the bell by 7 days
Nuvaring, or Vaginal Ring or Haloette
Endometrial Hyperplasia is a concern with which route(s) of Estrogen Therapy?
Oral and Transdermal (Not vaginal)
What risk factor is the greatest predictor of future fracture?
previous fracture (especially within the past 2 years)
When taking a clinical history during an assessment for primary dysmenorrhea you must assess the location, quality, onset, duration and consistency of the pain.
Describe the normal clinical presentation considering any 3 of the above
•LOCATION: Pain in lower abdominal or pelvic area that may radiate to lower back, groin or upper thighs.
•QUALITY: Symptoms of colicky and/or dull pain.
•ONSET: Start several hours before or after onset of menstrual flow
•DURATION: May persist up to 2 to 3 days
•CONSISTENT: Similar with each menstrual period
When considering a diagnosis of PMS, the reported symptoms should be assessed __________ and reproducible at least ___________ cycles
prospectively
2
A mid-cycle LH surge leads to these two physiologic changes to be monitored by women clever enough to recognize a potential time to abstain.
increase in body temperature and clearer, more elastic cervical mucus
You should recommend this for Sally, who is 12 hours late in taking her 25th day of her norethindrone (and had unprotected intercourse 2 days ago).
Take levonorgestrel 1.5mg and use back-up for 2 days
Talk about hard on the head! Sally wants to know what two options she has to stop her headaches during placebo week while taking Marvelon 28®.
Shorten to a 4 day HFI or use continuous dosing
Can systemic and vaginal estrogen be combined? Explain why or why not.
If a patient is experiencing VMS and GSM it is reasonable to combine - systemic estrogen is minimally effective for GSM and there are no risks of combining with a vaginal estrogen due to negligible systemic absorption.
For a patient at high risk (>20%) of fracture with no history of previous fracture and impaired kidney function (25ml/min) which agent would be preferred?
Denosumab
You are assessing a patient for primary dysmenorrhea. State 3 red flags that would prompt a referral for further investigation.
1st episode <6 months or >24 months after menarche
Suspect 2ndary dysmenorrhea
Atypical gynecologic symptoms such as...
Atypical systemic symptoms such as...
Intermenstrual Symptoms such as...
IUS inserted within the past year
Previous trial of optimal therapy failed
When considering treatment for PMS, what is an “ideal” hormonal contraception?
COC with continuous active pills preferred to hormone free interval
Drospirenone may be preferred progestogen (e.g. Yaz)
Q.R is a 42-year-old female with hypertension (chlorthalidone, ramipril), epilepsy (carbamazepine), BMI of 32 and a latex allergy. She had UPI 3 days ago because male refused to wear a condom. LMP 25 days ago, usual cycle 26 days. She’d like to know what to do now, how to protect from STIs and what contraceptive would be best moving forward.
No EC. Internal Condom. Mirena® IUS
Kegel beware! You should watch out for these three PID signs soon after IUD insertion.
Fever, suprapubic tenderness, discharge and uterine palpations (3 of 4)
No clot, I bid you NOT! SOGC experts estimate the risk of VTEs to be this many times greater in CHC users over their non-hormonal counterparts.
2-3 times greater
When is cyclic progestogen dosing recommended and why?
Causes a monthly withdrawal bleed. Useful during the menopause transition as helps reduce breakthrough bleeding.
A patient has experienced a fracture. Outline the key factors for determining if it is a fragility fracture.
NSAIDs are superior to APAP for primary dysmenorrhea. Explain why considering pathophysiology and the drug MOA.
Ovulatory cycles area associated with painful uterine contractions that result in uterine ischemia causing pain that is modulated and augmented by prostaglandins.
APAP acts centrally with minimal effect on peripheral pro-inflammatory prostaglandins compared to NSAIDs
What is the role of GnRH agonists (such as leuprolide) in premenstrual disorders?
-confirm diagnosis
- severe or refractory cases of PMDD