Reproductive History, Examination and Clinical Reasoning
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| Infertility | The inability of a sexually active, non-contraceptive couple to achieve pregnancy in one year
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| Menorrhagia | >80ml
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| Normal menstrual blood loss | 35ml
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| Normal menstrual duration | 3-7 days
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| Length of normal menstrual cycle | 24-35 days
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| Menarche | 10.5 - 16.5 years, Tanner stage 4
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| Adrenarche | 8 years
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| Peak onset of growth in males | 14 years
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| Peak onset of growth in females | 12 years
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| Last normal menstrual period | First day that they last bled
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| Secondary amenorrhoea | Lack of menstrual period for 6 months
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| Menopause | Absence of a period for 1 year
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| Normal time after menarche that periods are irregular | 2 years
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| Gravida | Number of pregnancies carried to a viable gestational age
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| Parity | The number of >20 weeks births (viable and non-viable)
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| Superficial dyspareunia | Vaginismus due to reflex of the pubococcygeus muscle
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| Deep dyspareunia | Infection of the uterus, pelvic inflammatory disease
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| Post-coital bleeding | Cervical cancer, uterine cancer, vaginal tears.
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| Clear, thin cervical mucus | Before ovulation
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| Thick, white cervical mucus | During luteal phase
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| Pelvic pain | Cystitis, ectopic pregnancy, UTI, pelvic inflammatory disease
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| Polycystic Ovarian Syndrome | Hirsutism, acne, difficulties with weight loss
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| Testes pain/lumps | Varicocele, epididymitis, tesicular torsion
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| Oral contraceptive pill contraindicated in smokers of this age group | >35 years
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| Day 21 progesteron | Marker of ovulation
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| FSH/oestradiol levels | Marker of menopause
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| Androgen studies | PCOS
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| First pass urine test | Chlamydia, gonorrhoea
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| Premature ovarian insufficiency | Menopause before the age of 40 years.
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| Number of primordial follicles at birth | 1,000,000
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| Number of primordial follicles at puberty | 400,000
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| Number of primordial follicles at 37 | 25,000
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| Estnorgestrol Implant (Implanon)- Effectiveness | 99.7%, typical 91%
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| Combined Oral Contraceptive Pill - Pros | Shorter, lighter and less painful periods. Cytoperone actetate improves skin
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| Combined Oral Contraceptive Pill - Cons | Sickness, bleeding between periods, headaches, bloating, mood swings. Not good for types of migraines, overweight, hypertensives, heart or liver conditions.
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| Combined Oral Contraceptive Pill - Effectiveness | 99.7%, typical 91%
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| Progesterone Only Pill - Pros | Better than COCP if breastfeeding, migraines, smoker, over 35, high BP.
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| Progesterone Only Pill - Cons | Must be taken in a 3 hr window each day, may be ineffective if taken late.
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| Progesterone Only Pill - Effectiveness | 99.7%, typical 91%
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| Estnorgestrol Implant (Implanon) - Pros | Lasts for 3 years,quickly return to fertility state, not affected by diarrhoea or vomiting
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| Estnorgestrol Implant (Implanon)- Cons | Irregular and more frequent periods, put on weight, bloating, mood swings or skin changes
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| Nuvaring - Action | A small soft ring made from oestrogen and progesterone. Sits in vagina for 3 weeks at a time.
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| Nuvaring - Pros | Shorter, lighter and less painful periods. Improves skin, less hormones than other methods
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| Nuvaring - Cons | Sickness, spotting, sore breasts, headache, blaoting. Not good for hypertension, heart condition, or liver disease.
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| Nuvaring - Effectiveness | 99.7%, typical 91%
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| Depot Provera - Action | An injection given every 12 weeks to stop ovulation each month.
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| Depot Provera - Pros | 50% chance of having no period
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| Depot Provera - Cons | Can take up to 1 year for fertility to return to normal. Break through bleeding, weight gain, sore breasts, decreased libido, mood swings, headache, skin changes
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| Depot Provera - Effectiveness | 99.7%,typical 93%
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| Copper Intrauterine Device - Action | Small device put inside the uterus by a trained doctor. Lasts 10 years.
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| Copper Intrauterine Device - Cons | May make periods heaier and more painful. Risk of infection during insertion
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| Copper Intrauterine Device - Effectiveness | >99% but expensive ($200)
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| Mirena Intrauterine Device - Action | Small plastic hormone impregnated device with white nylon strings that is put in the uterus by a trained doctor. Lasts 5 years
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| Mirena Intrauterine Device - Pros | Will make periods lighter or absent. Not affected by drugs or natural remedies
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| Mirena Intrauterine Device - Cons | Small risk on infection during inserion. Strict contraindication in breast cancer and thromboembolic disease
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| Mirena Intrauterine Device - Effectiveness | >99%, on PBS
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| Male Condom Effectiveness | 98% perfect, 85% typical
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| Female Condom Effectiveness | 95% perfect, 79% typical
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| Diaphragm - Cons | Must be cleaned and checked for holes before and after use. Risk of bladder infection
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| Natural Family Planning - Cons | Need to be aware of body changes. Can only have intercourse when libido is low. Hard to use if periods are irregular
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| Diaphragm - Effectiveness | 94% perfect, 85% typical
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| Natural Family Planning - Effectiveness | 99% perfect, 75% typical
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| Emergency Contraception - Action | Aims to stop ovaries from releasing an ovum
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| Period of highest female fertility | 2-3 days before ovulation
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| Emergency Contraception - Cons | Sickness, bleeding. Vomiting within 2 hrs makes it ineffective
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| Emergency Contraception - Effectiveness | 85% perfect use, depends on time taken after intercourse
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| Lactational Amenorrhoea - Effectiveness | 98% perfect with fully breastfeeding, less than 6-12 months post-partum and amenorrhoea
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| Withdrawal - Effectiveness | 96% perfect, 73% typical
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| Perimenopause | Period of time between when periods became irregular and 12 months after the last normal menstrual period
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