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