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Reproductive History

Reproductive History, Examination and Clinical Reasoning

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
Created by: Epoot