NR602 Week 2: Reflection Paper

Congratulations on completing the final week of women’s health in this course. This week we explored reproductive anatomy and common menstrual complaints seen in primary care. Dysmenorrhea and Abnormal Uterine Bleeding are common problems and differentiating their etiology requires knowledge of the associated conditions. The patient’s history is the most revealing which will inform your decision making. You will need to be comfortable in asking the tough questions to provide the best care.

Sexually transmitted infections are very prevalent in the United States. This week we completed modules from the National STD Curriculum which provided us with the tools for screening, diagnosis and appropriate treatment. Of course, education and prevention must be a part of the treatment plan.

Finally, we discussed the importance of cervical cancer screening in preventing cancer. We discussed the screening process and learned how to interpret the results.  Additionally, we looked at the current guideline recommendations regarding cervical cancer screening.

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• Dysmenorrhea is classified into primary and secondary causes. Secondary causes are due to anatomic pathology.
• Identifying the timing of the pain (cyclic vs. non-cyclic) is an important part of determining the etiology.
• NSAIDs are the first line treatment for dysmenorrhea and combined oral contraceptives are also beneficial.
• PMS and PMDD describe the physical and behavioral symptoms that occur in the luteal phase of the menstrual cycle.
• PMDD is a more severe form of PMS and is not as common.
• Mild PMS is typically managed symptomatically, whereas PMDD is often treated with SSRIs.
• Abnormal uterine bleeding is classified into structural abnormalities and conditions that are unrelated to structural abnormalities.
• The acronyms “PALM” and “COEIN” can be used to recall the conditions that fall into each category.
• Pregnancy should always be ruled out first in a female of reproductive age.
• Post-menopausal bleeding is considered cancer until otherwise proven.
• AUB work-up depends in history and physical findings.
• Bacterial vaginosis is the most common cause of vaginitis-it is not a sexually transmitted infection, but sexually active women are at higher risk than non-sexually active women.
• The Ansel criteria are used to diagnose bacterial vaginosis based on the characteristics of sampled vaginal fluid.
• Candidal vaginitis is associated with external and internal pruritus with clumpy “cottage-cheese like” discharge.
• The presence of an STI increases the risk of HIV.
• STI diagnosis and treatment is based on presenting symptoms, diagnostic testing and current guideline recommendations.
• Cervical cancer screening is performed via a PAP test; the most commonly used test is the ThinPrep® test.
• Cervical cytology results are reported according to the Bethesda system, which classifies abnormal cytology according to cancer risk.
• HPV is the most common cause of cervical cancer (some strains are more highly associated with aggressive types of cancer).
• There are many organizations that have recommendations for cervical cancer screening exams which are all very similar.
• Cervical cancer screening is not recommended in females less than 21 years of age regardless of their risk or history of sexual activity.

In weeks 3-8 we will be covering pediatric topics.  The content for women’s health that is covered in your textbook, lectures and modules will be represented on the midterm exam (not the final exam).

The following assignments are due in week 3:

• MyEvaluations Log
• Immunizations Case Study
• Website Exploration

If you are in a women’s health facility (or a family practice that frequently administers well women’s care) the concepts discussed in this week’s lecture will strengthen your ability to grasp the material. However, if you are not you will still gain the necessary knowledge needed to practice in a future clinical setting or your own practice. If you will encounter well women care infrequently in your practice, just know that there are numerous resources available to you for review.

After reviewing this week’s lesson, ask yourself the following questions:

• Do I understand the female reproductive anatomy and common causes of primary and secondary dysmenorrhea?
• Can I differentiate between the various medical terminologies used to describe abnormalities in the menstrual cycle?
• Can I classify and describe patterns of abnormal uterine bleeding according to the acronym, PALM-COEIN?
• Do I know the treatment options for the various menstrual disorders and more importantly, when a patient should be referred?
• Can I differentiate between common STIs and identify the correct treatment option based on guideline recommendations?
• Can I differentiate between ASCUS, LSIL, and HSIL cervical cytology and discuss the implications associated with each?
• Do I know the recommended screening ages and intervals according to the cervical cancer screening guidelines?