MPharm Programme. Women s Health

Transcription

1 MPharm Programme Women s Health Charlotte Earl-Sinha Slide 1 of 48

2 Genito-Urinary: Cystitis Inflammation of the bladder Causes Bacterial infection (E. coli) Poor Hygiene Toiletries Drugs Sexual intercourse Dehydration Slide 2 of 48

3 Genito-Urinary: Cystitis Symptoms Pain on passing urine Frequent need to pass urine Can only pass small amount of urine Dark cloudy urine Abdominal pain Blood in urine Fever and vomiting Slide 3 of 48

4 Genito-Urinary: Cystitis OTC Treatment Potassium Citrate (Cystopurin) Sodium Citrate (Cymalon ) Symptomatic relief alkalinise urine 1 sachet tds for 48hrs Cautions: HT, pregnancy, elderly, cardiac disease Slide 4 of 48

5 Genito-Urinary: Cystitis Counselling /Advice Drink plenty water Avoid caffeine, alcohol and acidic drinks Do not resist the urge to urinate Toilet hygiene (wipe front to back) Simple analgesics for pain Application of heat for pain (hot water bottle) Slide 5 of 48

6 Genito-Urinary: Cystitis Refer Men Children and pregnant women Recurrent attacks No improvement 24hrs after OTC treatment Red Flag symptoms see earlier Suspected uncontrolled diabetes Slide 6 of 48

7 Genito-Urinary: Thrush Vaginal yeast infection Candida Albicans Causes Antibiotics Diabetes Pregnancy Immunocompromised patient Oral contraceptives Tight synthetic underclothes Transfer during sex Slide 7 of 48

8 Genito-Urinary: Thrush Symptoms Vulval itching, soreness and irritation Odourless thick white discharge Pain on passing urine Pain during sexual intercourse Topical Treatment Clotrimazole external creams, internal cream, pessary Slide 8 of 48

9 Genito-Urinary: Thrush Oral Treatment Fluconazole 150mg capsule Counselling/Advice Clotrimazole can damage condoms/diaphragms Loose fitting cotton underwear Avoid irritants Avoid douching Treat partner Slide 9 of 48

10 Genito-Urinary: Thrush Refer 1 st time or more than 2 attacks in 6 months Under 16yrs or Over 60yrs Pregnant Blood in vaginal discharge Foul smelling/coloured discharge No improvement from OTC treatment (7days) Vulval or vaginal sores, ulcers or blisters Slide 10 of 48

11 Genito-Urinary: Bacterial vaginosis Infection caused by overgrowth of bacteria in the vagina Trigger factors IUDs Multiple sexual partners Excessive washing Symptoms Grey/white watery discharge with a fish-like odour Itchy or sore vagina Slide 11 of 48

12 Genito-Urinary: Bacterial Vaginosis Treatment Prescription only for treatment Topical metronidazole or clindamycin Oral metronidazole Referral important Untreated BV risk: PID/Miscarriage/Premature Labour OTC prevention Balance Active Vaginal Gel Slide 12 of 48

13 Genito-Urinary: Stress Incontinence Involuntary loss of urine during activities that raise intra-abdominal pressure e.g. Sneezing/ coughing Cause Weakness of urethral sphincter and pelvic floor muscles Childbirth, uterine prolapse, menopause, surgery Infection Slide 13 of 48

14 Genito-Urinary: Stress Incontinence Treatment Treat infection Pelvic floor exercise Electrical stimulation of pelvic floor muscles Surgery Vaginal cones/ devices Slide 14 of 48

15 Genito-Urinary: Stress Incontinence Counselling Wt loss and healthy lifestyle advice Drink enough fluid Avoid caffeine Use of absorbent pads Slide 15 of 48

16 Menstruation: Menstrual Cycle Usually begins at 13yrs old, can vary however 28 day cycle Ovulation occurs Day 14 First day of bleed = Day 1 Blood lost from vagina Bleed usually lasts approx. 5 days Slide 16 of 48

17 Menstruation: Dysmenorrhoea Primary Dysmenorrhoea 1 year after menstruation starts No specific cause Improves with age/after childbirth Occurs up to 1 day before bleed Lower abdominal pain, back pain, pain in top of legs Treat with OTC painkillers Application of heat might help Slide 17 of 48

18 Menstruation: Dysmenorrhoea Secondary Dysmenorrhoea Usually in older women Underlying condition: endometriosis, PID, fibroids, IUD Chronic rather then spasmodic pain Improves with treatment of underlying condition Symptoms start earlier in cycle and last longer Irregular bleeding and pain at any time of cycle Refer if suspected Slide 18 of 48

19 OTC Treatment Feminax Ultra Naproxen 250mg tablets (P) pack of 9 Provides relief from period pain and menstrual cramps First day: 2 tabs when pain starts, then take another 1 after 6-8hrs if needed Second and third day: 1 tablet every 6-8hrs Slide 19 of 48

20 OTC Treatment Feminax Express Ibuprofen lysine 342mg (16tabs) (GSL) Each tablet contains 200mg ibuprofen as lysine Fast relief for period pain and associated symptoms including cramps, backache and headaches Dosage: Over 12 years 1-2 tablets initially, then 1-2 every 4 hours thereafter Max 6 tablets in 24hrs Slide 20 of 48

21 Menstruation: Amenorrhoea The absence of menstruation Primary Amenorrhoea = failure to start periods Refer for investigation Secondary Amenorrhoea = absence of periods for 6 months Many possible underlying causes: pregnancy, exercise, menopause, stress, birth control, thyroid disorders, tumours, PCOS Slide 21 of 46

22 Menstruation: Menorrhagia Heavy periods Causes : - Non specific (dysfunctional uterine bleeding) - Fibroids, polyps, infection, endometrial cancer, PCOS, underactive thyroid Treatment: - Drugs: tranexamic acid, COC pill, NSAIDs, norethisterone tablets. - LNG-IUS - LA progestogen injection/implant - surgery Slide 22 of 48

23 Polycystic Ovary Syndrome Affects millions of women in the UK Underdeveloped follicles turn into cysts Approx 12 cysts per ovary Irregular or no release of eggs from ovaries Symptoms: Overweight, acne, excessive hair growth Treatment: Metformin/ OC no cure but can treat symptoms Risk Factors: Higher risk of diabetes, heart disease, uterine cancer Slide 22 of 46

24 Sexual Health: Sexually transmitted diseases Common symptoms that could indicate an STI: Unusual vaginal discharge Vaginal itching Rashes, lumps, blisters around genitals/anus Pain and/or bleeding during intercourse Bleeding between periods Pain or burning on passing urine Think: Chlamydia, Trichomoniasis, Warts, Herpes, Syphilis, Gonorrhoea IF POSSIBLE STILL REFER Slide 24 of 48

25 Sexual Health: Chlamydia Bacterial infection c.trachomatis 1 in 20 sexually active women in UK have Chlamydia Only 3/10 women are symptomatic Left untreated causes P.I.D OTC counselling and screening National Chlamydia Screening Programme (NCSP). OTC testing and prescribing Clamelle (azithromycin 500mg), in those over 16yrs, who have tested positive but no symptoms, or sexual partner has chlamydia with no symptoms. If symptoms present refer to GP Signposting local GUM clinic Slide 25 of 48

26 Sexual Health: PID Not an STD but most commonly caused by STDs Untreated Chlamydia and Gonorrhoea (90%) Symptoms Abdominal pain Vaginal discharge Spotting Nausea and/or vomiting Pain during sex/on urinating Slide 26 of 48

27 Sexual Health: PID Risk Factors for PID Multiple sexual partners Unprotected sex Insertion of IUD Giving Birth Surgery Refer any suspected case of PID for diagnosis and treatment Slide of 48

28 Sexual Health: Cervical Screening The Smear Test Not a test for STIs Tests for abnormal cervical cells Primary cause human papilloma virus (HPV) Pharmacist s role Knowledge/counselling/advice Especially young women Provision of HPV vaccination (Cervarix) on PGD Slide 28 of 48

29 Contraception: EHC Levonorgestrel and Ulipristal Acetate To be taken ASAP after unprotected sex Levonorgestrel effective up to 72hrs Ulipristal effective up to 120hrs (caution with OCs) Ulipristal P since 2015, Levonorgestrel POM and P (levonelle one step) Both available on some PGDs Slide 29 of 48

30 Contraception: OTC EHC Levonorgestrel 1500mg tabs (on PGD) Levonelle one step (P) Must be over 16yrs old Requires consultation with pharmacist before sale Can only be sold to the woman who needs it Effective up to 72hrs after unprotected sex Precise mode of action unknown Right to refuse to sell but MUST refer Slide 30 of 48

31 Contraception: OTC EHC Counselling Take as soon as possible If vomit or have diarrhoea within 2hrs repeat Next period may be early or late If next period late or unusual take pregnancy test Does not protect against STDs Advise on long-term contraception if necessary Levonorgestrel can be used while breast-feeding Slide 31 of 48

32 Contraception: OTC alerts! Always be mindful of women presenting with: sudden severe chest pain sudden breathlessness unexplained swelling or severe pain in calf of one leg severe stomach pain unusual severe, prolonged headache sudden partial or complete loss of vision sudden disturbance of hearing IF ON ORAL HORMONAL CONTRACEPTION REFER Slide 32 of 48

33 Pregnancy: Ovulation tests Test for LH in the urine. LH surge predicts that ovulation is going to occur in hours. Woman needs to know length of cycle to know when to start testing. Two most fertile days are LH surge and day after. Other methods include: Calendar Tracking Using fertility thermometer Slide 33 of 46 48

34 Pregnancy: Fertility Thermometer Slide 34 of 48

35 Pregnancy: Preparing for pregnancy Pharmacist s role health and lifestyle advice Healthy eating Plenty of fluids but avoid caffeine and alcohol Stop smoking Medication prescribed or OTC? Take Folic Acid 400mcg daily Take Vitamin D10 mcg daily Avoid Vitamin A Slide 35 of 48

36 Pregnancy: Pregnancy Tests Test for HCG in urine. Test positive from first day of missed period. Most more than 99% accurate. Some tests claim to be accurate four days before period is due. Slide 36 of 48

37 Pregnancy: OTC support Pain/Headache/Flu Analgesic= paracetamol. Refer severe pain and persistent or severe headache. Nausea and vomiting Morning sickness usually 1 st trimester. Ginger. Sea-bands. Refer constant and severe vomiting. Slide 37 of 48

38 Pregnancy: OTC support Indigestion/ heartburn Around half of women get heartburn. Increased intra-abdominal pressure and hormonal effects on sphincter. Sodium Alginate (Gaviscon). Constipation Estimated one in three suffer. Increase fluids and fibre. Avoid stimulant laxatives. Bulk laxatives preferred (ispaghula husk). Slide 38 of 48

39 Pregnancy : Ectopic Occurs when embryo implants in fallopian tube instead of uterus Presents with: Unusual vaginal bleeding Nausea and vomiting Lower abdominal pain/cramps on one side of the body Dizziness or weakness Pain in the shoulder, neck, or rectum Missed period Slide 39 of 48

40 Pregnancy : Ectopic Risk Factors IUD PID STI IVF History Congenital abnormality Life threatening refer any suspected Ectopic Pregnancy Slide 40 of 48

41 Overfeeding very unusual. Breastfeeding Underfeeding more common. Supplement with bottle/feeder cup. Is baby tongue-tied? Engorged breasts very painful. Do not use a breast pump. Reduce fluid intake. Refer to health visitor. Slide 41 of 48

42 Breastfeeding Cracked sore nipples Poor technique Refer to health visitor Baby positioned wrongly Refer to HV/ breastfeeding support team Infection? Baby has oral thrush? Soothing nipple cream- chamomile extract (kamillosan) Slide 42 of 46 48

43 Menopause The end of the menstrual cycle Ovaries stop producing eggs Oestrogen levels drop Menstrual cycle disrupted Perimenopause Can last several years Typically starts age 45 to 47 Post-menopause One year after last period Slide 43 of 48

44 Menopause Symptoms Hot flushes and night sweats Anxiety and depression Irritability Poor memory and concentration Insomnia Sexual changes Urinary problems Headaches and/or joint and muscle pain Slide 44 of 48

45 Menopause Complications Osteoporosis Heart Disease Stroke Weakness of pelvic floor Dryness of eyes, mouth, throat, vagina Thinning of skin and hair Slide 45 of 48

46 Menopause Treatments HRT Phyto-oestrogens (Soya; Black Cohosh). Homeopathy (pulsatilla; sepia; Sulphur). Herbal (Valerian; Feverfew; St John s Wort). Vitamins and minerals (Menopace) Calcium and vitamin D. Lubricants (Senselle; Replens; KY Jelly). Evening primrose oil. Slide 46 of 48

47 Menopause Counselling Contraceptive advice (!) Good diet (calcium rich food). Drink plenty of water. Stop smoking. Exercise. Refer Unusual bleeding. Slide 47 of 48

48 Weight loss and lifestyle Eating disorders Laxative addiction Losing weight effectively Diet and exercise Alcohol (weekly units maximum) Smoking Safe Sex Slide 48 of 48