3. A. Dysmenorrhea (Menstrual Cramps)
What is dysmenorrhea?
Dysmenorrhea is the medical term for
pain with menstruation.
There are two types of dysmenorrhea:
"primary" and "secondary".

4. Primary dysmenorrhea
 Is common menstrual cramps that are recurrent and
are not due to other diseases.
 Cramps usually begin one to two years after a woman
starts getting her period.
 Pain usually begins 1 or 2 days before or when
menstrual bleeding starts and is felt in the lower
abdomen, back, or thighs and can range from mild to
severe.
 Pain can typically last 12 to 72 hours and can be
accompanied by nausea, vomiting, fatigue, and even
diarrhea. Common menstrual cramps usually become
less painful as a woman ages and may stop entirely if
the woman has a baby.

5. Secondary dysmenorrhea
 Is pain that is caused by a disorder in the
woman's reproductive organs, such as
endometriosis, adenomyosis, uterine
fibroids, or infection.
 Pain from secondary dysmenorrhea usually
begins earlier in the menstrual cycle and lasts
longer than common menstrual cramps.
 The pain is not typically accompanied by
nausea, vomiting, fatigue, or diarrhea.

6. What are the symptoms of dysmenorrhea?
 Aching pain in the abdomen (pain may be severe at times)
 Feeling of pressure in the abdomen
 Pain in the hips, lower back, and inner thighs
What causes common menstrual cramps?
 Menstrual cramps are caused by contractions in the uterus
(which is a muscle) by a chemical called prostaglandin. The
uterus contracts throughout a woman's menstrual cycle.
During menstruation, the uterus contracts more strongly. If
the uterus contracts too strongly, it can press against nearby
blood vessels, cutting off the supply of oxygen to the muscle
tissue of the uterus. Pain results when part of the muscle
briefly loses its supply of oxygen.

7. What other factors influence menstrual cramps?
 An unusually narrow cervical canal.
 A retroverted uterus.
 Lack of exercise
 Psychological factors
How can I relieve mild menstrual cramps?
 Take ibuprofen as soon as bleeding or cramping starts.
 Place a heating pad or hot water bottle on your lower back or
abdomen.
 Rest when needed.
 Massage your lower back and abdomen.
 Avoid foods that contain caffeine.
 Avoid smoking and drinking alcohol.
 To help prevent cramps, make exercise a part of your weekly
routine.

9. B. Sexually Transmitted Infection
Sexually transmitted diseases (STD), also referred to as sexually
transmitted infections (STI) and venereal diseases (VD), are illnesses
that have a significant probability of transmission between humans by
means of human sexual behavior, including vaginal intercourse, oral
sex, and anal sex. While in the past, these illnesses have mostly been
referred to as STDs or VD, in recent years the term sexually transmitted
infections(STIs) has been preferred, as it has a broader range of
meaning; a person may be infected, and may potentially infect others,
without having a disease. Some STIs can also be transmitted via the
use of IV drug needles after its use by an infected person, as well as
through childbirth or breastfeeding. Sexually transmitted infections
have been well known for hundreds of years, and venereology is the
branch of medicine that studies these diseases.

10. Classification:
Sexually transmitted infection is a broader term than sexually
transmitted disease. An infection is a colonization by a parasitic
species, which may not cause any adverse effects. In a disease the
infection leads to impaired or abnormal function. In either case the
condition may not exhibit signs or symptoms. Increased
understanding of infections like HPV, which infects most sexually
active individuals but cause disease in only a few has led to
increased use of the term STI. Public health officials originally
introduced the term sexually transmitted infection, which clinicians
are increasingly using alongside the term sexually transmitted
disease in order to distinguish it from the former.
STD may refer only to infections that are causing diseases, or it may
be used more loosely as a synonym for STI. Because most of the time
people do not know that they are infected with an STI until they are
tested or start showing symptoms of disease.

11. Here are some of the most common STDs and their symptoms. It's
important to remember that you can get and pass many of these diseases
through different forms of sex (vaginal, anal, and oral).
1. Chlamydia
Most people have no symptoms. Abnormal discharge from the penis or
vagina, pain in the testicles, and burning with urinating. Long-term
irritation may cause lower abdominal pain, inflammation of the eyes and
skin lesions. In women, it can cause inflammation of the pelvic organs
pelvic inflammatory disease (PID). Chlamydia an be completely cured, but
can be caught again, especially if both sex partners aren't treated.
Signs and symptoms may include:
 Painful urination
 Lower abdominal pain
 Vaginal discharge in women
 Discharge from the penis in men
 Pain during sexual intercourse in women
 Testicular pain in men

12. 2. Genital Herpes
Small red bumps, blisters, or open sores on the penis,
vagina, or areas close by. Also, vaginal discharge in
women. Fever, headache, and muscle aches. Pain when
urinating. Itching, burning, or swollen glands in genital
area. Pain in legs, buttocks, or genital area. Symptoms
may go away and then come back. Some people may have
no symptoms. There is no cure. Treatment includes taking
a medicine to lower severity of symptoms.
When present, genital herpes signs and symptoms may
include:
 Small, red bumps, blisters (vesicles) or open sores
(ulcers) in the genital, anal and nearby areas
 Pain or itching around the genital area, buttocks and
inner thighs

13. 3. Trichomoniasis
Trichomoniasis is a common STI caused by a microscopic, one-celled
parasite called Trichomonas vaginalis. This organism spreads during
sexual intercourse with someone who already has the infection. The
organism usually infects the urinary tract in men, but often causes
no symptoms in men. Trichomoniasis typically infects the vagina in
women. When trichomoniasis causes symptoms, they may range
from mild irritation to severe inflammationincludes taking a
medicine to lower severity of symptoms.
Signs and symptoms may include:
 Clear, white, greenish or yellowish vaginal discharge
 Discharge from the penis
 Strong vaginal odor
 Vaginal itching or irritation
 Itching or irritation inside the penis
 Pain during sexual intercourse
 Painful urination

14. 4. Gonorrhea
Pain or burning when urinating. Yellowish and sometimes
bloody discharge from the penis or vagina. But, many men
have no symptoms. Can be completely cured, but can be
caught again, especially if both sex partners aren't
treated.
Signs and symptoms of gonorrhea may include:
 Thick, cloudy or bloody discharge from the penis or
vagina
 Pain or burning sensation when urinating
 Abnormal menstrual bleeding
 Painful, swollen testicles
 Painful bowel movements
 Anal itching

15. 5. Hepatitis B
Mild fever. Headache and muscle aches, joint pain.
Tiredness. Loss of appetite. Nausea and vomiting. Dark-colored
urine and pale bowel movements. Stomach pain. Skin and
whites of eyes turning yellow (jaundice). About 30% of people
have no symptoms.
Treatment inlcudes taking a medicine to help the liver
fight damage from the virus. There are medications available
to treat long-lasting (chronic) HBV-infection. These work for
some people, but there is no cure for hepatitis B when you first
get it.
Fortunately, routine immunization of all children with
the Hepatitis B vaccine will hopefully eliminate future Hepatitis
B infections.

16. 5. Hepatitis B
Some people never develop signs or symptoms. But for those
who do, signs and symptoms may occur after several weeks
and may include:
 Fatigue
 Nausea and vomiting
 Abdominal pain or discomfort, especially in the area of your
liver on your right side beneath your lower ribs
 Loss of appetite
 Fever
 Dark urine
 Muscle or joint pain
 Itching
 Yellowing of your skin and the whites of your eyes (jaundice)

17. 6. HIV Infection And AIDS
May have no symptoms for 10 years or more. Extreme fatigue.
Rapid weight loss. Frequent low-grade fevers and night sweats.
Frequent yeast infections (in the mouth). Red, brown, or
purplish blotches on or under the skin or inside the mouth,
nose, or eyelids. Women can have vaginal yeast infections and
other STDs, pelvic inflammatory disease (PID), and menstrual
cycle changes. There is no cure. Treatment includes taking
medicines to stop the virus from replicating, or making copies
of itself.
Early HIV signs and symptoms may include:
 Fever
 Headache
 Sore throat
 Swollen lymph glands
 Rash
 Fatigue

18. 6. HIV Infection And AIDS
These early signs and symptoms usually disappear within a
week to a month and are often mistaken for those of another
viral infection. During this period, you are very infectious.
More-persistent or -severe symptoms of HIV infection may not
appear for 10 years or more after the initial infection.
As the virus continues to multiply and destroy immune cells,
you may develop mild infections or chronic signs and
symptoms such as:
 Swollen lymph nodes — often one of the first signs of HIV
infection
 Diarrhea
 Weight loss
 Fever
 Cough and shortness of breath

19. 6. HIV Infection And AIDS
Signs and symptoms of later stage HIV infection include:
 Persistent, unexplained fatigue
 Soaking night sweats
 Shaking chills or fever higher than 100.4 F (38 C) for
several weeks
 Swelling of lymph nodes for more than three months
 Chronic diarrhea
 Persistent headaches
 Unusual, opportunistic infections

20. 7. Genital Warts (Human Papillomavirus (HPV)
Genital warts that usually first appear as small, hard painless
bumps on the penis, in the vaginal area, or around the anus.
They sometimes can be hard to see, but if left untreated can
turn into a fleshy, cauliflower-like appearance. Some people
have no apparent symptoms. HPV is linked with a higher risk of
cervical cancer in women.
Gardasil, the HPV vaccine, will hopefully decrease the risk of
getting genital warts and cervical cancer and can be given to
girls between the ages of 9 and 26 years of age.
The signs and symptoms of genital warts include:
 Small, flesh-colored or gray swellings in your genital area
 Several warts close together that take on a cauliflower shape
 Itching or discomfort in your genital area
 Bleeding with intercourse

21. 8. Syphilis
In the first (primary) stage, about 10 days to six weeks after exposure: a painless
sore (chancre) or many sores that will heal on their own. If not treated, infection
spreads to the next stage. Secondary stage: skin rash that usually does not itch and
clears on its own. Fever, swollen lymph glands, sore throat, patchy hair loss,
headaches, weight loss, muscle aches, and tiredness. Latent (hidden) stage:
symptoms disappear, but infection remains in body and can damage the brain,
nerves, eyes, heart, blood vessels, liver, bones, and joints. Late stage: not able to
coordinate muscle movements, paralysis, numbness, gradual blindness, dementia,
and possibly death. Can be completely cured, but can be caught again, especially if
both sex partners aren't treated.
However, having no symptoms does not mean that someone does not have an
infection that needs treating or an infection that can lead to a disease or medical
condition.
The common way to prevent the transmission of STIs or STDs is to avoid
unprotected sexual contact, whether it is vaginal, anal or oral. However, some STIs
or STDs such as herpes can still be passed even if a condom or dental dam is used.
It is important to educate yourself and others about how STIs or STDs are
transmitted and how to safeguard your sexual health, including identifying
symptoms and seeking medical help early.

22. 8. Syphilis
Primary
 These signs may occur from 10 days to three
months after exposure:
 A small, painless sore (chancre) on the part of your
body where the infection was transmitted, usually
your genitals, rectum, tongue or lips. A single
chancre is typical, but there may be multiple sores.
 Enlarged lymph nodes.
Signs and symptoms of primary syphilis typically
disappear without treatment, but the underlying
disease remains and may reappear in the second
(secondary) or third (tertiary) stage.

23. 8. Syphilis
Secondary
 Signs and symptoms of secondary syphilis may begin two
to 10 weeks after the chancre appears, and may include:
 Rash marked by red or reddish-brown, penny-sized sores
over any area of your body, including your palms and soles
 Fever
 Fatigue and a vague feeling of discomfort
 Soreness and aching
These signs and symptoms may disappear within a
few weeks or repeatedly come and go for as long as
a year.

24. 8. Syphilis
Latent
 In some people, a period called latent syphilis — in which no
symptoms are present — may follow the secondary stage. Signs and
symptoms may never return, or the disease may progress to the
tertiary stage.
Tertiary
 Without treatment, syphilis bacteria may spread, leading to serious
internal organ damage and death years after the original infection.
Some of the signs and symptoms of tertiary syphilis include:
 Neurological problems. These may include stroke and infection and
inflammation of the membranes and fluid surrounding the brain and
spinal cord (meningitis). Other problems may include poor muscle
coordination, numbness, paralysis, deafness or visual problems.
Personality changes and dementia also are possible.
 Cardiovascular problems. These may include bulging (aneurysm) and
inflammation of the aorta — your body's major artery — and of other
blood vessels. Syphilis may also cause valvular heart disease, such as
aortic valve problems.

25. 8. Syphilis
When a woman is pregnant STDs can be more serious for her
and her baby.
 A pregnant woman with an STD can infect her baby before,
during, or after the baby’s birth.
 She may also have early labor or early rupture of the
membranes surrounding the baby in the uterus.
 Pregnant women should ask their doctors about getting
tested for STDs, since some doctors do not routinely perform
these tests.

27. C. Postpartum Psychosis
 This condition is uncommon. It occurs in only one to two women per
1,000 births.
 In most cases it begins within the first two to four weeks following
the birth of the baby but can occur later than this.
 This is a serious and sometimes even life threatening condition and
urgent treatment is required. The baby’s safety may also be at risk.
 The word psychosis means to be out of touch with reality.
 A person may be out of touch with reality if they are experiencing
delusions or hallucinations (or both).
 is a rare illness, compared to the rates of postpartum depressions or
anxiety. It occurs in approximately 1 to 2 out of every 1,000
deliveries, or approximately 1% of births. The onset is usually
sudden, most often within the weeks postpartum.

28. Symptoms of Postpartum Psychosis
Symptoms of postpartum psychosis are consistent
with those of a bipolar I psychotic episode but have
some special "twists" specifically related to
motherhood. They include, but are not limited to:
 feeling ‘high’, ‘manic’ or ‘on top of the world’
 low mood and tearfulness
 anxiety or irritability
 rapid changes in mood
 severe confusion
 being restless and agitated
 racing thoughts

29.  behaviour that is out of character
 being more talkative, active and sociable than
usual
 being very withdrawn and not talking to people
 finding it hard to sleep, or not wanting to sleep
 losing your inhibitions
 feeling paranoid, suspicious, fearful
 feeling as if you’re in a dream world

30. Causes:
 Most, but not all cases of postpartum psychosis are
episodes of bipolar disorder.
 They may be due to other psychiatric conditions or
other medical conditions causing delirium. These are
what psychiatrists call “mixed mood states” (part of
bipolar disorder) and which can result in big
fluctuations in how a person is feeling and behaving.
Women seem to be particularly prone to these states
after having a baby.
 Some women are particularly vulnerable to the mental
effects of sudden changes in hormone levels (this seems
to set off an underlying mood disorder).
 Sleep deprivation may also be an important trigger.

31. Who is most likely to get postpartum psychosis?
 For many women with postpartum psychosis there may be no
warning. For other women it is clear that they have a high risk.
If you have ever had a diagnosis of bipolar disorder or
schizoaffective disorder, your risk of postpartum psychosis is
high. You may also be in this high risk group if you have had a
diagnosis of schizophrenia or another psychotic illness.
 If you also have a mother or sister who has had postpartum
psychosis, your risk may be even higher. Women who have had
postpartum psychosis before are also at very high risk. If you
are in one of these high risk groups your chance of having
postpartum psychosis is between 1 in 4 and 1 in 2 (25% to
50%). You should discuss your individual risk with a psychiatrist.
 You may be worried about your risk if a close relative has had
postpartum psychosis. If your mother or sister had postpartum
psychosis but you have not had any mental illness, your risk is
around 3 in 100 (3%). This is higher than the risk in the general
population. It is still much lower than for the very high risk
groups.

32. For women at high risk can anything be done to prevent it?
 Ideally let your psychiatrist and GP know that you want to get
pregnant before you start trying for a baby. You can discuss with them
any medications you are taking. They can advise you what you can do
to ensure you are as well as possible before becoming pregnant. Many
pregnancies are not planned. In that case, let people know as soon as
possible.
 If you are pregnant it is important to tell everyone involved in your
care about your previous illness. This includes your midwife,
obstetrician, GP and health visitor. Your mental health team and GP
need to know you are pregnant. They all need to know you have a
high risk of postpartum psychosis to make sure you get the care you
need. They should help you to make a plan for your care (see below).
 Paying attention to other factors known to increase the risk of
becoming ill may be important. These could include trying to reduce
other stressful things going on in your life. Try to get as much sleep
and rest as you can in late pregnancy and after the birth. With a new
baby this may difficult. Ask your partner or family to take on some of
the night time feeds if possible. Think about any factors which usually
trigger your episodes of illness. Try to do whatever you can to reduce
the chance of these happening.

33. Will medication stop me getting ill after the baby is born?
For women taking medication to help keep them well, the decision to
continue or stop medication in pregnancy is very difficult. There are no
right and wrong answers. There are risks involved with all possible
options. The options you can consider include:
 continuing on all or some of your current medication
 switching to other options which may be safer in pregnancy
 coming off all medications.
It is important to discuss these with your psychiatrist. This will help you
decide what is best for you and your baby.
Some women at high risk of postpartum psychosis may decide to start
medication in late pregnancy or after delivery. This may reduce the risk
of becoming ill. There is not enough research evidence to be sure about
this. A number of medications are sometimes used in this way. These
include antipsychotics and lithium. You should discuss this with your
psychiatrist.

35. D. Infertility
Infertility means not being able to get pregnant after one year of
trying (or six months if a woman is 35 or older). Women who can
get pregnant but are unable to stay pregnant may also be
infertile.
Pregnancy is the result of a process that has many steps. To get
pregnant:
 A woman's body must release an egg from one of her ovaries.
 The egg must go through a fallopian tube through the uterus
 A man's sperm must join with (fertilize) the egg along the way.
 The fertilized egg must attach to the inside of the uterus
(implantation).
Infertility can happen if there are problems with any of these
steps.

36. About 10 percent of women (6.1 million) in the United States ages 15-44 have
difficulty getting pregnant or staying pregnant, according to the Centers for
Disease Control and Prevention (CDC).
Infertility is not always a woman's problem. Both women and men can have
problems that cause infertility. About one-third of infertility cases are caused by
women's problems. Another one third of fertility problems are due to the man. The
other cases are caused by a mixture of male and female problems or by unknown
problems.
Most cases of female infertility are caused by problems with ovulation. Without
ovulation, there are no eggs to be fertilized. Some signs that a woman is not
ovulating normally include irregular or absent menstrual periods.
Ovulation problems are often caused by polycystic ovarian syndrome (PCOS). PCOS
is a hormone imbalance problem which can interfere with normal ovulation. PCOS is
the most common cause of female infertility. Primary ovarian insufficiency (POI) is
another cause of ovulation problems. POI occurs when a woman's ovaries stop
working normally before she is 40. POI is not the same as early menopause.

37. Less common causes of fertility problems in women include:
 Blocked fallopian tubes due to pelvic inflammatory disease.
Endometriosos, or surgery for an ectopic pregnancy
 Physical problems with the uterus
 uterine fibroids, which are non-cancerous clumps of tissue and
muscle on the walls of the uterus.

38. Many things can change a woman's ability to have a baby. These
include:
 Age
 Smoking
 Excess alcohol use
 Stress
 Poor diet
 Athletic training
 Being overweight or underweight
 Sexually transmitted infections (STIs)
 Health problems that cause hormonal changes, such as
polycystic ovarian syndrome

39. Many women are waiting until their 30s and 40s to have children.
In fact, about 20 percent of women in the United States now have
their first child after age 35. So age is a growing cause of fertility
problems. About one-third of couples in which the woman is over
35 have fertility problems.
Aging decreases a woman's chances of having a baby in the
following ways:
 Her ovaries become less able to release eggs
 She has a smaller number of eggs left
 Her eggs are not as healthy
 She is more likely to have health conditions that can cause
fertility problems
 She is more likely to have a miscarriage

40. Women 35 or older should see their doctors after six months of
trying. A woman's chances of having a baby decrease rapidly every
year after the age of 30.
Some health problems also increase the risk of infertility. So,
women should talk to their doctors if they have:
 Irregular periods or no menstrual periods
 Very painful periods
 Endometriosis
 Pelvic inflammatory disease
 More than one miscarriage

41. In women, the first step is to find out if she is ovulating each
month. There are a few ways to do this. A woman can track her
ovulation at home by:
 Writing down changes in her morning body temperature for
several months
 Writing down how her cervical mucus looks for several months
 Using a home ovulation test kit (available at drug or grocery
stores)

42. Doctors can also check ovulation with blood tests. Or they
can do an ultrasound of the ovaries. If ovulation is normal,
there are other fertility tests available.
Some common tests of fertility in women include:
 Hysterosalpingography:
This is an x-ray of the uterus and fallopian tubes.
Doctors inject a special dye into the uterus through the
vagina. This dye shows up in the x-ray. Doctors can then
watch to see if the dye moves freely through the uterus and
fallopian tubes. This can help them find physical blocks that
may be causing infertility. Blocks in the system can keep the
egg from moving from the fallopian tube to the uterus. A
block could also keep the sperm from reaching the egg.

43.  Laparoscopy:
A minor surgery to see inside the abdomen. The
doctor does this with a small tool with a light called a
laparoscope. She or he makes a small cut in the lower
abdomen and inserts the laparoscope. With the laparoscope,
the doctor can check the ovaries, fallopian tubes, and uterus
for disease and physical problems. Doctors can usually find
scarring and endometriosis by laparoscopy.
Finding the cause of infertility can be a long and emotional
process. It may take time to complete all the needed tests

44. Treatment:
Infertility can be treated with medicine, surgery, artificial
insemination or assisted reproductive technology Many times
these treatments are combined. In most cases infertility is treated
with drugs or surgery.
Doctors recommend specific treatments for infertility based on:
 Test results
 How long the couple has been trying to get pregnant
 The age of both the man and woman
 The overall health of the partners
 Preference of the partners

45. Intrauterine insemination (IUI) is an infertility treatment that is
often called artificial insemination. In this procedure, the woman is
injected with specially prepared sperm. Sometimes the woman is
also treated with medicines that stimulate ovulation before IUI.
IUI is often used to treat:
 Mild male factor infertility
 Women who have problems with their cervical mucus
 Couples with unexplained infertility

46. Assisted Reproductive Technology is a group of different methods used to help
infertile couples. ART works by removing eggs from a woman's body. The eggs
are then mixed with sperm to make embryos. The embryos are then put back in
the woman's body.
Some things that affect the success rate of ART include:
 Age of the partners
 Reason for infertility
 Clinic
 Type of ART
 If the egg is fresh or frozen
 If the embryo is fresh or frozen
The U.S. Centers for Disease Control and Prevention (CDC) collects success rates
on ART for some fertility clinics. According to the 2006 CDC report on ART, the
average percentage of ART cycles that led to a live birth were:
 39 percent in women under the age of 35
 30 percent in women aged 35-37
 21 percent in women aged 37-40
 11 percent in women aged 41-42

47. ART can be expensive and time-consuming. But it has allowed many couples to have
children that otherwise would not have been conceived. The most common
complication of ART is multiple fetuses. But this is a problem that can be prevented
or minimized in several different ways.
Common methods of ART include:
 In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most
effective ART. It is often used when a woman's fallopian tubes are blocked or
when a man produces too few sperm. Doctors treat the woman with a drug that
causes the ovaries to produce multiple eggs. Once mature, the eggs are removed
from the woman. They are put in a dish in the lab along with the man's sperm for
fertilization. After 3 to 5 days, healthy embryos are implanted in the woman's
uterus.
 Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF.
Fertilization occurs in the laboratory. Then the very young embryo is transferred
to the fallopian tube instead of the uterus.
 Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into
the woman's fallopian tube. So fertilization occurs in the woman's body. Few
practices offer GIFT as an option.
 Intracytoplasmic sperm injection (ICSI) is often used for couples in which there
are serious problems with the sperm. Sometimes it is also used for older couples
or for those with failed IVF attempts. In ICSI, a single sperm is injected into a
mature egg. Then the embryo is transferred to the uterus or fallopian tube.

48. ART procedures sometimes involve the use of donor eggs (eggs from
another woman), donor sperm, or previously frozen embryos. Donor
eggs are sometimes used for women who cannot produce eggs. Also,
donor eggs or donor sperm is sometimes used when the woman or man
has a genetic disease that can be passed on to the baby. An infertile
woman or couple may also use donor embryos. These are embryos that
were either created by couples in infertility treatment or were
created from donor sperm and donor eggs. The donated embryo is
transferred to the uterus. The child will not be genetically related to
either parent.
Surrogacy
Women with no eggs or unhealthy eggs might also want to consider
surrogacy. A surrogate is a woman who agrees to become pregnant using
the man's sperm and her own egg. The child will be genetically related to
the surrogate and the male partner. After birth, the surrogate will give up
the baby for adoption by the parents.

49. Gestational Carrier
Women with ovaries but no uterus may be able to use a gestational
carrier. This may also be an option for women who shouldn't become
pregnant because of a serious health problem. In this case, a woman
uses her own egg. It is fertilized by the man's sperm and the embryo is
placed inside the carrier's uterus. The carrier will not be related to the
baby and gives him or her to the parents at birth.
Recent research by the Centers for Disease Control and Prevention
showed that ART babies are two to four times more likely to have certain
kinds of birth defects. These may include heart and digestive system
problems, and cleft (divided into two pieces) lips or palate. Researchers
don’t know why this happens. The birth defects may not be due to the
technology. Other factors, like the age of the parents, may be involved.
More research is needed. The risk is relatively low, but parents should
consider this when making the decision to use ART.
Nurse’s Role:
The role of the infertility nurse is continually expanding and changing to
meet the demands of couples undergoing assisted reproduction.
.

51. E. Osteoporosis
Osteoporosis or porous bone is is a disease in which bone tissue is
normally minerized but the mass (density) of the bone is decreased
and the structural integrity of trabecular bone is impaired.
 The old bone is reabsorbed faster than the new bone is being made
causing the bone to lose density , becoming thinner and more
porous
 A natural process breaks down bones or removed (resorption) and
builds them back up again (formation) at the microscopic level.
 Children and young adults build more bone than they break down.
Pregnant women release bone to transfer needed minerals to the
developing fetus and then build up their own bone strength again
after giving birth.
 In women, bone loss is most rapid in the first five years after
menopause but persists throughout the postmenopausal years,
possibly because they no longer need extra stores of minerals to
support a developing fetus.
 People who have osteoporosis are at greater risk for fracturing their
bones, especially in the hip, vertebrae (spine) and wrist

52. The WHO has defined osteoporosis based on density:
 Normal is greater than 833mg/cm ^2
 Osteopenia or decreased bone mass is 833 to 648 mg/cm ^2
 Osteoporosis is below 648 mg/cm ^2
.
Risk factors:
Genetic
 Family with osteoporosis
 White race
 Increase age
 Female sex
Anthropometric
 Small stature
 Fair or pale skinned
 Thin build

53. Hormonal and metabolic
 Early menopause ( natural or surgical)
 Late menarche
 Nulliparity
 obesity
 Hypogonadism
 Gaucher disease
 Weight below normal
Dietary
 Low dietary calcium and vitamin D
 Low endogenous magnesium
 Excessive protein
 High in caffeine
 Anorexia
 Malabsorption

54. Lifestlye
 Sedentary
 Smoker
 Alcohol consumption (excessive)
Drugs
 Heparin-promote bone resorption by increasing collagen
breakdown
 Depo-medroxyprogesterone acetate
 corticosteroids
 Dilantin
 Loop diuretics
 Methotrexate

55. Osteoporosis Symptoms:
Early in the course of the disease, osteoporosis may cause no
symptoms. Later, it may cause dull pain in the bones or muscles,
particularly low back pain or neck pain.
Later in the course of the disease, sharp pains may come on
suddenly.
The pain may not radiate it may be made worse by activity that
puts weight on the area, may be accompanied by tenderness, and
generally begins to subside in one week. Pain may linger more
than three months.

56. Osteoporosis screening:
 DXA X-ray (Dual x-ray absorptiometry) scan the most
common screening tool is a, which measures bone mineral
density in the hip spine or elsewhere.
 Radiologic examination
 Computed tomography-are also helpful
 Test for level of serum calcium, phosphate, alkaline
phosphatase, protein electrophoresis
 Serum and urinary biochemical markers like urinary N-
telopeptide (NTx), C- telopeptide (CTx) and
deoxypyuridinoline –markers of resorption

57. Drug Treatments:
The goals of osteoporosis treatment are to slow down the
rate of calcium and bone loss and to stop the disease to
progresses too far.
Women diagnosed with osteoporosis or osteopenia are
usually told they need to take prescription medication to
prevent further bone loss and reduce the risk of fractures.
The most common drugs are the ff:

58. Hormones:
1. Estrogen and progestin treatment to prevent osteoporosis
— but not to treat it. Both estrogen alone and combinations
of estrogen and progestin reduce women’s risk of
osteoporosis and bone fracture. But, the hormones also
increase the risk of breast cancer, heart attack, stroke, and
pulmonary embolism. So, these hormones should be the last
choice for osteoporosis prevention and should be used only
when other prevention methods are not safe or appropriate
for a particular woman.

59. 2. Teriparatide (brand name: Forteo)
 is a derivative of human parathyroid hormone (PTH), the
primary regulator of calcium and phosphate metabolism in
bones
 A daily 20mg inj
 shown to stimulate new bone formation and prevent spine,
hip, wrist and other bone fractures in women with
osteoporosis.
 generally used only for women with severe osteoporosis,
 side effects can include nausea, leg cramps, and
dangerously high calcium levels. It’s also very expensive,
and some insurance companies are reluctant to cover it.

60. 3. Calcitonin (brand names: Fortical or Miacalcin; not the same as
calcium supplements
 has been shown to prevent fractures of the spine but not of the
hip and wrist.
 Slow bone loss in post menopausal women,
 increase bone density ,
 relieves pain associate to bone fracture and reduces risk of
spinal fracture.
 It is approved to treat women with osteoporosis, but its
approval was based on weaker evidence than more recently
approved drugs, and its use is not generally recommended.
 Women who take calcitonin must watch their intake of foods
with high calcium levels (e.g. milk, cheese) as excessive calcium
can be dangerous. Calcitonin is administered through a nasal
spray; side effects may include nasal congestion and nausea.

61. Bisphosphonates
 widely prescribed for osteoporosis treatment and
prevention.
 The FDA has approved eight bisphosphonates to prevent
bone loss and fractures in post-menopausal women:
alendronate (Fosamax), etidronate (Didronel), ibandronate
(Boniva), risedronate (Actonel), tiludronate (Skelid),
pamidronate (Aredia) and zoledronic acid (Reclast and
Zometa)2.
 Some are taken daily; others are formulated for weekly
monthly or yearly use.
 The drugs are also incorporated into newly formed bone
and can persist in them for years, so the effects last well
beyond cessation of use.

62. In May 2012, in an important update, the FDA expressed concerns
about the safety and effectiveness of bisphosphonate use beyond
3 to 5 years. According to these studies3,4,5, women who received
continuous bisphosphonate treatment for 6 or more years had a
fracture rate between 9.3% and 10.6%, while patients who did not
continue the treatment after 3-5 years actually had a lower
fracture rate of between 8.0 and 8.8%.
 In light of these studies, the FDA states that they believe that
women at low risk of fracture should consider stopping
bisphosphonates after 3-5 years
 In addition to questions of efficacy, there are safety concerns.
Bisphosphonates seem to have fewer risks than hormones, at
least in the first five years,
 Bisphosphonates also can cause severe heartburn and ulcers
and damage the stomach and esophagus if not taken in a very
careful regimen (on an empty stomach, with a full glass of water,
while sitting upright for up to an hour and also risk f
oesophageal cancer

63. Selective Estrogen Receptor Modulators (SERMs)
@Raloxifene (Evista) are compounds that act like estrogen
on some tissues (eg. bone tissue) and have an anti-estrogen
effect on other tissues (eg. breast and sometimes uterus).
 The FDA has approved) to prevent and treat osteoporosis.
 The drug has been tested more extensively than
bisphosphonates and although it reduces the risk of spine
fractures, it does not reduce hip fracture risk.
 It also raises different safety concerns that include
increased risks of blood clots, hot flashes, nausea, and leg
cramps.

64. @lasofoxifene,
 treatment of osteoporosis in postmenopausal women.
 appears to reduce spine fractures in the first three years of
use.
 Like raloxifene, it increases the likelihood of blood clots,
and it also increases vaginal bleeding and women taking
the drug were subjected to more invasive procedures such
as endometrial biopsies, D&Cs and even hysterectomy.
 The NWHN recommended to the FDA that approval of
lasofoxifene be delayed until the agency can fully review
the research on extended use so that we’ll know more
about the effects and effectiveness of using the drug for
extended periods of time.
 NWHN also expressed concern that Pfizer, the company
that makes lasofoxifene, will encourage women to take this
drug for other uses that haven’t been fully evaluated by the
FDA. Subject to FDA’s request for more information, in
2010 Pfizer decided to withdraw its application for approval
of lasofoxifene.

65. @Bazedoxifine( Aprela)
 This year (2012) Pfizer is seeking approval for a new
hormone therapy with claims of delivering benefits of HT
without the risks by combining estrogen with bazedoxifene.
 Bazedoxifene, a similar SERM to lasofoxifene is approved
for treatment of osteoporosis in Europe, but not in the USA
due to FDA’s concerns about its side effects of strokes and
blood clots7.
 NWHN will monitor the FDA approval process for this
proposed new drug very carefully and will report our
findings as soon as possible.

66. Monoclonal antibodies
Denosumab(Prolia)
 A new class of medication (denosumab) is a monoclonal antibody that inactivates
the natural bone breakdown mechanism.
 In 2010, the FDA approved denosumab for osteoporosis treatment. ,
 it is an injection given twice a year for osteoporotic patients in whom other
treatments have failed or who have severe osteoporosis and a high risk for
fractures.
 While the drug has been shown to be effective in reducing fractures and
preventing bone loss, it also causes significant health problems.
 Denosumab’s cellular target in bone also exists in the immune system and serious
infections requiring hospitalization (eg. heart infections), skin reactions, atypical
fractures and slow healing of fractures are among the side effects
 Concerns exist that its immune system effects could include ovarian and cervical
cancer, pancreatic cancer and breast cancer recurrences.
 Prolia is an expensive medication with uncertain effects of long term use. The
NWHN is concerned that for most postmenopausal women the benefit of Prolia
does not outweigh the risks.
 We recommend that women requiring osteoporosis treatment not try
denosumab until they’ve tried other FDA-approved osteoporosis medications.

67. Alternatives
 Alternatives to drugs exist for making and keeping bones
strong.
 The National Institutes of Health’s 2000 Consensus
Statement on Osteoporosis reviewed the research on
osteoporosis prevention and treatment and found strong
scientific evidence that calcium and Vitamin D intake are
crucial to develop and preserve strong bones.
 Regular exercise (especially resistance and high-impact
activities) contributes to the development of bone mass.
 Other promising interventions focus on preventing
fractures: balance training reduces the risk of falling, which
is often responsible for broken bones in older people.

68. = A few small studies have shown that hip protectors, along
with training on how to use them can help reduce the risk of
fracture if a fall occurs.
= Large randomized trials didn't find any benefits, though.
Other practical ways to reduce the risk of falling include
making sure that vision prescriptions are up-to-date,
= checking prescriptions for drug interactions that might
cause dizziness, eliminating fall-causing hazards in the home
(like slippery rugs, grandkids’ toys with wheels),
= wearing appropriate shoes.

69. HEALTH ALERT (Anderson M. Delmas PD 2001)
www.karger.com/gazette/65/anderson2/index.htm
 Worldwide, osteoporosis affects approximately 1 in 3
women over the age of 50 years
 A woman is more likely to have hip fracture caused by
osteoporosis than she is getting any of the common
cancers such as breast, endometrial or ovarian cancer
 In the middle east, the number of hip fracture will triple in
the next 20years
 Asian expects the most dramatic increased in hip fractures
during the next decades, mainly because of an aging
population but also due to a changing lifestyle.

71. F. Menopause
The permanent cessation of menses that may occur
naturally or occurs following certain surgeries,
chemotherapy or radiation therapy.
The mean age of onset of menopause is typically
between the ages of 45 to 55.
When you have not had a period (or even light
spotting) for 12 consecutive months.

72. Perimenopause (before menopause)
 denotes the years prior to menopause those
encompass the symptoms associated with normal
menstrual cycles and cessation of menses. This period
is marked by irregularity of menstrual cycles.
 When you start noticing something is a little “off”,
(usually with your periods) or maybe it seems like
you’re more irritable than usual.

73. Causes of Menopause:
 Natural physiological mechanism in a women’s body
wherein she stops menstruating. During menopause a
woman’s hormone mechanisms undergo numerous
changes that finally lead to the cessation of menstrual
cycles.
 Surgery – ex. Hysterectomy (surgical menopause)
 Chemotherapy or radiation therapy – ex. Cancer
(chemical menopause)

74. Risk Factors of Menopause:
Smoking – has been linked to earlier onset of the
menopausal process wherein it is dependent on the
number of cigarettes smoked and the duration of the
habit.
Complications:
Menopausal women may experience bleeding even after
cessation of menses. They may also be at increased risk
of developing osteoporosis, cardiovascular disorders or
cancer of the colon.

75. Common Signs and Symptoms:
 Hot flashes, flushes, night sweats and/or cold
flashes, clammy feeling
 Irregular heart beat
 Irritability
 Mood swings, sudden tears
 Trouble sleeping through the night/sleeplessness
(with or without night sweats)
 Irregular periods; shorter, lighter periods; heavier
periods, flooding; phantom periods, shorter cycles,
longer cycles

76. Common Signs and Symptoms:
 Incontinence, especially upon sneezing,
laughing; urge incontinence (urgency of
urination, burning or pain during urination)
 Itchy, crawly skin
 Aching, sore joints, muscles and tendons
 Increased tension in muscles
 Breast tenderness
 Headache change: increase or decrease

77. Common Signs and Symptoms:
 Loss of libido
 Dry vagina
 Crashing fatigue
 Anxiety, feeling ill at ease
 Feelings of dread, apprehension, doom
 Difficulty concentrating, disorientation, mental
confusion
 Disturbing memory lapses

78. Common Signs and Symptoms:
 Gastrointestinal distress, indigestion, flatulence,
gas pain, nausea
 Sudden bouts of bloat
 Depression
 Exacerbation of existing conditions
 Increase in allergies
 Weight gain
 Hair loss or thinning, head, pubic, or whole
body; increase in facial hair

79. Common Signs and Symptoms:
 Dizziness, light-headedness, episodes of loss of
balance
 Changes in body odor
 Electric shock sensation under the skin and in
the head
 Tingling in the extremities
 Gum problems, increased bleeding
 Burning tongue, burning roof of mouth, bad
taste in mouth, change in breath odor

80. Common Signs and Symptoms:
 Osteoporosis (after several years) and bone
fracture
 Changes in fingernails: softer, crack or break
easier
 Tinnitus: ringing in ears, bells, 'whooshing,'
buzzing etc.
*Note: Some symptoms may also be signs of the
following (hypothyroidism, diabetes, depression with
another etiology, and/or other medical conditions).

81. How to diagnose:
 Diagnosis is based on factors such as the age of
the woman and signs and symptoms observed.
 Absence of periods for a span of one year along
with other features of menopause is usually
diagnostic.
 Measurement of the FSH levels in the body
 Additional tests that may need to be repeated
periodically in order to check for any abnormal
changes in the body.

82. Treatment:
 Therapy is based on the severity of the symptoms of
menopause.
 Lifestyle modifications such as
 Diet modifications (high fiber, low fat, foods rich in
antioxidants, soya)
 Exercise
 Smoking cessation
 Decreased alcohol intake
 Relaxation and stress reduction
 Hormone replacement therapy (HRT) – is generally advised
for women who are symptomatic and are at high risk of
developing cardiovascular disorders, osteoporosis,
Alzheimer disorder or colonic cancer.
 Menopausal women may also be required to take calcium
and vitamin supplements.

83. BARROGA, Marilyn Richelle
DIGUEL, Brenda Lee
GRAGERA, Jennifer C.
MASIGMAN, Mary Ann
PAESTE, Gloria
SERRANO, Cecille
VALENTON, Kathleen Anne Marie