MATERNITY CH 7, 8, 9, 11

biological factors contributing to STI transmission

- asymptomatic nature - resistance to treatment or lack of a cure - other: douching, immature cervix, uncircumcised penis

maternal effects of gonorrhea

- miscarriage - preterm labor - PROM - amniotic infection syndrome - chorioamnionitis - postpartum endometritis - postpartum sepsis

social factors contributing to STI

- poverty and marginalization - access to health care - secrecy and moral conflict about sexuality

maternal effects of chlamydia

- premature rupture of membranes_ preterm labor - postpartum endometritis

bx factors contributing to STI transmission

-Early initiation of intimate sexual activity -Numerous sex partners -High-risk sex partners -High risk sexual behavior -Inconsistent and incorrect condom use -Substance abuse -Sexual coercion -Lack of knowledge of and concern about STIs

Copper IUD

-Form of contraception, alco prevents STDs and infections - must teach women to frequently check to see if thread is lying in vagina. If thread is missing the IUD may have moved up and will be ineffective

pelvic inflammatory disease (PID)

-inflammation and infection of organs in the pelvic region; salpingitis, oophoritis, endometritis, endocervicitis - one of the leading causes of female infertility

tell woman to stop the pill if she reports any of the following symptoms: ACHES

A- abdominal pain C- chest pain H- headaches E- eye problems (vascular accident) S - severe leg pain (DVT)

A woman has preinvasive cancer of the cervix. Which modality would the nurse discuss as an available option for a client with this condition? a.Cryosurgery b.Colposcopy c.Hysterectomy d.Internal radiation

ANS: A Cryosurgery, laser surgery, and loop electrosurgical excision procedure (LEEP) are several techniques used to treat preinvasive lesions. Colposcopy is the examination of the cervix with a stereoscopic binocular microscope that magnifies the view of the cervix. This examination would have already been performed as part of the diagnosis of preinvasive cancer of the cervix. A hysterectomy is performed if the cancer has extended beyond the cervix. Women with positive pelvic nodes (indicating invasive cancer) usually receive whole pelvis irradiation.

Which woman has the highest risk for endometrial cancer? a.Postmenopausal woman with hypertension b.Woman who has an intrauterine device (IUD) c.Client who has been on birth control for 15 years d.Perimenopausal woman who has a cystocele

ANS: A Endometrial cancer is most often seen in postmenopausal women between the ages of 50 and 65 years. Hypertension is a risk factor associated with the development of this malignancy. The use of an IUD does not increase a woman's risk for endometrial cancer. A client who has been on birth control for 15 years is not at increased risk for endometrial cancer; the birth control contraceptives might actually offer some protection. The development of a cystocele will not increase a woman's risk for endometrial cancer.

Which condition is the most common malignancy of the reproductive system? a.Endometrial cancer b.Cervical cancer c.Ovarian cancer d.Vulvar and vaginal cancer

ANS: A Endometrial cancer occurs most frequently in Caucasian women and after menopause. Certain viral infections and sexually transmitted diseases (STIs) create risks for cervical cancer. Ovarian cancer is the most malignant reproductive system cancer and accounts for the most deaths. Cancers of the vulva and vagina are relatively rare.

A postmenopausal woman has been diagnosed with two leiomyomas (fibroids). Which clinical finding is most commonly associated with the presence of leiomyomas? a.Abnormal uterine bleeding b.Diarrhea c.Weight loss d.Acute abdominal pain

ANS: A Most women are asymptomatic. Abnormal uterine bleeding is the most common symptom of leiomyomas. Diarrhea is not commonly associated with leiomyomas. Weight loss does not usually occur in the woman with leiomyomas, and the client with leiomyomas is unlikely to experience abdominal pain.

With regard to the treatment plan for a pregnant woman with gynecologic cancer, which statement about timing or type of treatment is correct? a.The fetus is most at risk during the first trimester. b.The fetus is most at risk during the second trimester. c.The fetus is most at risk during the third trimester. d.Surgery is more risky than chemotherapy in the first trimester.

ANS: A The first trimester is the most vulnerable period for the growing fetus. Women may be faced with making a decision about terminating the pregnancy, depending on the stage and extent of the disease. For advanced disease in the second trimester, alkylating agents, 5-fluorouracil (5-FU), and vincristine are relatively safe for the fetus. For advanced disease in the third trimester, alkylating agents, 5-FU, and vincristine are relatively safe for the fetus. Surgery is less risky than chemotherapy in the first trimester.

What is the most common reproductive tract cancer associated with pregnancy? a.Cervical b.Uterine c.Ovarian d.Fallopian tube

ANS: A The incidence of cervical cancer concurrent with pregnancy is reported to be 1 in 2000 pregnancies making it the most common reproductive tract cancer associated with pregnancy. Uterine cancer is rarely diagnosed during pregnancy. Ovarian cancer is the second most frequent cancer diagnosis in pregnancy. At an incidence rate of approximately 1%, fallopian tube cancer remains a rare occurrence. The peak incidence of tubal cancer is between the ages of 50 and 55 years; for this cancer to be concurrent with pregnancy is only a remote possibility.

A woman exhibits symptoms that may lead to a possible diagnosis of polycystic ovary syndrome (PCOS). While completing the initial assessment of the client, which clinical finding would the nurse not anticipate? a.Anorexia b.Hirsutism c.Irregular menses d.Infertility

ANS: A These clients often are obese rather than anorexic with weight loss. Approximately 40% of these women also display glucose intolerance and hyperinsulinemia. Excessive hair growth is often present in women with PCOS. This client is likely to have irregular menses or even amenorrhea. Infertility as a result of decreased levels of follicle-stimulating hormone is common with this syndrome.

The client is undergoing treatment for ovarian cancer. Which common nutritional problems are related to gynecologic cancers and the treatment thereof? (Select all that apply.) a.Stomatitis b.Constipation c.Increased appetite d.Diarrhea e.Nausea and vomiting

ANS: A, B, D, E Altered taste, stomatitis, constipation, anorexia, diarrhea, and nausea and vomiting are all possible nutritional complications related to gynecologic cancers and their treatment. The nurse must assess accordingly and adapt the client's plan of care. To ensure recovery, these women should consume a diet high in iron and protein, drink plenty of fluids, and eat foods high in vitamins C, B, and K.

The client has undergone hysteroscopic uterine ablation to destroy a number of smaller fibroids. The nurse is preparing to provide discharge instructions. Which information is a priority for the patient and should be included in the teaching plan? (Select all that apply.) a.Analgesics and nonsteroidal antiinflammatory drugs can be used for pain control. b.Vaginal discharge is to be expected for 5 to 7 days. c.Sexual activity can be resumed after 48 hours. d.Next menstrual period will be irregular. e.Provider should be notified if heavy bleeding occurs.

ANS: A, D, E Before discharging the client, the following information should be given: analgesics can be used for pain relief as needed, normal activities can be resumed within several days, vaginal discharge is to be expected for 4 to 6 weeks, and the use of tampons and sexual activity should be avoided for 2 weeks. The next menstrual period will be irregular, and the provider should be notified for heavy bleeding or signs of infection.

The nurse should be aware that a pessary is most effective in the treatment of which disorder? a.Cystocele b.Uterine prolapse c.Rectocele d.Stress urinary incontinence

ANS: B A fitted pessary may be inserted into the vagina to support the uterus and hold it in the correct position. Usually a pessary is used for only a short time and is not used for the client with a cystocele. A rectocele cannot be corrected by the use of a pessary. A pessary is not likely the most effective treatment for stress incontinence.

Which ovarian neoplasm is described as a growth that contains hair, teeth, and sebaceous secretions? a.Ovarian fibroma b.Dermoid cyst c.Uterine polyp d.Follicular cyst

ANS: B Dermoid cysts are germ cell tumors, usually occurring in childhood, that may contain teeth, hair, bones, and sebaceous secretions and may unilaterally or bilaterally develop. Treatment is most often surgical removal. An ovarian fibroma is a solid ovarian neoplasm that develops from connective tissue, usually after menopause. A uterine polyp is a tumor that grows on the uterine wall on a stalk or pedicle. A follicular cyst develops within the ovaries of young women in response to follicle rupture and should resolve within one or two menstrual cycles.

The prevalence of urinary incontinence (UI) increases as women age, with more than one third of the women in the United States suffering from some form of this disorder. The symptoms of mild-to-moderate UI can be successfully decreased by a number of strategies. Which of these should the nurse instruct the client to use first? a.Pelvic floor support devices b.Bladder training and pelvic muscle exercises c.Surgery d.Medications

ANS: B Pelvic muscle exercises, known as Kegel exercises, along with bladder training can significantly decrease or entirely relieve stress incontinence in many women. Pelvic floor support devices, also known as pessaries, come in a variety of shapes and sizes. Pessaries may not be effective for all women and require scrupulous cleaning to prevent infection. Anterior and posterior repairs and even a hysterectomy may be performed. If surgical repair is performed, then the nurse must focus her care on preventing infection and helping the woman avoid putting stress on the surgical site. Pharmacologic therapy includes selective serotonin-norepinephrine reuptake inhibitors or vaginal estrogen therapy. However, pharmacologic therapy is not the first action a nurse should recommend.

A 48-year-old woman has just had a hysterectomy for endometrial cancer. Which statement alerts the nurse that further teaching is needed? a."I can't wait to go on the cruise that I have planned for this summer." b."I know that the surgery saved my life, but I will miss having sexual intercourse with my husband." c."I have asked my daughter to come and stay with me next week after I am discharged from the hospital." d."Well, I don't have to worry about getting pregnant anymore."

ANS: B Stating that she will miss having sexual intercourse with her husband indicates that further teaching is needed for this client regarding sexual activities after a hysterectomy. Although intercourse may be initially uncomfortable, the use of water-soluble lubricants, relaxation exercises, and changes in position may be helpful. Expressing plans for a vacation is a positive psychologic state with plans for the future. Stating that her daughter will stay with her indicates the client understands that she may need assistance during her acute recovery period. Stating that she no longer needs to worry about getting pregnant indicates knowledge related to the reproductive cycle and a positive outlook.

What information is important for the nurse to include in planning for the care of a woman who has had a vaginal hysterectomy? a.Expect to be fully recovered in 4 to 6 weeks. b.Expect no changes in her hormone levels. c.Expect surgical menopause. d.Take tub baths to aid in healing.

ANS: B Unless the ovaries were also removed, hormonal levels should not change. Menses will cease, but the hypothalamus-pituitary-ovarian axis remains intact. The woman should expect to have vaginal discharge for 4 to 6 weeks. Full recovery varies from woman to woman, depending on risk factors and individual healing. Surgical menopause occurs only if the ovaries are also removed. The client should avoid tub baths, intercourse, and douching until after the follow-up examination.

A client in late middle age who is certain she is not pregnant tells the nurse during an office visit that she has urinary problems, as well as sensations of bearing down and of something in her vagina. What condition would the nurse suspect based upon this report? a.Pelvic relaxation b.Cystoceles and/or rectoceles c.Uterine prolapse d.Genital fistulas

ANS: B Uterine displacement can be caused by congenital or acquired weakness of the pelvic support structures and is known as pelvic relaxation. Cystoceles are protrusions of the bladder downward into the vagina; rectoceles are herniations of the anterior rectal wall through a relaxed or ruptured vaginal fascia. Both can produce a bearing-down sensation with urinary dysfunction. They occur more often in older women who have borne children. Uterine prolapse is a more serious type of displacement. In women with a complete prolapse, the cervix and body of the uterus protrude through the vagina. Genital fistulas are perforations between genital tract organs. Most occur between the bladder and the genital tract.

Leiomyomas (also known as fibroid tumors) are benign tumors arising from the muscle tissue of the uterus. Which information related to these tumors is accurate? (Select all that apply.) a.Are rapid growing b.Are more common in African-American women c.Are more common in women who have never been pregnant d.Obesity is a risk factor with leiomyomas e.Become malignant if left untreated

ANS: B, C, D The exact cause of leiomyomas remains unknown, although genetic factors may be involved in their development. Most are found in the body of uterus and are classified according to their location on the uterine wall. They are benign, slow growing, and often spontaneously shrink after menopause.

When caring for clients with neoplasms of the reproductive system, the nurse must begin by assessing the woman's knowledge of the disorder, its management, and prognosis. This assessment should be followed by a nursing diagnosis. Which diagnosis fails to address the psychologic effect of these disorders? a.Anxiety, related to surgical procedures b.Disturbed body image, as a result of changes in anatomy c.Risk for injury, related to lack of skill for self-care d.Interrupted family processes

ANS: C Although risk for injury, related to lack of skill for self-care, is appropriate to this client's condition, this diagnosis is more suited to the client's learning needs than the psychologic effect. Anxiety, related to surgical procedures, is appropriate for addressing psychosocial concerns; the client may also develop anxiety related to the diagnosis and prognosis and whether or not surgery is required. Disturbed body image is an applicable diagnosis; changes in her anatomy and function may also result in low self-esteem and ineffective coping skills. Interrupted family processes is a possible and acceptable diagnosis; functional and anatomic changes may result in the client's inability to fulfill her familial role. Depending on the severity of her condition, interrupted family processes could also lead to social isolation.

A woman has arrived for her preoperative testing appointment. She is scheduled for a myomectomy the following day. What condition would require the client to undergo this procedure for symptom relief? a.Numerous small fibroid tumors b.Bartholin cysts c.Fibroid tumors near the outer wall of the uterus with a uterine size no larger than at 12 weeks of gestation d.Leiomyomas (also known as fibroid tumors) in a uterus larger than 14 weeks of gestation

ANS: C If a fibroid tumor lies near the outer wall of the uterus and the uterine size is no larger than at 12 to 14 weeks of gestation and the symptoms are significant, a myomectomy (i.e., removal of the tumor) may be performed. This procedure leaves the uterine walls relatively intact, thereby preserving the uterus for future pregnancies. Laser surgery or electrocauterization can be safely used to destroy numerous small fibroid tumors. Bartholin cysts are benign lesions of the vulva. If the cyst is symptomatic or infected, surgical incision and drainage may provide relief. A hysterectomy (i.e., removal of the entire uterus) is the treatment of choice if bleeding is severe or if the fibroid tumor is obstructing the normal function of other organs.

The nurse provides education to a client about to undergo external radiation therapy. Which statement by the client reassures the nurse that the teaching has been effective? a."I am using ointment to keep my skin from drying out." b."I wash the irradiated area with deodorant soap." c."My diet is high in protein, and I drink at least 2000 ml of fluid a day." d."I wash off the markings for the radiation site after each treatment."

ANS: C To maintain good nutrition, the woman should eat high-protein meals or use protein supplements and should have a high daily fluid intake of 2 to 3 L. The woman is counseled about good skin care and taught to avoid soaps, ointments, cosmetics, and deodorants because these may contain metals that would alter the radiation dose she receives. Markings may be made to indicate the exact location needed for irradiation and should remain until the treatment is complete.

Which precaution should the nurse take while caring for a client who is undergoing internal radiation therapy for cervical cancer? a.Wear gloves when assessing the cervical intracavity implant. b.Instruct the client to urinate in the lead-lined bedpan or "hat" every 2 hours. c.Prepare the client for an enema before inserting the implant. d.Limit staff or visitor exposure to 30 minutes or less in an 8-hour period.

ANS: D Staff and visitor exposure should be limited to 30 minutes or less in an 8-hour period to reduce the risk of overexposure to radiation. Nurses need to protect themselves from overexposure to radiation. Wearing a shield is one method of protection. An indwelling catheter is inserted to prevent urinary distention that could dislodge the applicator. No bowel preparation is necessary.

Which woman is at the greatest risk for psychologic complications after hysterectomy? a.55-year-old woman who has been having abnormal bleeding and pain for 3 years b.46-year-old woman who has had three children and has just been promoted at work c.62-year-old widow who has three friends who have had uncomplicated hysterectomies d.19-year-old woman who had a ruptured uterus after giving birth to her first child

ANS: D The 19-year-old woman is still in her childbearing years. Often the uterus is related to self-concept in women in this age group, and they may feel that sexual functioning is related to having a uterus. The 55-year-old woman is past her childbearing years and has had bleeding and pain for 3 years. The hysterectomy may be well received as a method of pain relief. The 46-year-old woman has a family and positive events occurring in her life (job promotion). The 62-year-old woman is past her reproductive years and has relationships with others who have had positive outcomes.

A client has just returned from a uterine artery embolization (UAE) procedure. Before her discharge, a discussion concerning the symptoms that require a call to the provider postprocedure is very important. Which symptom would reassure the client that the procedure went well with no reason to call the provider? a.Temperature of 39° C b.Swelling or hematoma at the puncture site c.Abnormal vaginal discharge d.Urinary frequency

ANS: D The physician should be notified if the client is experiencing urinary retention. Urinary frequency is not a complication of UAE. A body temperature of 39° C or higher may indicate the presence of an infectious process, and the physician should be notified. A slight fever or pain may be experienced as a result of acute fibroid degradations. Swelling or hematoma at the puncture site may be an indication of bleeding into the groin. The client should not experience any abnormal vaginal discharge (e.g., foul odor, brown color, brown tissue).

In vitro fertilization - embryo transfer (IVF-ET)

Assisted hatching and preimplantation of genetic diagnosis

Chlamydia medications

Azithromycin (Zithromax), amoxicillin (Amoxil), erythromycin (Ery-Tab)

Informed Consent: BRAIDED

B: benefits R: risks A: alternatives I: inquiries and questions D: decisions may change mind E: explanations D: documentation

Caused by overabundance of Gardnerella bacteria Treat with antibiotics

Bacterial vaginosis

Common 'other infection" Many factors contribute to infection Men and women can carry the organism

Candidiasis: yeast infection

Follicular Cysts

Develop in the normal ovaries of young women as the result of a mature Graafian follicle failing to rupture - can occur when an immature follicle does not reabsorb fluids after ovulation

Gonorrhea medications

Ceftriaxone (Rocephin)

Responsible for 80% of women's tubal infertility Infects 2.8 million Americans each year

Chlamydia

Pubic lice

Phithirus pubis commonly known as crabs parasitic insects that can inhabit various body areas, especially the genitals

carcinoma in situ (CIS)

Diagnosed when the full thickness of epithelium is replaced with abnormal cells.

colposcopy

Examination of vagina and cervix with a colposcope (a stereoscopic binocular microscope that magnifies the view of the cervix) to identify neoplastic or other changes.

conization

Excision of a cone-shaped section of tissue from the endocervix.

the conscious decision on when to conceive throughout the reproductive years

Family Planning

Cysts that can cause sever pain, asymptomatic unless they rupture, and usually shrink after 2-3 menstrual cycles

Follicular cyst symptoms

700,000 Americans contract gonorrhea each year Can cause sterility in both men and women

Gonorrhea

STI causing severe depression of cellular immune system 20% of new cases are in women

HIV

45 millions infected and the goal is to manage symptoms

Herpes Simplex Virus (HSV)

3 forms of emergency contraception

High doses of oral progestinsLevonorgestrel 2 doses-High doses of COCs or estrogen-Insertion of copper IUD

20 million carries, 5.5 new cases yearly - treatment and vaccine available

Human Papillomavirus (HPV)

untreated STI consequences

Infertility . sterility untreated PID caused 15% of womens infertility blindness cancer, heart disease

Trichomoniasis medication

Metronidazole 2g orally once or Tindazole 2g orally once

bacterial vaginosis medications

Metronidzole 500mg BID for 7 days metronidazole gel 0.75%, 5g intravaginally bid for 7 days Clindamycin cream 2% 5g intrvaginally at bedtime for 7 days

maternal effects of syphilis

Miscarriage, preterm labor

Clinical manifestations of leiomyoma

Most are asymptomatic but abnormal uterine bleeding is the most common symptom •Can affect implantation and maintenance of pregnancy causing preterm labor, miscarriage, or difficult labor •A woman may complain of: backache, lower abdominal pressure, constipation, urinary incontinence, dysmenorrhea, nausea and vomiting may occur if tumor obstructs the intestine

Corpus Luteum Cyst

Occur after ovulation and caused by the secretion of progesterone, causing fluids to build up in corpus luteum

human chronionic gonadotropin (hCG)

Ovulation induction direct action on ovarian follicle to stimulate miosis IM injection

fetal effect of Group B streptococci

Preterm birth

Follitropin

Purified FSH treatment of polycystic ovary syndrome assisting in reproductive technique. SubQ injection

biopsy

Removal of a small piece of tissue for microscopic examination and diagnosis.

Metformin

Restores cyclic ovulation and menses in many women with PCOS. Induces ovulation through reducing insulin resistance and effects the gonadotropins and androgens; stimulating the ovary

most common reported infection in the US

STI

Leiomyoma (fibroids)

Slow growing benign tumors arising from the muscle tissue of the uterus, rarely malignant. Often occurs after age 50 in African american women and women who have never been pregnant.

Infection has stages that indicate progression of infection Can lead to brain damage and death in newborns

Syphilis

fetal effects of chlamydia

low birth weight

Asymptomatic•But women have a feeling of fullness if the ovary is enlarged

Thicker Lutein cyst manifestation

Syphilis

Treponema pallidum

Most common curable STI in young women Men and women can carry the organism

Trichomoniasis

Maternal effects of Group B streptococci

UTI Chorioamnionitis postpartum endometritis sepsis meningitis

Menotropins (Repronex, Menopur)

Used in conjunction with hCG to promote follicular maturation and ovulation in anovulatory patients IM injection dosage based on ovarian response

Intrauterine Insemination (IUI)

a form of assisted reproduction in which sperm are injected directly into a woman's uterus

transcervical sterilization

a method of female sterilization using a tiny coil that is inserted through the vagina, cervix, and uterus into the fallopian tubes causes scar tissue in the tubes preventing conception

semen analysis

measurement of the number, shape, and motility of sperm cells 1.5-5mL pH of 7.2 or higher viscosity greater than 3

The device or practice that decreases the risk of conceiving

birth control

Chemical barriers may reduce the risk of some STIs but are not effectiveagainst ______, _________, & ___________

cervical chlamydia and gonorrhea or HIV infection

most effective birth control method

sterilization implant IUD

fetal effect of Herpes simplex virus

congenital infection

GnRH agonists Ganirelix acetate, cetrorelix acetate

controlled ovarian stimulation for infertility treatment suppresses gonadotropin secretion, inhibit premature LH surges in women undergoing ovarian hyperstimulation

A semen analysis must be

delivered to the lab within 30 minutes of collection

maternal effects of HPV

excessive bleeding from lesions after birth rauma

Assisted reproductive therapy (ART)

fertility treatments in which both eggs and sperm are handled

Should not take contraception if

have hypertension, clotting disorder, rick for breast cancer

Polycystic ovarian syndrome occur with

high levels of estrogen, testosterone and luteinizing hormone caused by decreased secretion of follicle stimulating hormone

female infertility causes

hormonal and ovulatory factors tubal and peritoneal factors uterine factors (developmental anomalies, endometritis) Vaginal-cervical factors

Clomiphene citrate (Clomid)

induces ovulation by altering estrogen and stimulating follicular growth to produce a mature ovum. tablet beginning with 50mg/day for 5 days, increases by cycle

Cystitis

inflammation of the bladder often related to sexual activity and not an STI

maternal effects of HIV

intrauterine infection

bartholin cysts

most common benign lesion of vulva. caused by obstruction of the Bartholin duct causing it to enlarge, recurrence is common and permanent opening for drainage may be recommended

Manifestation of corpus luteum cyst

pain, tenderness, delayed menses, and irregular or prolonged menstrual flow - rupture of a cyst can cause intraperitoneal hemorrhage disappears within 1-2 menstrual cycles

Tubal Occulsion (female)

permanent form of contraception surgical procedure consisting of severance and or burning or blocking the fallopian tubes to prevent fertilization

fetal effect of gonorrhea

preterm birth IUGR

fetal effect of syphilis

preterm birth still birth congenital infection

Gamete intrafallopian transfer (GIFT)

procedure in which the sperm and ovum are placed directly in a fallopian tube

contraception

the intentional prevention of pregnancy during sexual intercourse

cervical cancer

the third most common reproductive cancer; begins as neoplastic changes in the cervical epithelium. characterized by CIN I-III. CIN i is mild, CIN II is moderate dysplasia, CIN III is severe and carcinoma in situ. CIN II & III are high grade SIL and CIN I is low grade SIL. SIL (squamous intraepithelial lesion). pap test to detect preinvasive. diagnosis identified by use of colposcopy, biopsy, conization.

Danazol

treats endometriosis. suppresses ovarian activity

Thicker Lutein Cyst

uncommon, Develops due to prolonged stimulation of ovaries by Human chorionic gonadotropin (HCG) or drug used to induce ovulation Occurs in women with large placentas such as multiple gestation or diabetics

Male infertility causes

undescended testes hypospadias varicocele low testosterone azoospermia oligospermia substance abuse

Caused by several different bacteria

urinary tract infections

oral contraceptives 91-day regimen

woman takes pill for 91 days, then takes a break for a week, then starts again

Clinical manifestations of Polycystic ovarian syndrome

•Obesity•Hirsutism (excessive hair growth) •Irregular menses or amenorrhea •Infertility •Impaired glucose tolerance •Type 2 diabetes• Fatty liver •Cardiovascular disease