ch. 6 reproductive system concerns Flashcards
amenorrhea
1) absence of menstrual flow
2) clinical indicators of several health issues:
- absence of both menarche and secondary sexual characteristics by age 13
- absence of menses by age 15, regardless of presence of normal growth and development (PRIMARY AMENORRHEA)
- absence of menses within 5 years of breast development
- a 6-month or more absence of menses after a period of menstruation (SECONDARY AMENORRHEA) -> common reason: pregnancy
3) although amenorrhea is NOT a disease, it is often the sign of one
- BUT most commonly, amenorrhea is a result of pregnancy -> structural issue, pituitary issues
TIP:
- predevelopment 2-3 years before onset menses
- thyroid function, hormones (LG, FSH)
- start: 13 years old
- primary: no period by 15 years
- secondary: period stops after starting
menstrual disorders
1) hypogonadotropic amenorrhea:
(a) problem in central hypothalamic pituitary axis
(b) results from hypothalamic suppression due to:
- stress or a sudden and severe weight loss (nursing students)
- eating disorder
- strenuous exercise
- mental illness
- chronic disease
(c) assessment
(d) counseling and education
2) exercise associated amenorrhea
3) mgmt of amenorrhea
perimenstrual pain and discomfort (PPD)
- dysmenorrhea (painful periods)
- premenstrual syndrome (PMS) (50-70%)
- premenstrual dysphoric disorder (PMDD) (3-8%)
- symptoms clusters that occur before/after the menstrual flow starts (2 weeks)
- PPD is a health problem that can have a significant effect on a woman’s quality of life
dysmenorrhea
pain during OR shortly before menstruation
1) primary dysmenorrhea:
- a condition associated with the ovulatory cycle
- causes: arises from the release of prostaglandins with menses -> increased uterine cramping
- mgmt depends on the severity of the problem and the individual woman’s response to various treatment: tylenol, motrin, NSAIDs, alieve, lifestyle changes
- cures after pregnancy
2) secondary dysmenorrhea:
- menstrual pain that develops later in life than primary dysmenorrhea, typically after age 25 years
- usually asociated with pelvic pathology
- diagnosis and treatment (varies per patient)
premenstrual syndrome (PMS) & premenstrual dysphoric disorder (PMDD)
1) cyclic symptoms begin in the luteal phase of menstrual cycle (ovulation -> start next period)
(a) PMS: affects 75% of all women
- complex, poorly understood condition that includes ONE OR MORE of several psychologic, and behavioral symptoms
(b) premenstrual dysphoric disorder (PMDD):
- severe variant of PMS 3-8% of childbearing women
- specific criteria for diagnosis: FIVE OR MORE affective or physical symptoms
(c) mgmt:
- diet and exercise, time mgmt
- herbal therapies
- NSAIDs, diet, exercise, time mgmt, stress mgmt, depression/anxiety
TIP:
PMS: 1 physical/1 affective symptoms
- headache, breast tenderness, pelvic cramps, bloating, edema, mood changes, depressed, craving salt/chocolate, overwhelmed
PMDD: 5 physical/5 affective symptoms
- trouble with work/school
menstrual disorders: endometriosis
1) presence and growth of endometrial tissue outside of the uterus (main cause of pain)
- very common in infertile women, chronic pelvic pain
(a) major symptoms:
- dysmenorrhea
- deep pelvic dyspareunia (painful intercourse)
- abnormal bleeding (uterus still sheds)
(b) mgmt:
- drug therapy (oral contraceptives to balance, NSAIDs)
- surgical intervention (sometimes, laparotomy)
menstrual disorders: alterations in cycle
1) alterations in cyclic bleeding 5-15% women
(a) 30-45% infertile women
(b) 33% women with chronic pain (PCOS 1/3 women)
(c) menstruation that is:
- scant at normal intervals (28 days)
- infrequent (2-3 month break)
- excessive (continuous bleed)
- between periods (breakthrough bleeding)
2) now classified by etiology/pattern of bleeding using acronym (PALM-COEIN)
3) treated with NSAID’s or OCP’s of surgery
PALM-COEIN
P- polyp (98% benign)
A- adenomyosis (cells in myometrium)
L- leiomyoma (aka fibroids, extension of uterine muscle, lots of pain, will shrink after menopause, decrease hgb)
M- malignancy & hyperplasia
C- coagulopathy
O-ovulatory dysfunction (PCOS, perimenopause, tumor)
E- endometrial
I- latrogenic
N- not yet classified
TIP:
- occurs along with endometriosis
menopause
1) amenorrhea for 12 consecutive months
2) physiologic characteristics
- anovulation occurs more frequently
- menstrual cycles increase in length
- ovarian follicles become less sensitive to hormonal stimulation from FSH and LH (can increase d.t want of ovarian stimulation but can’t)
- progesterone is not produced by the corpus luteum
- FSH values are elevated
tip:
- avg age: 52 years
- range: 30-60 years
- release ova Qmonth, but they get tired
- corpus luteum in ovaries -> release estrogen/progesterone to maintain pregnancy until placenta takes over
menopause: physical changes during perimenopausal period
1) bleeding
2) genital changes (loss pubic hair, vaginal atrophy/dryness)
3) vasomotor instability
- hot flush
- hot flash
4) mood and behavioral responses (fatigue/irritablilty, insomnia, women (45-50years)
menopause: health risks of perimenopausal/menopausal hormone therapy
1) health risks of perimenopausal women:
- osteoporosis (caucasian/asian women)
- coronary heart disease
2) menopausal hormonal therapy:
- decision to use hormone therapy: risks (BC pills)
- side effects: stroke, heart attack, breast cancer
- treatment guidelines: low dose OC
- bioidentical and custom compounded hormones
- alternative therapies
menopause care mgmt
1) plan of care/interventions:
- sexual counseling: lubircant
- nutrition (decrease salt, eat 1/2 as much)
- exercise (150 min/week)
- medications for osteoporosis (phosomax, muscle strength exercise)
- midlife support groups: nurses should be familiar with local and online resources to direct women to agencies and online sources that supply correct information and support
