Common gyno issues Flashcards
Amenorrhea
-Absence of menses
-Symptom, not a diagnosis
-Defects in hypothalamus-pituitary-ovarian-uterine axis
-Primary: absence by age 15 w/ absence of development or absence by age 16 w/ normal development
-Secondary: absence of regular menses for 3 cycles or irregular menses for 6 months in women who have previously menstruated
-Cause 1 of 4 factors: ovarian failure, congenital absence of uterus and vagina, GnRH deficiency, delay of puberty
Amenorrhea tx
-Primary: correction of underlying disorders, estrogen replacement therapy
-Secondary: drugs, surgery, radiation for tumors, dopamine agonists or bromocriptine for hyperprolactinemia, cyclic progesterone or oral contraceptives if anovulation, nutritional counseling if ED, GnRH is hypothalamic failure, thyroid replacement therapy if hypothyroidism
Amenorrhea nursing assessment
-Tanner stages of breast development: Stage 1: tip of nipple raises (papilla elevation), Stage 2: breast buds palpable at 11 yrs, Stage 3: elevation of breast contour at 12 yrs, Stage 4: areolae form mound on breast 13 yrs, Stage 5: adult breast contour
-Labs: karyotype for turner syndrome, ultrasound for ovarian cysts, hCG for pregnancy, thyroid fxn for thyroid disorder, prolactin level for pituitary tumor, FSH level for ovarian failure, LH level for gonadal dysfxn, 17-ketosteroids for adrenal tumor
Primary dysmenorrhea
-Painful menstrual bleeding in absence of underlying pathology
-Cyclic perimenstrual pain
-Pain starts along w/ start of bleeding and last 2-3 hrs
-Linked w/ early smoking
-Caused by increased prostaglandin production by endometrium in ovulatory cycle
-Highest during 1st 2 days of menses
Secondary dysmenorrhea
-Painful menstruation refers to painful menstrual d/t pelvic or uterine pathology
-Pain gets worse over time
-Endometriosis is most common cause
-No cure, but remove cause
Dysmenorrhea tx
-Surgery and ovarian suppressive agents (OCs, progestins, GnRH antagonists, levonorgestrel-releasing intrauterine systems, and androgenic agents
-Hormonal txs associated w/ unwanted side effects and recurrence of s/s when stopped
-Use CAM
-If endometriosis can’t be treated w/ surgery, give OCs, prostaglandin inhibitors, devo-provera
-NSAIDs such as ibuprofen or naproxen are common
Dysmenorrhea s/s
-Sharp, intermittent spasms of pain, usually in subrapubic area
-Pain may radiate to back of legs or to lower back
-Peaks as flow becomes heaviest
-N/V/D
Dysmenorrhea dx
-CBC to rule out anemia
-Urinalysis to rule out bladder infection
-hCG pregnancy test
-Cervical culture to rule out STI
-Erythrocyte sedimentation rate to detect inflammatory process
-Stool guaiac test to exclude GI bleeding
-Pelvic/vaginal ultrasound to detect masses
-Laparoscopy
Dysmenorrhea home mgmt
-Exercise
-Limit salty foods
-Increase water
-Increase fiber
-Use heating pads
-Take warm showers
-Sip on warm beverages
-Keep legs elevated
-Stress mgmt
-Stop smoking, decrease alc use
Abnormal uterine bleeding (AUB)
-Any deviation from normal menstrual
-Common in beginning and end of reproductive years
-D/t hormone disturbance
-May cause anemia
AUB causes
-PALM (structural): polyp, adenomyosis, leiomyomas, malignancy
-COEIN (other): coagulopathy, ovulatory dysfxn, endometrial, iatrogenic, not yet classified
-OCs, NSAIDs, GnRH analogs, danazol, LNG IUS, androgens, antifibrinolytics, Fe replacement therapy
-Surgery: D&C, ablation, embolization, hysterectomy
AUB dx
-CBC for anemia
-Prothrombin time for blood dyscrasias
-Pregnancy test to rule out miscarriage
-Thyroid-stimulating hormone for hypothyroidism
-Vaginal ultrasound to measure endometrium
-Pelvic ultrasound for structural abnormalities
-Endometrial biopsy for intrauterine pathology
-D&C for dx eval
AUB nursing mgmt
-Take antiemetics w/ high-dose estrogen (nausea common)
-Chronic anovulation can result in infertility and long-term problem of hyperandrogenism
-Severe anemia secondary to prolonged menses
-Depression and embarrassment secondary to irregular and heavy bleeding
-Endometrial cancer associated w/ prolonged buildup of endometrial lining w/o menstrual bleeding
PMS
-s/s that occur during luteal phase or last half of menstrual cycle and resolve w/ onset of period
-Peak 4-7 days prior
PMS tx
-Lifestyle: reduce stress, exercise, diet and water, decrease caffeine, stop smoking and alc, vitamins, vitamin E 400 units daily, Ca 1200-1600 mg daily, Mg 200-400 mg daily
-Meds: NSAIDs 1 week prior, low-dose OCs, SSRIs, anxiolytics, diuretics, progestins, GnRH agonists, danazol
-CAM: Ca supplements, vitex agnus castus (chaste berry tree), hypericum perforatum (st. john’s wort), angelica sinensis (dong quai), paeonia lactiflora (chinese peony), yoga, Mg, vitamin B6, evening primrose oil, ginkgo biloba, viburnum, dandelion, stinging nettle, burdock, raspberry leaf, skullcap
PMS s/s
-Anxiety
-Cravings
-Depression
-Hydration
-Other
-Affective: depression, angry outburst, irritability, angry
-Somatic: breast tenderness, abdominal bloating, edema, headache
-s/s relieved by day 4-13 of period
PMDD
-Premenstrual dysphoric disorder
-More serious
-Severe depression, anxiety, irritability
-Adolescents and women who experience more extensive emotional s/s of PMS should be dx for PMDD bc they may need SSRIs
Endometriosis
-Tissue similar to lining of uterus grows outside of it
-Found in ovaries, fallopian tubes, outer surface of uterus, bowels, perineum
-Places where tissue attaches are called implants or lesions
-Several mini periods where the endometriosis tissue exists
Endometriosis dx
-Definitive dx made during surgery and biopsy
-Ultrasound to rule out fibroids
-Nonspecific pelvic tenderness
-Hallmark finding is presence of tender nodular masses on uterosacral ligaments, posterior uterus, or posterior cul-de-sac
Endometriosis tx
-Conservative surgery: removal of lesions, may need to be repeated, allows for pregnancy to occur in future
-Definitive surgery: hysterectomy, woman can’t be pregnant in future
-Meds: NSAIDs, OCs, progestogens, antiestrogens, GnRH-a
-Gold standard is laparoscopic surgery w/ painkillers
Infertility
-Primary: inability to conceive a child after 1 yr of regular unprotected sex
-Secondary infertility: inability to conceive after previous pregnancy
Infertility causes
-Main causes are ovarian dysfxn and tubal/pelvic pathology
-Social strain and stress are highest among couples w/o clear etiology
-Female factor: anovulation, tubal damage, ovarian failure, endometriosis
-Male factor: low or absent #s of motile sperm in semen, ED
-Unexplained
Infertility cultural considerations
-African Americans: assisted reproductive techniques are unnatural
-Hispanic: children validate marriage, large families
-Orthodox Jewish: procreation is a mitzvah, a good religious deed, don’t use OCs
-Roman Catholics: assisted reproductive techniques are frowned up
Fertilization
1) release of normal oocyte
2) production of spermatozoa
3) transport of gametes fallopian tube
4) transport of cleaving embryo into endometrium
Infertility tx
-Lifestyle changes
-Intrauterine insemination
-IVF
-Egg donation or surrogate
-Ovulation-enhancement drugs and timed sex
Infertility male assessment
-Semen analysis
-Men abstain from sex for 2-5 days prior to sample
-Man ejaculates into container and gives it to lab within 1 hr
Infertility female assessment
-Home ovulation predictor kits: ELISA test determine LH in urine, significant change in color = LH surge aka most fertile day
-Clomiphene citrate challenge test: assesses ovarian reserve (ability for eggs to fertilize), FSH levels drawn on day 3 and 10 after woman has taken 100 mg clomiphene citrate on days 5-9, if FSH > 15 = infertile
-Hysterosalpingography: gold standard, assesses for fallopian tube obstruction, 3-10 mL of oil medium is injected into endocervical canal
-Laparoscopy: used when abnormalities found in ultrasound or when endometriosis is suspected
Contraception effectiveness hierarchy
-Most effective: sterilization, IUD, implant
-Very effective: injectable contraceptive, patch, ring, pills
-Less effective: condoms, diaphragm, fertility awareness
