Common menstrual disorders Flashcards
When is menarche usually? menstrual period
around 13 years old in the United States.
What happens during mensration in all the hormones?
↓ Estrogen(E2) & Progesterone (P4)- stimulates hypothalamus (GnRh)
↑ GnRH stimulates follicle-stimulating hormone (FSH)
↑ FSH stimulates development of the ovarian follicles= ↑ovarian production of E2
Slight midcycle ↓ E2 triggers GnRH to stimulate the anterior pit to secrete luteinizing hormone (LH)
A Surge of LH and small ↑ E2 stimulates ovulation. If fertilization doesn’t occur- E2 & P4 decrease and the corpus luteum regresses
What happens in the follicular phase of the ovarian cycle?
- Follicular phase
- Before ovulation FSH & E2 cause development of 1-30 follicles
- LH causes 1 oocyte to mature and is released (usually around day 14)
What happens in the follicular phase of the ovarian cycle?
Luteal Phase
- Begins after ovulation- ends with menstruation
- Corpus luteum secretes E2/P4= peak day 8
- Corpus luteum regresses without conception
What’s the MENSTRUAL PHASE of the endometrial cycle?
The shedding of the functional endometrium
Whats the PROLIFERATIVE PHASE of the endometrial cycle?
E2 causes- Rapid endometrial growth
What’s the SECRETORY PHASE of the endometrial cycle?
P4 causes endometrium to thicken- ↑ blood
What’s the ISCHEMIC PHASE of the endometrial cycle?
Spasm and necrosis of the functional layer of the endometriuum
The surge of which hormone causes Which hormone is responsible for the maturation and release of an oocyte at midcycle?
LH
What is Amenorrhea?
Absence of menstrual flow
Primary and Secondary cause for Amenorrhea?
primary: anatomical, disease
process
secondary: pregnancy
s/s of amenorrhea? what’s the assessment?
s/s: absence of menstruation
assessment: history and exam
What is hypogonadotropic?
and what is the cause?
Absence of menstrual flow due to hypothalamic suppression
Etiology: stress, low weight range, excessive exercise.
S/S of hypogonadoptropic amenorrhea?
S/S: absence of menstruation
assessment and management for hypogonadotropic amenorrhea?
Assessment: history & physical examination; Hcg, FSH, TSH, prolactin
Management: Counseling & education regarding stress, exercise, and weight loss. ** OCA’s, Ca supplements
What is dysmenorrhea?
Pain during or shortly before menstruation
What is primary dysmenorrhea and what is the cause?
Abnormally increased uterine activity
Etiology: Physiologic alteration; prostaglandin excess
S/S of primary dysmenorrhea?
S& S: severe cramps, back pain, GI sx
Management of primary dysmenorrhea?
Management: Alleviating discomfort Nonsteroidal anti-inflammatory drugs OCA’s Education
What is secondary dysmenorrhea? and whats the cause?
Acquired menstrual pain associated with possible pelvic pathology
Etiology: Adenomyosis, Endometriosis, PID, fibroids
What are the S/S of secondary dysmenorrhea and what is the assessment?
S&S: heavy mentrual flow, dull lower abd ache
Assessment:
Pelvic exam/ USG exam
What is the management of secondary dysmenorrhea?
Management:
Treatment directed to removal of underlying pathology.
Comfort: NSAIDS, OCA’s, diet, exercise, heating pads
When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended?
D. Using a heating pad on the abdomen to relieve cramping
***double check for the answer.
What is PMS premenstrual syndrome?
cyclic symptoms occurring in luteal phase of menstrual cycle.
when you’re cray cray
What is the cause of PMS?
Etiology: Poorly understood
S/S of PMS?
S&S: Cluster of physical, psychologic, and behavioral symptoms
Management of PMS?
Management: diet, exercise, and herbal therapies ** education, avoid caffeine, limit ETOH
In helping a client manage premenstrual syndrome (PMS), the nurse should:
a. Recommend a diet with more body-building and energy food such as red meat and sugar.
b. Suggest herbal therapies, yoga, and massage.
c. Tell the client to push for medications from the physician as soon as symptoms occur to lessen their severity.
d. Discourage the use of diuretics.
What is Endometriosis?
Presence and growth of endometrial tissue outside of uterus
What is the cause of endometriosis?
possible retrograde menstruation
What are the s/s of endometriosis?
Dysmenorrhea & dyspareunia
what is the management of endometriosis?
Drug therapy- Danazol; Lupron; OCA’s, NSAIDS
Surgical intervention – Lap 40%
Education/ Support
What are Fibroids?
Benign tumor that originates from the myometrium of the uterus
what causes Fibroids?
genetic, hormones- association with CHTN
what are the S/S of fibroids?
menorrhagia, dysmenorrhea
What is the management of Fibroids?
Medication
Surgically- myomectomy
What are the 3 alterations in cyclic bleeding?
- oligomenorrhea
- hypomenorrhea
- metrorrhagia
What is the Oligomenorrhea?
Infrequent menses Q 40-45d
Etiology- pituitary tumor, excessive exercise, low BMI, PCOS, perimeno
What is hypomenorrhea?
Scant bleed, normal interval
Etiology- similar as Oligo
What is Metorrhagia?
Intermenstrual bleed
Etiology- pregnancy, onset of OCA, endom, fibroids, & cancer
What is Menorrhagia? etiology?
Excessive menstrual bleed (duration or amount)
Etiology- fibroids, malignancy, polyps
What is Menometrorrhagia?etiology?
excessive menstrual bleed which is irregular & frequent
Etiology- adenomyosis, fibroids
What is abnormal uterine bleeding? etiology?
Irregular in amount, duration or timing
Etiology- Obesity, hyperthyroidism, hypothyroidism, PCOS. DUC- dx after rulle out other casues
Management- hospitalize prn, transfusion, D&C, endometrial bx, ablation (Novasure)
What is Fibrocystic breasts?
benign breast changes characterized by small cysts
What is the cause of Fibrocystic breasts?
imbalance of estrogen/ progesterone
What are the S/S of Fibrocystic breasts?
timing, characteristics
How do you detect Fibrocystic breasts?
Detection: Exam, USG, aspiration, FNA
Management for Fibrocystic breasts?
Management: conservative, Vit E, OCA’s, surgical removal, NSAIDs, decrease caffeine, smoking & ETOH
Can you name a few other menstrual disorders?
Lipomas
Nipple Discharge
Galactorrhea
Mammary Duct Ectasia
Intraductal Papilloma
*** EDUCATION- BSE, CBE, intervals, dietary changes, comfort measures
Malignancy screening?
ACOG–BSE has the potential to detect palpable breast cancer and can be recommended.
Newer concept called “breast self-awareness“
EDUCATION
What are S/S of breast cancer?
Hard, fixed lump, irregular borders, nipple discharge, discoloration, unilateral
Breast cancer management?
Surgical Radiation Adjunct Hormone Chemotherapy
Do menstrual disorders diminish the quality of life?
yes!
