Common Reproductive Issues. MENSTRUAL DISORDERS lecture 15 Flashcards
1
Q
*Endometriosis: endometrial tissue grows outside uterus causing bleeding during menstrual cycle, creating a greater risk of uterine cancer:
A
- Endometriosis: Endometrial tissue grows outside the uterus, leading to bleeding during the menstrual cycle and an increased risk of uterine cancer.
- Dysmenorrhea: Also known as “menstrual cramps,” it refers to painful menstruation.
- Pelvic discomfort: This is a symptom often associated with endometriosis.
- Infertility: Endometriosis can make the uterine lining less suitable for implantation, leading to infertility.
- Dyspareunia: Painful intercourse can occur due to endometriosis.
- Depression: Endometriosis can lead to depression due to hormonal changes.
2
Q
Endometriosis
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- Affects 1 in 10 women.
- There is a delay of 3 to 11 years between the onset of symptoms and diagnosis.
- The cause of endometriosis is unknown.
- Endometrial tissue responds to cyclical hormonal stimulation, leading to changes that correspond with hormonal fluctuations.
3
Q
*Endometriosis: Risk factors
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- Early age of menarche (<12 years)
- Short menstrual cycles (<28 days)
- Nulliparity (never having had a baby) increases the risk of developing endometriosis later in life.
- Heavy and prolonged periods (> 1 week)
- There is a familial component, with a 7-10 times higher risk if a first-degree relative has it.
- Multiparity (having multiple children) and increased lactation lower the risk of developing endometriosis.
4
Q
Endometriosis: Symptoms
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- Pelvic pain that starts 1-2 days before expected menstruation
- Infertility defined as being unable to conceive after 1 year of trying
- Heavy menstrual bleeding, leading to extra blood loss
- Fatigue, often due to heavy menstrual bleeding and pain
- Dyspareunia, causing painful intercourse
- Dysuria, resulting in painful urination
- Painful bowel movements during periods
- Gastrointestinal upsets such as diarrhea, constipation, and nausea are common symptoms.
5
Q
Endometriosis: Therapeutic Management and Nursing Care
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- Diagnosis is typically confirmed through laparoscopy, which allows for visualization and biopsy, or ultrasound.
- Treatment options include:
- Analgesics (pain relievers)
- Oral contraceptives to regulate hormones
- GnRH antagonists (Gonadotropin-Releasing Hormone antagonists)
- Surgery, including hysterectomy, depending on the severity of symptoms.
- GnRH antagonists work against the release of pituitary hormones FSH and LH.
- The recurrence rate for endometriosis is approximately 40-50%.
6
Q
- Menopausal Transition (perimenopause): This is the period leading up to menopause.
- Menopause is the time in a woman’s life when her periods (menstruation) eventually stop, and the body goes through changes that no longer allow her to get pregnant.
- Menopause is a natural event that typically occurs in women between the ages of 45 and 55.
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7
Q
Menopause
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- Menopause is characterized by the complete cessation of menses for a period of 12 months, resulting in a loss of high levels of estrogen and progesterone.
- The average age of menopause is approximately 51.5 years old.
8
Q
- Ovarian response to FSH decreases, leading to a loss of primary estrogen and progesterone production.
- In simpler terms, fewer eggs in the ovary mean a reduced response to FSH, which results in the failure to release eggs and consequently, a loss of progesterone and estrogen.
- This loss of estrogen and progesterone leads to significant physiological changes.
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9
Q
Menopausal Changes in the Reproductive Tract
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- In menopause, a woman stops producing eggs, and as a result:
- Periods occur less frequently until they eventually stop.
- Vaginal dryness is common.
- Painful sexual intercourse or a reduced interest in sex may occur.
- The vaginal walls become thinner, dryer, less elastic, and may become irritated.
- Atrophy of the labia can occur.
- There is a higher risk of vaginal yeast infections.
- The vagina may hypertrophy and shrink on itself, increasing the chance of stress incontinence.
- The uterus becomes dry.
- Ovaries have significantly fewer eggs, typically down to around 3%.
10
Q
Symptoms
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- Menopause symptoms include:
- Vaginal dryness
- Thinning and reduced elasticity of vaginal walls
- Dyspareunia (painful intercourse)
- Decreased libido
- Atrophy of the labia
- Increased risk of yeast infections due to changes in vaginal pH from acidic to alkaline
- General loss of pelvic muscle tone, which can be improved with pelvic floor exercises
- Stress incontinence
- Menopause can also lead to various other symptoms and health risks, including:
- Anxiety
- Sleep disturbances
- Depression
- Weight gain and bloating, often leading to constipation due to slowed motility caused by decrease in progesterone
- Irregular menstruation
- Mastodynia (breast pain)
- Headaches or migraines
- Hot flashes, characterized by sudden and intense feelings of heat in the face, neck, chest, accompanied by sweating, tachycardia, and flushed/reddened skin tone.
- Vasomotor dysfunction, which can result in incorrect contraction and dilation of blood vessels
- Osteoporosis, a health risk as estrogen is needed to maintain healthy bones
- Cardiovascular disease, including hypertension and myocardial infarction, as a potential health risk during menopause.
11
Q
Therapeutic Management & Nursing Care
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- There are both hormonal and non-hormonal interventions available for managing menopause symptoms.
- Recent recommendations have shifted towards using lower doses of estrogen to prevent hot flashes.
- It’s important to manage care on an individual basis.
- Treatment should be customized based on the patient’s history, risk factors, and needs. For example, hormone replacement therapy may not be recommended for individuals at risk of breast or ovarian cancer.
- Evening primrose is a popular natural remedy, but there is limited evidence to support its effectiveness.
12
Q
Vasomotor Instability (Hot Flashes)
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- Common, with an incidence of approximately 75-85%.
- Non-hormonal interventions for managing menopause symptoms include:
- Reducing alcohol consumption, hot drinks, and spicy foods.
- Utilizing stress management techniques such as walking, reading, and meditation.
- Wearing layered clothing to help regulate body temperature.
- Considering the use of herbs like evening primrose, although there is limited evidence to support its effectiveness.
- Staying well-hydrated with water.
13
Q
Osteoporosis
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- Approximately 10 million Americans have osteoporosis.
- There are about 34 million individuals at risk for the disease.
- Osteoporosis is often described as having “porous bones,” and it increases the risk of fractures.
- This condition occurs when there is either excessive bone loss, inadequate bone formation, or both.
- Osteoporosis is characterized by reduced bone mineral density.
14
Q
Bone mass peaks btw 25 & 35 yo
Rapid loss of bone mass after menopause
Bone loss in just the few years after onset of menopause may be as high as 20% of lifetime bone loss
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15
Q
- Osteoporosis typically doesn’t present with symptoms itself, but its primary consequence is an increased risk of bone fractures.
- Common sites for fractures in osteoporosis include the vertebral column, ribs (which do not expand as they used to), hips (resulting in a high risk of hip fractures), and wrists (which can be painful).
- Typically, individuals are recommended to have a bone density scan around the age of 65.
- Osteoporosis is often not diagnosed until a fracture occurs, making early detection and prevention crucial.
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16
Q
In osteoporosis, when viewed under a microscope, the bone structure resembles a honeycomb, with larger and more pronounced holes compared to healthy bone tissue.
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17
Q
Are you @ risk for osteoporosis?
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- Having a thin frame.
- Being of Caucasian or Asian ethnicity, particularly of European or Asian ancestry.
- A family history of the condition, as well as lower bone mineral density.
- The use of cortisone-like drugs for conditions such as asthma, arthritis, or cancer, which can affect bone density.
- A diet low in calcium, typically less than 1000mg per day, which can contribute to the risk of osteoporosis.
- Genetic factors, with approximately 25 to 80% of the risk believed to be influenced by genetics, and over 30 genes associated with osteoporosis have been identified.
Additional risk factors for osteoporosis include:
- Maintaining a sedentary lifestyle, which can contribute to reduced bone density.
- Consuming more than two drinks with caffeine per day.
- Consuming more than two alcoholic drinks per day, as excessive alcohol intake can increase the risk of fractures.
- Soft drinks, which may contain phosphoric acid, have been suggested in some studies to increase the risk of osteoporosis.
- Tobacco use is believed to inhibit the activity of osteoblasts, which are responsible for filling in bone cavities and promoting bone formation.
- Bone remodeling, a crucial process for bone health, occurs in response to physical stress.
- Smoking tobacco has been proposed to inhibit osteoblast activity, potentially leading to reduced bone density.
- It can also lead to an earlier onset of menopause and increased breakdown of exogenous estrogen, further affecting bone health.
18
Q
Calcium Requirements: calcium + vit d
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Calcium requirements for different groups are as follows:
- Adolescents and young adults: 1200-1500mg of calcium per day.
- Women aged 25-50 years: 1000mg of calcium per day.
- Women over 50 years, especially postmenopausal women: 1200mg of calcium per day when calcium and vitamin D intake is considered.
19
Q
slide 25
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20
Q
Calcium Absorption
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Calcium absorption can be decreased by various factors, including:
- Caffeine consumption, which can increase calcium excretion.
- Alcohol consumption, which interferes with calcium absorption.
- High phosphate consumption can lead to hyperphosphatemia and hypocalcemia, reducing calcium levels in the body.
- Excessive protein consumption may require an increased calcium intake to help neutralize the by-products of protein metabolism, although the relationship is not entirely clear.
- Soft drinks may also have an impact on calcium absorption and bone health, possibly due to the presence of phosphoric acid and other factors, but the exact mechanism is not well-defined.
21
Q
Weight-bearing exercise is indeed a highly effective intervention for maintaining and improving bone health. It is often considered a top recommendation because it helps stimulate bone remodeling and density. A sedentary lifestyle, on the other hand, can be a significant risk factor for osteoporosis and other bone-related issues. Engaging in weight-bearing exercises regularly can help mitigate this risk and contribute to overall bone health.
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22
Q
- Fosamax: This medication is used to treat or prevent osteoporosis. It works by altering the cycle of bone formation and breakdown in the body, thereby slowing down bone loss while increasing bone mass. It can be used by both men and women, particularly in cases where bone health is at risk, such as men who take steroids.
- Progesterone: This is a hormone often used as a botanical supplement during menopause to alleviate symptoms.
- Osteoclast: This is a type of cell responsible for nibbling at and breaking down bone tissue. Osteoclasts are involved in bone resorption, which is part of the bone remodeling process.
- Osteoblast: These cells are responsible for making new bone tissue. They play a crucial role in bone formation and regeneration.
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23
Q
Medications
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- Bisphosphonates
- Selective estrogen receptor modulators (SERMs)
- Calcitonin: Used for kidney patients
- Monoclonal antibodies
- Hormonal medications
- Estrogen therapy: Considered a second-line therapy for osteoporosis
- Side effects: Blood clots, heart disease
Remember, it’s important to be familiar with this information rather than trying to memorize it.
24
Q
Medications:Do NOT try to memorize this but DO be familiar.
A
Medications for osteoporosis either prevent calcium reabsorption in other parts of body when needed (Inhibiting Osteoclast Activity:) or promote bone formation. All treatments are recommended to be given WITH:
- Calcium
- Vitamin D
- Diet
- Exercise
- Fall prevention
25
Q
Cardiovascular Disease
Why Does the Risk of Cardiovascular Disease (CVD) Increase with Menopause?
- Estrogen Decline: During menopause, estrogen levels drop significantly. Estrogen has protective effects on blood vessels, and its decline can lead to increased CVD risk.
- Lipid Profile Changes: Menopause can result in higher “bad” LDL cholesterol and lower “good” HDL cholesterol levels, which are linked to atherosclerosis and CVD.
- Blood Pressure Increase: Some women experience higher blood pressure during and after menopause, a known risk factor for heart disease.
- Body Composition Shift: Menopause often involves a shift toward more body fat and less muscle, which can affect metabolism and increase CVD risk.
- Inflammation: Menopause can lead to increased inflammation, which is a risk factor for atherosclerosis and other heart conditions.
- Loss of Estrogen’s Benefits: Estrogen has several heart-protective effects, like widening blood vessels and reducing inflammation. Lower estrogen levels reduce these benefits.
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Regarding Cardiovascular Disease (CVD) and Lifestyle:
- The importance of healthy living before and AFTER menopause
- Exercise
- Diet
- Smoking cessation
- Hormone therapy DOES NOT reduce CVD
- Heart disease is the leading killer of women
- Estrogen may be responsible for healthy vasculature, but estrogen therapy has not been shown to prevent CVD
26
Q
Regarding LDL cholesterol and HDL cholesterol after menopause:
- LDL cholesterol increases after menopause.
- HDL is considered “good” cholesterol.
Additional points:
- Most research on this topic has been conducted in Caucasian women.
- The etiology of these changes is unclear.
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27
Q
Hormone Therapy: relieve some of the symptoms that affect women at menopause
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- Previously known as Hormone Replacement Therapy (HRT).
- Currently called Estrogen Therapy (ET), Progesterone Therapy (PT), or Hormone Therapy (HT).
- Progesterone is given with estrogen to decrease the incidence of endometrial cancer in women at risk.
- Certain medications known as selective estrogen receptor modulators (SERMs) produce estrogen-like effects in the bone and provide protection against postmenopausal bone loss.
