Gyn issues Flashcards
amenorrhea
-absence of menses during reproductive years
-primary and secondary
two types of primary amenorrhea
-absence of menses by age 14 with absence of development of secondary sexual characteristics
-absence of menses by age 16 with normal development of secondary sexual characteristics
mgmt of primary amenorrhea
-correct problem, any underlying disorder
-estrogen replacement
secondary amenorrhea
-absence of regular menses for 3 cycles or irregular menses for 6 months in women who have previously menstruated regularly
-ex: pregnancy
-Normal for children around 12yo who have a period once but havent had another in a long time (unless she is sexually active)
mgmt of secondary amenorrhea
-cyclic progesterone
-oral contraceptive
dysmenorrhea
-painful menstruation
-primary & secondary
primary dysmenorrhea (spasmodic)
-increased prostaglandin production which causes cramping & pain during menstruation, normal
-mgmt: birth control, ibuprofen
secondary dysmenorrhea (congestive)
-pelvic or uterine pathology
-cause: endometriosis (most common) or fibroids
-mgmt: find underlying problem, contact OBGYN
assessment of secondary dysmenorrhea
-pmh
-sexual hx
-menstrual hx
-bimanual pelvic exam
s/s of dysmenorrhea
pain, n/v, diarrhea, fatigue, fever, h/a, dizziness; bloating, water retention, weight gain, muscle aches, food cravings, breast tenderness
dysmenorrhea pt education
-comfort measures: heat, lifestyle changes, pain relief
-Exercise to increase endorphins and suppress prostaglandin release.
-Limit salty foods to prevent fluid retention.
-Increase water consumption to serve as a natural diuretic.
-Increase fiber intake with fruits and vegetables to prevent constipation.
-warmth: heating pads, warm bath/showers, warm beverages
-Keep legs elevated while lying down or lie on your side with knees bent.
-stress mgmt and relaxation techniques
-Stop smoking and decrease alcohol use which causes vasoconstriction.
abnormal uterine bleeding
-painless endometrial bleeding that’s prolonged, excessive, and irregular and not attributed to any underlying structural or systemic disease
-r/t to hormone disturbance
-tx involves finding underlying cause
types of abnormal uterine bleeding
-menorrhagia: abnormally heavy flow or prolonged flow
-metrorrhagia: in between, irregular, frequent bleeding
-menometrorrhagia: prolonged or excessive bleeding at irregular intervals; will become anemic, may need blood transfusion depending on heaviness of flow
premenstrual syndrome
recurrent physical, emotional, and behavioral symptoms that occur during the luteal phase or last half of the menstrual cycle and resolve with the onset of menstruation
PMDD mgmt
-vitamin supplements
-diet changes, limit caffeine and simple carbs
-exercise
-lifestyle, rest
-meds: sarafem/rozac- fluoxetine… doesn’t rely on therapeutic dose, levels out mood, start 14 days before cycle and end when cycle starts
endometriosis
-complex syndrome characterized by an estrogen-dominant chronic inflammatory process that affects primarily pelvic tissues, including the ovaries
-caused when tissue similar to that of the endometrium implants outside of the uterus, most commonly throughout the abdominal cavity
endometriosis dx
laprascopic exam
endometriosis mgmt
-pregnancy/oral contraceptives/heat/rest
-lap surgery
-meds: NSAIDS-helps with inflammation, Depo-stops periods, Lupron- puts in menopausal state for a few months (most women can’t tolerate menopausal sx)
endometriosis assessment
-infertility
-pain, not r/t size of lesions
-nonspecific pelvic tenderness
-tender nodular masses on uterosacral ligaments, posterior uterus or posterior cul-de-sac
menopause
-absence of menstruation for one full year
-usually occurs between ages 45-52, avg age is 52
menopause s/s
-Brain: hot flashes; sleep, mood, and memory problems
-Heart: lower levels of HDL; increased risk of CVD
-Bones: bone density loss; increased risk of osteoporosis
-Breasts: duct and gland tissue replaced by fat, breasts droop
-Genitourinary: vaginal dryness due to lack of estrogen, stress incontinence, cystitis
-Bladder is very estrogen dependent
Needs vaginal form of estrogen, no oral pill
Vaginal lubricant- water based, no petroleum jelly
-Gastrointestinal: less Ca+ absorbed; increased fractures
-Skin: skin dry, thin; collagen decreases
menopausal transition assessment
-screen for osteoporosis
-screen for CVD
-risk for cancer
-plan lifestyle changes to prevent chronic conditions
infertility
inability to conceive a child after 1 year of regular sexual intercourse unprotected by contraception
types of infertility
-primary: woman has never been pregnant
-secondary: woman has achieved at least on previous pregnancy prior to this attempt
infertility risk factors
-AMA (> or = age 35)
-hx of PID & STIs
-hx of pelvic and abdominal surgeries/procedures
-atypical secondary sex characteristics
-hx of spontaneous abortions
-hx of menstrual issues
-nutrition: under/over weight, anorexia
-substance abuse & excessive etoh (male & female)
-exposure to teratogenic substances
-male scrotum exposure to hot temps
-endocrine &/or genetic d/o
-anomalies
infertility mgmt
-female: hormone eval, pelvic exam, ultrasound, hysterosalpingography, hysteroscopy, laparoscope
-male: semen analysis
non medical mgmt of infertility
-nutrition & diet
-exercise, yoga, stress mgmt
-herbal meds if prescribed
-acupuncture
-avoid high scrotal temps
common meds for infertility
-clomid (clomiphene citrate), used for 3 cycles advise to have intercourse every other day for 1 week after starting
-metformin
-antimicrobial for existing infection
therapeutic medical mgmt of infertility
-artificial insemination/intrauterine insemination
-IVF
-donor eggs or sperm
-surrogates or gestational embryo carrier
