Gyne Flashcards
menstruation
periodic shedding of the endometrium at approximately monthly intervals, accompanied by blood loss, that identifies the reproductive years of a woman’s life
menarche
- occurs between ages 9-16 yrs
- avg onset: 12-13 yrs
- mediated by hormonal activity: hypothalamus, pituitary gland, & ovaries
normal period lasts….
2-7 days
normal cycle patterns range…
- from 20-40 days
- may be as short as 17 or as long as 45
menstrual flow
varies from 20-80mL per menses
- dark red
- less viscious than blood & usually does not clot
shedding
- endometrium
- blood
- mucus
- vaginal cells
clotting
may be an indication of heavy flow or vaginal pooling
absence of menarche
- abnormal or irregular
- pregnant
- hormonal imbalance
endometrial hyperplasia
??
menstrual problems
- women may experience menstrual cycles that fall outside of the norm
- missed period
- change in length of cycle
- changes in flow, color, or consistency
- other menstrual symptoms
beginning of menstrual cycle
- 1st day of menstruation
- FSH levels begin to rise
- follicular phase
follicular phase
- single follicle matures fully under FSH stimulation
- mature follicle stimulates estrogen production causing a negative feedback resulting to decreased FSH
- when estrogen level peaks at 12th day of cycle, a surge of LH is produced triggering ovulation in 1-2 days
- complete follicular maturation & ovulation occurs only in the presence of LH though initial stage is stimulated by FSH
luteal phase
- blood vessels begin to coil, increasing the surface area of the vascular supply
- glandular tissue matures & secretes a glycogen (rich substances), & glandular ducts dilate
- if the corpus luteum regresses, estrogen & progesterone level falls the endometrial lining cannot be supported resulting to blood vessels contracting & tissue begins to slough
menstrual problems
- PMS (premenstrual syndrome)
- PMD-D (premenstrual dysphoric disorder)
- dysmenorrhea
- amenorrhea
- oligomenorrhea
- menorrhagia
PMS
- complex of symptoms during luteal phase
- usually occurs < 35 yrs
- repetitive symptoms
- not present other times of month
- biological trigger with compounding psychological factors
- serotonin involved
- imbalance of estrogen & progesterone
- nutritional deficiencies (vit B6 or mag)
- occurs before menstruation
PMD-D
- type of PMS
- severe mood disorder in addition to PMS
physical PMS symptoms
- breast discomfort
- peripheral edema
- abd bloating
- sensation of weight gain
- episodes of binge eating
- HA
PMS symptoms of ANS arousal
- palpitations
- dizziness
- anxiety
- depression
- irritability
- mood swings
diagnosing PMS
- eliminate possible causes: thyroid dysfunction, uterine fibroids, depression
- no definitive diagnosis test for PMS
- based on symptom analysis: encourage diary recording for 2-3 months
goal of PMS
-reduce severity of symptoms & enhance sense of control & quality of life
nursing care in PMS
- assessment & supportive counseling
- dietary guidance
- stress mgmt
- vitamin supplementation
- pharm. tx
dysmenorrhea
- affect 50% of all women
- painful menstruation: painful abd cramping
primary dysmenorrhea
- excessive prostaglandin or increased sensitivity
- teens to mid 20s: happens a few years after menarche when regular ovulatory cycles begin
- related to ovulation
secondary dysmenorrhea
- underlying causes: endometriosis, PID, uterine fibroide
- occurs mostly at 30-40 yrs old
s/s of primary dysmenorrhea
- starts 12-24 before onset of menses
- pain more sever 1st day, rarely lasts 2 days
- lower abd pain (colicky), frequently radiates to lower back & upper thighs
- n/v/d, fatigue, HA, light headedness
s/s of secondary dysmenorrhea
- occurs after a problem free period
- unilateral pain, generally more constant, but continues longer than primary
- depending on cause: dyspareunia, irregular bleeding, painful defecation
mgmt of dysmenorrhea
- distinguish what type
- complete health hx: special attention to menstrual & gyne hx
- teaching
- drinking hot beverages, warm baths
- proper nutrition, exercise, avoid constipation, good body mechanics
- reduce stress & fatigue
- stay active
tx of primary dysmenorrhea
- heat, massage
- biofeedback, relaxation
- mild exercise, avoid fatigue
- NSAIDs
- oral contraceptives
- acupuncture & transcutaneous nerve stimulation
non responsive pain mgmt in dysmenorrhea
-evaluate chronic pelvic pain
tx of secondary dysmenorrhea
- depends on cause
- some will be helped by similar interventions as primary
- depending on underlying causes, additional drug or surgical interventions may be used
amenorrhea
absence of cessation of menstrual flow
primary amenorrhea
failure of menstrual cycles to being by age 14-16 if secondary sex characteristics are present
causes of primary amenorrhea
- **pregnancy
- Turner’s syndrome: when girls have only one normal X chromosome
- hormonal imbalances
- systemic diseases
- hypothalamic pituitary abnormalities
- excessive exercise, malnutrition, anorexia nervosa/bulimia, & tumors result to decreased ovarian hormones
secondary amenorrhea
-cessation of menstrual cycles once established
causes of secondary amenorrhea
- DM
- TB
- poor nutrition
- ovarian tumors
diagnosing amenorrhea
- pregnancy test: urine test of hCG
- hormonal levels: hCG; prolactin levels high, estrogen levels low
- tumor markers: may rise before disease is evident: AFP, CA 125, hCG
mgmt of amenorrhea
- depends on the cause
- tx to improve timing of cycle
- relaxation tx
- increase diet
- decrease exercise
- hormonal tx for eating disorders
- psychological support for congenital & fertility abnormalities
- emotional support
dysfunctional uterine bleeding
bleeding due to a disruption in the menstrual cycle
oligomenorrhea
- long intervals between menses (>35 days)
- oligomenorrhea related to anovulation is common in women at the beginning and end of menses
anovulation cycles
- corpus luteum fails to get formed and thus no progesterone
- results to unopposed estrogen causing excessive buildup of the endometrium, increasing risk for endometrial CA
- progesterone or BC ordered to ensure endometrial lining
menorrhagia
- excessive menstrual bleeding either 7days+ or 80mL +
- mostly related to anovulation
in menorrhagia, young women should watch for
- clotting disorders
- uterine fibroids
- endometrial polyps
tx of menorrhagia
- monitor blood loss & replacement if H&H is low
- oral progesterone & estrogen to stabalize endometrium
- balloon thermotherapy
- fertility drug if pt wants to get pregnant, otherwise BC
- tramexamic acid
metrorrhagia
- irregular bleeding or bleeding between menses (spotting)
- mostly related to ectopic pregnancy or spontaneous abortion
- may be related to cervical or endometrial polyps, infection, CA
- common during 1st cycles of using BC and with long acting progestin tx
- must rule out endometrial CA in postmenopausal women
- HRT of exogenous estrogen is a common cause
menometrorrhagia
excessive bleeding (irregular intervals)
assessment
- pelvic exam
- pregnancy test
- coagulation studies
- hormone levels
- hgb testing
- pain
- vaginal discharge: white, thick, curdy
- psychosocial
surgical interventions
- D&C: only done if unable to get info from endometrial biopsy & US
- US or hysteroscopy
- myomectomy
- endometrial ablation
- hormonal regimens & embolization
- consider: desire for children?
myomectomy
fibroid removal without uterus removal
endometrial ablation
laser or electrosurgical technique effective tx for menorrhagia
nursing mgmt
- teach characteristics of menstrual cylce
- discuss myths related to activity, bathing, swimming, exercise, sex
- assess for s/s of anemia
- changing of tampon r/t toxic shock syndrome
s/s or toxic shock syndrome
- high fever
- n/v/d
- weakness
- myalgia
- sunburn like symptoms
