Lecture 15C Reproductive system concerns

Question 1

Amenorrhea

Answer 1

Absence of menstrual flow
Not a disease, often the sign of one
Most common and benign → result of pregnancy
May be clinical symptom of a variety of disorders
First action w/ a pt. reporting amenorrhea is a pregnancy test (hCG); if negative, usually a sign of clinical disorder. Dylantin and COCs associated with amenorrhea.

Question 2

Exercise-associated amenorrhea

Answer 2

Female athlete triad: 1. Eating disorder; 2. amenorrhea; 3. premature osteoporosis.

Question 3

Nutritional considerations for amenorrhea

Answer 3

Daily calcium intake 1000-1500 mg

Vitamin D 400-600 IU

Question 4

Primary dysmenorrhea

Answer 4

Abnormally increased uterine activity/myometrial contractions
Result of prostaglandins in 2nd half of cycle - these women will have more intense labors.
Most common in late teens and early twenties, incidence declines w/age

Question 5

Primary dysmenorrhea management

Answer 5

Decrease salt and refined sugar intake 7-10 d before menses, natural diuretics.
NSAIDs - ibuprofen taken at regular intervals

Question 6

Secondary dysmenorrhea

Answer 6

Acquired menstrual pain
Menstrual pain that develops later in life than primary (after age 25)
May have other symptoms suggestive of underlying cause
Dull, lower abdominal aching, radiating to back or thighs
Bloating or pelvic fullness

Question 7

Hypogonadotropic amenorrhea

Answer 7

Suppression of the hypothalamus, from stress, etc.

Question 8

PMS/PMDD with partial hysterectomy

Answer 8

PMS and PMDD can still occur because ovarian function is necessary for the disorder, not the presence of a uterus.

Question 9

Nutritional supplementation with PMS/PMDD

Answer 9

Vitamin B6, up to 100-150 mg/day
Vitamin E, up to 600 IU/day
Calcium, 1000 -1200 mg/day 
Magnesium, up to 300-400 mg /day 
Evening Primrose Oil (*not* during pregnancy)

Question 10

PMDD pharmacological therapy

Answer 10

SSRIs: Fluoxetine (Sarafem); Paroxetine (Paxil); Sertaline (Zoloft)
YAZ (an oral contraceptive)

Question 11

Endometriosis

Answer 11

Presence and growth of endometrial tissue outside of the uterus. Believed to be the result of reverse flow of blood and endometrial tissue.
Tissue found most commonly in and near ovaries; can be in stomach, lungs, spleen, and intestines. Often grows on surgical scars (i.e., previous cervical surgery.
Disappears with menopause
A leading cause of infertility

Question 12

Endometriosis and menstruation

Answer 12

Each month, estrogen causes all endometrial tissue, regardless of location, to become inflamed and painful - pelvic pain, sacral backache, dyspareunia, secondary dysmenorrhea, constipation and pain during exercise.

Question 13

Average age of menopause

Answer 13

51-52

Question 14

Average of perimenopause or climacteric phase

Answer 14

46

Question 15

Declaration of menopause requires

Answer 15

No menstrual periods (no ovulation) for 12 months, including spotting - continue to use contraception.

Question 16

Hormonal changes in menopause

Answer 16

1. FSH is elevated because the ovarian follicle becomes less sensitive to it.
2. Progesterone and estrogen is decreased.

Question 17

SCOVU mnemonic for menopause symptoms

Answer 17

S - Sleep disorders
C - Cardiovascular 
O - Osteoporosis
V - Vasomotor
U - Urogenital
(Also: Cognitive disorders)

Question 18

Due to falling estrogen levels, there is an increased risk of developing _ after menopause

Answer 18

Cardiovascular disease: Causes an increase in LDL (bad cholesterol) and a decrease in HDL (good cholesterol); causes decreased elasticity of the blood vessels.

Question 19

Osteoporosis and menopause

Answer 19

Estrogen plays a role in stimulating osteoblasts, as well as the conversion of vitamin D to calcitonin; falling estrogen levels inhibit new bone from being formed - results in thinning of the bones.

Question 20

Depoprovera

Answer 20

Causes reversible osteoporosis, women should not take this medication for more than 2 years.

Question 21

Increased intake of calcium and vitamin D

Answer 21

At age 40 - at least 1200 mg/day of calcium and at least 400 IU/day of vitamin D.

Question 22

Medications for osteoporosis

Answer 22

Miacalcin, Fosamax, Actonel, Boniva, Reclast, Evista - follow instructions precisely - some require woman to remain in an upright position afterward.

Question 23

Menopause hormonal therapy (MHT)

Answer 23

Controversial - long term use is associated with increased risk for blood clots, heart attack, stroke, invasive breast cancer; should only be used on a short term basis (1-3 years) and for very disruptive menopausal symptoms.

Question 24

Contraindications to hormone therapy

Answer 24

Women w/increased risk of cardiovascular disease
High risk or hx of breast CA
May worsen myomas of the uterus
Women with a known hx of gallbladder disease (conjugated estrogens are associated with an increased incidence)