Menstruation Physiology and Disorders Flashcards
1
Q
FSH AND LH
A
- released by pituitary glands
- helps in production of estrogen and progesteron
2
Q
FSH
A
helps in maturation of ovum
3
Q
LH
A
helps in ovulation
4
Q
Possible Problems (no menstruation, (-) PT)
A
- problem in their FSH wherein the eggs were not able to mature or there is less production of LH = problem with pituitary gland
- anatomical abnormalities or physiologic imbalances
5
Q
Possible Causes of Problems
A
- lifestyle
- genetics
6
Q
Menstruation
A
in response to the hormone, the endometrium proliferates and (if no fertilization), it sheds
7
Q
Menstruation Stabilizes at…
A
28 days within 1-2 years of puberty with a range of 24- 34 days
8
Q
Irregular Menstruation at…
A
- the extreme of reproductive years
- 2 years after menarche
- 5 years before menopause
9
Q
Ovulation occurs at…
A
15 months for completion of the first 10 cycles up to 20 cycles before ovulating
10
Q
Mittelschmerz
A
- abdominal pain during ovulation
- sharp cramps
- several hours of discomfort
- pain on LLQ (most common) OR LRQ
- scant vaginal bleeding
11
Q
Mittelschmerz Cause
A
drop or two of follicular fluids of blood that spills in abdominal cavity
12
Q
Mittelschmerz Management
A
mild analgesic (acetaminophen)
13
Q
Dysmenorrhea
A
- painful menstruation
- pain is caused by release of prostaglandin (caused by the smooth muscle contraction and pain in the uterus) in response to tissue destruction
14
Q
Dysmenorrhea Underlying Illness
A
(if too much pain)
1. pelvic inflammatory disease
2. uterine myomas or tumors
3. endometriosis (abnormal formation of endometrial tissue)
15
Q
Primary Dysmenorrhea
A
- cramping pain that comes before or during period
- caused by natural chemicals (prostaglandins, blood vessels)
- occurs in the absence of organic disease
16
Q
Secondary Dysmenorrhea
A
- caused by some health conditions
- may experience heavy period
- may have irregular periods, bleeding in between periods, unusual discharge or painful bleeding after intercourse
- ovarian cyst/ tumors, endometrial polyps, STI, PCOS, or use of IUD (assess properly)
- occurs as a result of an organic disease
17
Q
Dysmenorrhea Symptoms
A
- bloating
- pain
- colicky (sharp) pain
- aching, pulling sensation of vulva and inner thigh
18
Q
Dysmenorrhea Management
A
- analgesics
- low dose of oral contraceptive (aspirin, ibuprofen, naproxen sodium)
** do not take aspirin or ibuprofen with an empty stomach; may cause gastric irritation
19
Q
Aspirin
A
mild prostaglandin inhibitor
20
Q
Ibuprofen
A
strong prostaglandin inhibitor
21
Q
Menorrhagia
A
- abnormal heavy flow >80mL per menses
- may indicate endometriosis, pelvic inflammatory disease, early pregnancy loss, disseminated intravascular coagulation (DIC) or bleeding disorder
22
Q
Menorrhagia Assessment
A
- ask normal flow rate for saturation of napkin or tampon (NORMAL: 25 mL/ hr)
- more than normal = anemia or iron loss
- assess properly and refer immediately
23
Q
Menorrhagia Management
A
- administration of iron supplements (sufficient hemoglobin formation)
- progesterone during luteal phase
- low dose oral contraceptive/ GNRH inhibitor to decrease flow
24
Q
Metrorrhagia
A
- bleeding between menstrual periods
- there might be spotting (indicates temporary low level or progesterone)
25
Amenorrhea
- absence or cessation of menstrual flow
- common in athletes (low ratio of fat to muscle = excessive secretion of prolactin = decrease in GnRH)
26
Primary Amenorrhea
- absence of menses at the age of 15 in the presence of normal growth and secondary sexual characteristics
- clinical symptoms have a variety of disorders
27
Secondary Amenorrhea
- absence of 3 or more periods in a row by someone who has had periods in the past
- most common cause: pregnancy
- may be caused by problems with hormones
28
Amenorrhea Possible Causes
1. chromosomal problem
2. genetic problem with ovaries
3. hormonal issues
4. problems with hypothalamus or pituitary gland
5. structural problem with reproductive organ
29
Hypogonadotropic Amenorrhea
- problem in the central hypothalamic-pituitary axis
- genetic inability to produce FSH and LH
- results from hypothalamic suppression that results to stress and body fat-to-lean ratio
30
Hypogonadotropic Amenorrhea Management
- counseling and education
- plan on how to discontinue or decrease medication affecting menstruation
- resolve source of stress (deep breathing, massage)
- decrease intensity of training
- estrogen therapy (protect bone loss)
- progesterone supplementation
- develop plans altering lifestyle and decreasing stress
31
Endometriosis
- abnormal growth of extrauterine endometrial cells = excessive endometrial production = reflux of mens flow = deficient immunologic response = excess estrogen prod. = failed luteal phase = no ovulation or irregular
- cul de sac of peritoneal cavity (dyspareunia or painful coitus) or on uterine ligaments of ovaries
- usually in nulliparous women
- causes dysmenorrhea
- chocolate cyst
- contains glands, stoma, responds to cyclic hormonal stimulation in uterine endometrium
- during proliferative and secretory phase
- tissue bleeds before or after menstruation
- result in inflammatory response with subsequent fibrosis
- adhesion to adjacent organs
- can be developed on the third or fourth decade of life, more common with adolescents with disabling pelvic pain
32
Endometriosis Swelling
inflammation of surroinding tissue in abdominal cavity and their is pain = prostaglandin released
33
Endometriosis Chocolate Cyst
- cystic area of endometriosis in ovary
- old blood causes dark coloring of cyst content
34
Endometriosis Assessment
1. uterus is displaced by tender to touch
2. palpable nodules (in ovary or cul de sac)
35
Endometriosis Possible Causes
1. transtubal migration or retrograde menstruation
2. endometrial tissue regurgitated or mechanically transported from the uterus during menstruation to the uterine tubes, peritoneal tubes (implants to the ovaries and other organs)
36
Endometriosis Symptoms
1. pelvic pain
2. dysmenorrhea
3. dyspareunia
4. abnormal menstrual bleeding
5. infertility
6. chronic non-cyclic pelvic pain heaviness
7. pain radiating to the thigh
8. pain with defecation, constipation
37
Endometriosis Management
- based on severity
- pain: NSAID
- continual OCPs (low ratio estrogen-progestin ratio to shrink endometrial tissue)
- hormonal antagonist
- surginal. medical intervention
- estrogen/ progesterone oral based contraceptive (stimulate implant regression)
- synthetic androgen (Danazol): shrink abnormal tissue
- GnRH agonist therapy
38
Endometriosis Hormonal Antagonist
- suppress ovulation
- reduce endogenous estrogen production
- subsequent endometrial lesion growth
39
Endometriosis GnRH Agonist Therapy
- suppress pituitary gonadotropin secretion
- for people who would like to be pregnant after condition
- Leuprolide, Synarel, Zoladex
