Module 1 study guide Flashcards
Why are menstrual cycles not regular for young teens
Because the HPO axis is not developed enough to communicate with each other
when is menstrual cycle regularity expected to develop in teens
6-18 or 24 months after first period
What are the times when pelvic exam should be completed?
- There are sx…and the best way to determine cause of sx is to complete exam
- screening…ie pap smear
- Do not have to do bimanual exam….not a good screening test
What about when organizations contradict themselves or someone else about pelvic exam
shared decision making….
let client know that there are controversies….
so we look at them as individual and determine what they want to do
What should we be using annual exam time for according to ACOG?
Will not complete head to toe physical….
1. health teaching
2. maybe a focus assessment…depending what they are due for
3. screening.
4. risk assessment…firearm, seatbelt
5. vaccinations..
6. what the reproductive life plan is etc etc.
7. how are things going sexually….etc etc…..
why do we need to study menstrual cycle
so that we can dx abnormal
in able to understand contraception
fertility
etc etc
What particular hormone causes dysmenorrhea
Prostaglandin
First line management for dysmenorrhea
exercise…..not during menstrual cycle
NSAIDS….at least 48 hours ahead…reduce the amount of prostaglandin produced…..dose…400 q6 hours with food or milk
Warmth
small dose of birth control pills…..causes endometrial lining to be very small and thin…because they are small and thin and because ovulation is being suppress…there aren’t many prostaglandin floating around.
When does PMS or PMDD happen in the menstrual cycle?
Before menses….pre—menstrual
Anytime after ovulation and before day one of bleeding that someone has sx is considered PMS
Some people starts as soon as enough progesterone starts circulating others…
they have sx more from the drop off of the peak of progesterone
Happens in the Luteal phase……
If patient not not ovulate they would not have a luteal phase…so they would not have PMS
PMS vs depression
timing…
when does it happen and how long it last…
if it last longer than 2 weeks….major depressive disorder
PMS vs PMDD
PMDD is much more severe….Premenstrual dysphoric disorder
interfering with functioning.
missing work
having fights with family so they have to lock themselves away…etc etc.
Suicide ideation before menstrual cycle every month…..
PMS
if they are functioning even if its taking some work to function…its PMS….
How do we treat PMS
Stepwise approach:
1st: shared decision making…..
Ask the patient…..
Tracking…daily sx record…
what are some lifestyle option for PMM
Exercise…..evidence that regular exercise will improve sx
simple carbohydrate….white rice/sugar/flour etc….will make sx worse
Acupuncture
Acupressure
Curcumin
CBT….cognitive behavior therapy
Prostaglandins
A type of hormone that results in
smooth muscle contraction
vasoconstriction
Which in turn leads to
hypoxia in the uterine muscle.
Prostaglandins are typically release from the endometrium during the very early menstrual phase, following the secretory phase in the uterus.
There are few prostaglandins produced in the endometrium during the proliferative phase:
reason why dysmenorrhea is so often associated with ovulatory cycles but not anovulatory one.
THEREFORE: No ovulation…..no secretory endometrium…..no secretory endometrium…fewer prostaglandins produced.
When does PMS normally starts
During the luteal phase of the menstrual cycle…
Luteal phase starts after ovulation when the corpus luteum forms and is churning out progesterone.
The closer a person gets to the beginning of bleeding the worse their PMS is.
PMS only occur in ovulatory cycles.
