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Nursing 531 (Womens Health) > Week 2: (Menstural Abnormalities) > Flashcards

Week 2: (Menstural Abnormalities) Flashcards

Part 1

1
Q

What is the normal menstrual cycle?

A
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2
Q

What are some abnormalities related to the menstrual cycle?

A
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3
Q

How does the NP correct these abnormalities related to the menstrual cycle?

A
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4
Q

How does having menstrual problems impact the chronically ill client?

A
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5
Q

How does having menstrual problems impact the disabled client?

A
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6
Q

Abnormal uterine bleeding

A
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7
Q

dysmenorrhea

A
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8
Q

PMS

A
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9
Q

Menstrual Cycle:

Normal cyclic event

A

starts at age 11-50 y/o

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10
Q

Thelarche

A

Breast development starts first in cycle

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11
Q

Adrenarche

A

Increase adrenal androgen release starts 2nd

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12
Q

How many cycles does a woman have in her lifetime?

A

300-400 cycles

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13
Q

True or False the menstrual cycle varies

A

True (can be different)
-stress
-hormone levels etc

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14
Q

How long does a cycle last?

A

21-40 (or 35 days even)

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15
Q

How much blood loss is there in a menstrual cycle?

A

30-80 ml’s

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16
Q

How many phases does the menstrual cycle have?

A

3 phases

  1. menstruation
  2. follicular (proliferative phase)
  3. luteal & secretory phase

M-F-L

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17
Q

What are the 3 phases in the menstrual cycle?

A
  1. Menstruation
  2. Foliicular or Proliferative phase
  3. Luteal or secretory phase
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18
Q

The start of the menstrual cycle is?

A

Menarche

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19
Q

The end of the menstrual cycle is?

A

Meno-pause (it pauses or ends)

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20
Q

What 2 organs go through changes in the menstrual cycle?

A
  1. The ovaries
  2. The uterus

O-U! WE change!!

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21
Q

What starts cycle day 1?

A

Menstruation/bleeding

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22
Q

How long does menstruation last?

A

3-7 days

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23
Q

Then the follicular or proliferative phase (2nd phase)

What part of the body does this happen in?

A

Ovary & Uterus

This happens at the same time!

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24
Q

The follicle releases ____ hormone which stimulates the anterior pituitary gland to release ____ & ____

A

Gonadotropin (this hormone helps regulate ovarian & testicular function)

FSH (follicle stimulating hormone) (this hormone helps stimulate the ovaries to produce eggs)

&
LH (luteinizing hormone)
This helps control the menstural cycle & triggers the release of an egg from the ovary

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25
Q

FSH & LH (IN the Follicular or Proliferative Phase) 2nd phase!

A

Both stimulate the ovaries for the follicule to grow and mature (the egg)

26
Q

How long does the follicular (growth of the egg) Last in the cycle?

A

1-14 days

In a 28 day cycle

27
Q

In the 3rd phase of the menstural cycle (LH) luteinizing hormone acts on the ovary to stimulate ___?

A

Ovulation (the release of the egg (ovum) from the ovaries

28
Q

In the 3rd phase (Luteal or secretory)
The corpus luteum produces progesterone

A

Progesterone is a hormone released by the corpus luteum in the ovary.

Its role is to help the menstrual cycle & maintain the early stages of pregnancy

29
Q

Where is progesterone mainly secreted?

A

This is secreted in the corpus luteum

30
Q

What is the corpus luteum?

A

During the menstrual cycle an egg is released from the ovary at ovulation (day 14 approx)

The left overs of the ovarian follicle that encase the developing egg is called the corpus luteum.

So the corpus (encloses the egg) to help support it through releases a hormone called progesterone (oestradiol)

31
Q

What is the role of progesterone?

A

This hormone prepares the body for pregnancy if/when the egg is released & fertilized.

32
Q

If the egg is not fertilized?

A

The corpus luteum breaks down/dies really

Since it breaks down progesterone also falls & a new menstrual cycle begins again

33
Q

If an egg is fertilized?

A

Progesterone helps stimulate the growth of blood vessels that supply the lining of the womb (the endometrium)

Progesterone also helps stimulate glands in the endometrium to release nutrients that feed the early embryo (baby)

34
Q

___ hormone prepares the tissue lining of the uterus to allow the fertilized egg to implant & helps to maintain the endometrium (lining of the womb) throughout pregnancy

A

progesterone

35
Q

During early stages of pregnancy progesterone is still produced by the corpus luteum & is essential for supporting ___ & ___

A

pregnancy & the placenta

36
Q

good source yourhormones.info

A

Will be tested on the menstrual cycle!! ***

37
Q

A-menorrhea

A

The absence of periods

Causes:
-menopause
-pregnancy
-use of birth control
-side effects from meds
-delayed puberty
-stress

38
Q

Oligo-menorrhea

A

Infrequent periods/little to scant amount
(fewer than 6-8 periods in a year)

May > 35 days between periods

Causes:
-hormone imbalances

-PCOS- 75-85% experience oligo BECAUSE causes body to produce androgens (testosterone) that can interrupt ovulation, time of cycle & when ovaries release an egg

-Hyperthyroidism- The thyroid gland triggers pituitary gland to make too much prolactin & too little estrogen

-Untreated PID (STI) infection/inflammation disrupts menstrual cycle

-DM (overweight vs underweight)

-Eating disorders

-Extreme physical activity

39
Q

Poly-menorrhea

A

-frequent periods/menstruation
-frequent bleeding

-Menstrual cycles are shorter than 21 days

40
Q

Causes of poly-menorrhea

A

-Perimenopause (almost entering menopause)
-PCOS
-BC pills
-Excessive exercise
-Eating disorders
-Thyroid disorders
-short follicular phase
-Inadequate luteal phase

41
Q

Hyper-menorrhea/menorrhagia

A

Heavy periods (prolonged vaginal bleeding)

42
Q

Causes of hyper-menorrhea/menorrhagia

A

-endometriosis
-hormonal imbalance (obesity, thyroid problems)
-cancer- cervical cancer
-fibroids
-meds
-genetic bleeding disorders
-If no egg is released to make progesterone (this can cause heavy periods)

43
Q

Metro-rragia/meno-mentro-rrhagia

A

Metrorrhagia
light to heavy bleeding BETWEEN/METRO regular periods

Meno-metrorrhagia
Increased uterine bleeding irregular & more frequent

44
Q

Hypo-menorrhea

A

scant amount of blood or less bleeding during period

45
Q

Inter-menstrual bleeding

A

Bleeding in between periods

46
Q

Patho of primary Ammenorrhea

A

-dysfunctional hormonal axis
-defects in CNS
-lesions of CNS
-Genitalia defects
-Gonadal defects

47
Q

Examples of primary Amenorrhea

A
  1. Prader- willa- a genetic condition with chromosome 15 abnormalities
  2. turners syndrome
  3. hydrocephalus
  4. absence of vagina or uterus
  5. trauma, tumors, infections
48
Q

patho secondary to Amenorrhea

A

1.hysterectomy
2.uterine adhesions
3.decreased ovarian secretion
4.tumors
5. weight loss
6.intra-uterine pregnancy (IUP)
7. menopause
8. endocrine disorders

49
Q

What should you know about Amenorrhea?

A

-If hormone levels are present & WNL (within normal limits) suspect structural abnormalities or hysterectomy

-If increased ovarian steroid hormones - you can inhibit ovulation

-If there are decreased ovarian steroid hormones-you can have inhibited ovulation

50
Q

Anovulation can be caused by a decreased/irregular secretion of

A

gonadotropins

51
Q

Hyperprolectinemia (look this up) effects the feedback loop

A
52
Q

What should you see clinically/need to do a full workup for amenorrhea?

A

1.no breast development or pubic hair by 13 y/o
2.no menses by age 15
3.normal onset of breast development & pubic hair is (7-13)
BUT no period within 5 years

53
Q

Subjective data for Amenorrhea

A

-chart review & history
-age
-menstrual history or absence of periods
-associated symptoms
-reproductive health history
-sexual history
-pregnancy & breastfeeding history
-medical & surgical history
-meds & allergies
-social history
-ROS (review of systems)

54
Q

Subjective data Amenorrhea associated symptoms:

A

-hyerprolactinemia or prolactinoma
-PCOS
-ovarian insufficiency
-outflow tract obstruction or asherman syndrome
-hypothalmic amenorrhea

55
Q

Objective data for Amenorrhea:

A

-vital signs
-height & weight (BMI)
-thyroid
-tanner staging
-pelvic exam: for physical cause of amenorrhea
-signs of endocrine/nervous system disorder

**visual field exam defects can show pituitary adenoma

-analysis: probable? amenorrhea

differential dx includes:
secondary amenorrhea from pregnancy, lactation, med use, BC pills, PCOS, hypothalmic dysfunction, thyroid disease,prolactinemia, primary ovarian insufficiency, cushing syndrome,asherman syndrome with intrauterine adhesions or cervical stenosis, exogenous androgens, neoplasms, med/substance abuse,genetic factors, adrenal hyperplasia

plan: see figure 7-2 Tharpe p. 409 *** come back to (midwifery book)

-lab tests?
-meds?
-referrals?
-surgeries?

56
Q

Dysfunctional uterine bleeding

A

Abnormal uterine bleeding from a disturbance in the menstrual cycle.

57
Q

____ uterine bleeding is NOT associated with disease tumors or infections

A

dysfunctional

15-20% dysfunctional during a lifetime

*accounts for 25% of surgery
like D&C’s or ablations

58
Q

___ occurs with anovulatory cycles and occurs during perimenopause

** usually does not have dysmenorrhea associated with it

A

dysfunctional uterine bleeding

59
Q

Dysfunctional uterine bleeding?

Subjective data?
Questions?
What do you expect?

A

**the general subjective data in women’s historys

-chart review & history
-age
-menstrual history or absence of periods
-associated symptoms
-reproductive health history
-sexual history
-pregnancy & breastfeeding history
-medical & surgical history
-meds & allergies
-social history
-ROS (review of systems)

60
Q

Differential dx for dysfunctional uterine bleeding?

A

-fibroids
-coagulation defects
-thyroid dysfunction

61
Q

testing for dysfunctional uterine bleeding?

A

-cbc
-pap smear
-pregnancy test
-if pregnancy test is negative (you can order an ultrasound)
-you can check coagulation studies if there is a family history

coagulation studies:
platelet, PTT, bleeding time, TSH

**all normal you can do an endometrial biopsy

if endometrial biopsy comes back normal- have the MD follow up with a hystersoscopy

62
Q

plan for dysfunctional uterine bleeding?

A

Psychosocial interventions?
-discuss plan
-meds

Medications?
-low dose BC pills
BUT if a woman is trying to get pregnant you would not try low dose birth control pills

Surgeries?
-D&C
-hysteroscopy

Referrals?
-follow up in 3 months
Follow up?

Nursing 531 (Womens Health) (10 decks)

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