Week 2: (Menstural Abnormalities) Flashcards
Part 1
What is the normal menstrual cycle?
What are some abnormalities related to the menstrual cycle?
How does the NP correct these abnormalities related to the menstrual cycle?
How does having menstrual problems impact the chronically ill client?
How does having menstrual problems impact the disabled client?
Abnormal uterine bleeding
dysmenorrhea
PMS
Menstrual Cycle:
Normal cyclic event
starts at age 11-50 y/o
Thelarche
Breast development starts first in cycle
Adrenarche
Increase adrenal androgen release starts 2nd
How many cycles does a woman have in her lifetime?
300-400 cycles
True or False the menstrual cycle varies
True (can be different)
-stress
-hormone levels etc
How long does a cycle last?
21-40 (or 35 days even)
How much blood loss is there in a menstrual cycle?
30-80 ml’s
How many phases does the menstrual cycle have?
3 phases
- menstruation
- follicular (proliferative phase)
- luteal & secretory phase
M-F-L
What are the 3 phases in the menstrual cycle?
- Menstruation
- Foliicular or Proliferative phase
- Luteal or secretory phase
The start of the menstrual cycle is?
Menarche
The end of the menstrual cycle is?
Meno-pause (it pauses or ends)
What 2 organs go through changes in the menstrual cycle?
- The ovaries
- The uterus
O-U! WE change!!
What starts cycle day 1?
Menstruation/bleeding
How long does menstruation last?
3-7 days
Then the follicular or proliferative phase (2nd phase)
What part of the body does this happen in?
Ovary & Uterus
This happens at the same time!
The follicle releases ____ hormone which stimulates the anterior pituitary gland to release ____ & ____
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
FSH & LH (IN the Follicular or Proliferative Phase) 2nd phase!
Both stimulate the ovaries for the follicule to grow and mature (the egg)
How long does the follicular (growth of the egg) Last in the cycle?
1-14 days
In a 28 day cycle
In the 3rd phase of the menstural cycle (LH) luteinizing hormone acts on the ovary to stimulate ___?
Ovulation (the release of the egg (ovum) from the ovaries
In the 3rd phase (Luteal or secretory)
The corpus luteum produces progesterone
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
Where is progesterone mainly secreted?
This is secreted in the corpus luteum
What is the corpus luteum?
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)
What is the role of progesterone?
This hormone prepares the body for pregnancy if/when the egg is released & fertilized.
If the egg is not fertilized?
The corpus luteum breaks down/dies really
Since it breaks down progesterone also falls & a new menstrual cycle begins again
If an egg is fertilized?
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)
___ 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
progesterone
During early stages of pregnancy progesterone is still produced by the corpus luteum & is essential for supporting ___ & ___
pregnancy & the placenta
good source yourhormones.info
Will be tested on the menstrual cycle!! ***
A-menorrhea
The absence of periods
Causes:
-menopause
-pregnancy
-use of birth control
-side effects from meds
-delayed puberty
-stress
Oligo-menorrhea
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
Poly-menorrhea
-frequent periods/menstruation
-frequent bleeding
-Menstrual cycles are shorter than 21 days
Causes of poly-menorrhea
-Perimenopause (almost entering menopause)
-PCOS
-BC pills
-Excessive exercise
-Eating disorders
-Thyroid disorders
-short follicular phase
-Inadequate luteal phase
Hyper-menorrhea/menorrhagia
Heavy periods (prolonged vaginal bleeding)
Causes of hyper-menorrhea/menorrhagia
-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)
Metro-rragia/meno-mentro-rrhagia
Metrorrhagia
light to heavy bleeding BETWEEN/METRO regular periods
Meno-metrorrhagia
Increased uterine bleeding irregular & more frequent
Hypo-menorrhea
scant amount of blood or less bleeding during period
Inter-menstrual bleeding
Bleeding in between periods
Patho of primary Ammenorrhea
-dysfunctional hormonal axis
-defects in CNS
-lesions of CNS
-Genitalia defects
-Gonadal defects
Examples of primary Amenorrhea
- Prader- willa- a genetic condition with chromosome 15 abnormalities
- turners syndrome
- hydrocephalus
- absence of vagina or uterus
- trauma, tumors, infections
patho secondary to Amenorrhea
1.hysterectomy
2.uterine adhesions
3.decreased ovarian secretion
4.tumors
5. weight loss
6.intra-uterine pregnancy (IUP)
7. menopause
8. endocrine disorders
What should you know about Amenorrhea?
-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
Anovulation can be caused by a decreased/irregular secretion of
gonadotropins
Hyperprolectinemia (look this up) effects the feedback loop
What should you see clinically/need to do a full workup for amenorrhea?
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
Subjective data for Amenorrhea
-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)
Subjective data Amenorrhea associated symptoms:
-hyerprolactinemia or prolactinoma
-PCOS
-ovarian insufficiency
-outflow tract obstruction or asherman syndrome
-hypothalmic amenorrhea
Objective data for Amenorrhea:
-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?
Dysfunctional uterine bleeding
Abnormal uterine bleeding from a disturbance in the menstrual cycle.
____ uterine bleeding is NOT associated with disease tumors or infections
dysfunctional
15-20% dysfunctional during a lifetime
*accounts for 25% of surgery
like D&C’s or ablations
___ occurs with anovulatory cycles and occurs during perimenopause
** usually does not have dysmenorrhea associated with it
dysfunctional uterine bleeding
Dysfunctional uterine bleeding?
Subjective data?
Questions?
What do you expect?
**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)
Differential dx for dysfunctional uterine bleeding?
-fibroids
-coagulation defects
-thyroid dysfunction
testing for dysfunctional uterine bleeding?
-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
plan for dysfunctional uterine bleeding?
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?
