Week 7 - Menstrual cycle & Uterus Flashcards
Symptoms of PMS and PMDD
Mastalgia, weight and appetite changes, emotional lability, and bloating.
Treatment for PMS and PMDD
SSRIs – for PMD with predominantly emotional symptoms (Fluoxetine, sertraline, paroxetine)
‣ Continuous – daily dose
‣ Intermittent – begin daily with ovulation and continue to days 1-2 of menses
‣ Symptom onset dosing: begin with onset of symptoms stop with end of menses
Hormonal contraception – combined therapy with estrogen and progesterone – OC pills, the ring or hormonal patches
Anxiety medications like Xanax
Diuretics for fluid retention and bloating
Primary dysmenorrhea
‣ strong, frequent uterine contractions are believed to cause hypoxia and even ischemia of the muscle, resulting in pain
‣ NSAIDS effective in treating symptoms
Secondary dysmenorrhea
Caused by an underlying pathology, such as endometriosis (the most common cause), adenomyosis (the second most common cause), nonhormonal intrauterine devices, fibroids, and scarring from abdominal surgery or infection
‣ Diagnosed with symptoms, usually onset 2+ years after menarche, HPE, imaging
S/S of primary and secondary dysmenorrhea
‣ painful cramping with menses. Patients also report backache, pain that radiates into the thighs, nausea and vomiting, diarrhea, sweating, headaches, fatigue, and sleeping disorders
‣ symptoms occur with ovulary cycles
Abnormal Uterine Bleeding (AUB)
- bleeding that is atypical in frequency, regularity, duration, and timing in the absence of structural abnormalities
Endometriosis
Growth or multiple growths (polyps) of endometrial tissue found outside of the uterine cavity
Symptoms of endometriosis
‣ Dysmenorrhea
‣ Painful intercourse
‣ Rectal pain w/defecation
‣ Urgent micturition
Risk factors for endometriosis
‣ Increased age
‣ Hereditary
‣ Caucasian
‣ Early menarche
Uterine fibroids
benign tumors of the uterine myometrium
‣ Microscopic to very large, single or multiple
‣ Most common indication for hysterectomy
Symptoms of uterine fibroids
‣ Menorrhagia
‣ Infertility
‣ Bowel/bladder complaints
Risk factors for uterine fibroids
‣ Hereditary
‣ Obesity
‣ Black
‣ Primiparous status (giving birth to only one child)
Adenomyosis
growth of endometrial tissue into the uterine myometrium (smooth muscle layer)
Symptoms of Adenomyosis
‣ Menorrhagia
‣ Diffusely enlarged, tender, boggy uterus
Treatment for adenomyosis
‣ gonadotropin-releasing hormone (GnRH) agonist,
‣ myomectomy,
‣ oral contraceptives,
‣ intrauterine device (IUDs
Pelvic inflammatory disease
occurs in the upper female genital tract and includes any combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis. Most commonly caused by gonorrhea or chlamydia
S/S of PID
‣ abdominal, pelvic, and low back pain;
‣ abnormal vaginal discharge;
‣ intermenstrual or postcoital bleeding;
‣ fever
‣ nausea and vomiting
‣ urinary frequency
Assessment for PID
Comprehensive history
‣ recent pelvic surgery,
‣ abortion, childbirth,
‣ dilation of the cervix
‣ insertion of an intrauterine device (IUD) within the past month.
Sexual history should be obtained,
‣ current or most recent sexual activity
‣ number of partners,
‣ method of contraception;
risk for STIS
Amenorrhea
absence of menses – commonly caused by pregnancy, hypothalamic amenorrhea and PCOS
Dysmenorrhea
defined as painful cramps that occur with menstruation
Toxic Shock Syndrome
A rare, life-threatening complication of certain bacterial infections characterized by an acute onset characterized by fever, low blood pressure, a sunburn-like body rash, and end-organ damage.
Signs and symptoms of Toxic Shock Syndrome
‣ a rapid onset of fever, hypotension, and rash
‣ Multisystem organ involvement in addition to less specific symptoms, such as myalgias, headache, and pharyngitis, which may then progress to organ dysfunction.
Diagnosing Toxic shock syndrome
- Negative results on the following tests, if obtained:
‣ Blood or cerebrospinal fluid cultures (blood culture may be positive for Staphylococcus aureus)
‣ Negative serologies for Rocky Mountain spotted fever, leptospirosis, or measles
Clinical findings positive for:
‣ Fever: temperature greater than or equal to 102.0°F (greater than or equal to 38.9°C)
‣ Rash: diffuse macular erythroderma
‣ Desquamation: 1–2 weeks after onset of rash
‣ Hypotension: systolic blood pressure less than or equal to 90 mm Hg for adults or less than the fifth percentile by age for children younger than 16 years
‣ Multisystem involvement (three or more of the following organ systems):
‣ Gastrointestinal: vomiting or diarrhea at onset of illness
‣ Muscular: severe myalgia or creatine phosphokinase level at least twice the upper limit of normal
‣ Mucous membranes: vaginal, oropharyngeal, or conjunctival hyperemia
‣ Renal: blood urea nitrogen or creatinine at least twice the upper limit of normal for laboratory or urinary sediment with pyuria (greater than or equal to 5 leukocytes per high-power field) in the absence of urinary tract infection\
‣ Hepatic: total bilirubin, alanine aminotransferase enzyme, or asparate aminotransferase enzyme levels at least twice the upper limit of normal for laboratory
‣ Hematologic: platelets less than 100,000/mm3
‣ Central nervous system: disorientation or alterations in consciousness without focal neurologic signs when fever and hypotension are absent
Treatment for Toxic Shock Syndrome
‣ Broad spectrum antibiotics -clindamycin (bacteriostatic and not bacteriocidal), penicillin 14 day course
Polycystic Ovarian Syndrome
condition in which the ovaries produce an abnormal amount of androgens (male sex hormones) that are normally present in small amounts. If not enough hormones needed to ovulate are present the ovaries can develop small cysts.
Symptoms of PCOS
‣ Missed periods, irregular periods, or very light periods.
‣ Ovaries that are large or have many cysts.
‣ Excess body hair, including the chest, stomach, and back (hirsutism)
‣ Weight gain, especially around the belly (abdomen)
‣ Acne or oily skin.
‣ Male-pattern baldness or thinning hair.
‣ Infertility.
Assessment for PCOS
‣ Most common cause of hyperandrogenism, occurs in approximately 80% of women with androgen excess
‣ Clinical and/or biochemical evidence of hyperandrogenism
‣ Oligo-anovulation
‣ Polycystic ovaries
‣ Exclusion of other etiologies
Diagnosis of exclusion. If history, physical examination, and laboratory testing rule out all other possible causes of hyperandrogenism, the most likely diagnosis is PCOS
Cervical Cancer Staging
SIL – squamous intraepithelial lesions
CIN – cervical intraepithelial neoplasia
‣ CIN 1 – low grade, involves lower 1/3 of layer of cervical cells
‣ CIN 2 (high grade) moderately severe, 2/3 thickness of cervical layer affected by abnormal cells
‣ CIN 3 – (high grade) – full thickeness of cervical layer affected by abnormal cells. AKA carcinoma in situ. Dysplasia becomes cancer when it invades the basement membrane.
Cervical cancer screening guidelines
‣ Under age 21 – no screening
‣ Age 21-29 – Screen with cervical cytology every 3 years
‣ Age 30-65 – screen every three years with cytology along, screen every 5 years with cervical cytology and HPV testing
‣ Over age 65 – no screening
Cervical cancer prevention
HPV vaccine, two doses starting at age 9-12 given 6-12 months apart
PMS diagnostic symptoms
i. 1 affective + 1 somatic symptom
ii. Symptoms occur 5 days prior to menstrual flow
iii. Relief w/in 4 days of completion of menses
iv. No symptoms until return of luteal phase
v. Symptoms have occurred for 3 continous cycles
vi. PMDD ruled out
vii. Negative impact on social or economic function
PMDD diagnostic criteria
PMDD diagnosis requires at least 5 symptoms from the following list, with at least 1 of those symptoms from the first four symptoms listed.
- Depressed mood or hopelessness
- Anxiety or tension
- Lability
- Increased or persistent anger, irritability or interpersonal conflicts
- Decreased pleasure or interest
- Difficult concentrating
- Lethargy
- Change in appetite
- Insomnia or hypersomnia
- Feeling overwhelmed or out of control
- Breast tenderness or swelling
- Abdominal bloating
- Headache
- Joint muscle or pain
- Weight gain
- Extremity swelling
Vaginitis
inflammation of the vagina characterized by an increased vaginal discharge containing numerous white blood cells
Cause of vaginitis
Occurs when the vaginal environment is altered, either by microorganisms or disturbance that allows pathogens to proliferate
Vulvovaginitis
General term for a collection of vulvar and vaginal symptoms, such as itching, burning, irritation, and sometimes dysuria or dyspareunia.
Inflammation of the vulva and vagina, may be caused by vaginal infection or copious amounts of leukorrhea
Bacterial vaginosis
Happens when here is a change in the pH of the vagina either due to reduction in lactus bacteria or invasion or overgrowth of pathogenic bacteria
S/S of Bacterial Vaginosis
- thin greyish white adherent discharge
- fishy smell – may be worse with intercourse
- mild/no itching
- difficulty urinating
- may be mostly asymptomatic
- vaginal walls may be pink or pale but not erythematous
Diagnosing BV
3 of 4 symptoms must be present for diagnosis
- white, thin adherent vaginal discharge
- pH 4.5 or greater
- Positive whiff/KOH test
- Clue cells on microscopic examination (more than 20 percent of epithelial cells are clue cells)
Management of Bacterial Vaginosis
Metronidazole 500mg BID for 7 days or 0.75% vaginally inserted daily for 5 days
Vulvovaginal candidiasis S/S
itching, burning, irritation, and sometimes dysuria or dyspareunia caused by candida
- Thin or thick, curd like, resembles cottage cheese
- No smell
- Swelling, erythema and itching
- Dysuria with severe cases
Treatment for vulvovaginal cadidiasis
- OTC topical azoles
- 1 dose 150mg of PO fluconazole
