NURS 371: CH 6- Exam 2

Common Menstrual Disorders

•Amenorrhea

•Dysmenorrhea (Primary & Secondary)

•Premenstrual Syndrome (PMS)

•Premenstrual Dysphoric Disorder (PMDD)

•Endometriosis

•Alterations in cyclic bleeding

Amenorrhea

•Absence of menstrual flow

•Clinical signs of a variety of disorders

•The absence of both menarche and secondary sexual characteristics by age 14 years

•Absence of menses by age 15, regardless of presence of normal growth and development (primary amenorrhea)

•Absence of menstruation within 5 years of breast development

•A 6-month (or more) absence of menses after a period of menstruation (secondary amenorrhea)

•Although amenorrhea is not a disease, it is often the sign of one.

Amenorrhea: Types

•Hypogonadotropic amenorrhea

•Exercise-associated amenorrhea

•Management of amenorrhea

Hypogonadotropic amenorrhea:

Problem in central hypothalamic-pituitary axis

What is this suppression related to sudeen stress, weight loss/ weight gain

Amenorrhea is also a classic sign of eating disorders

Assessment:

Begins with thorogh health assmesnt,

Exercise-associated amenorrhea

If this may be the contributing factor, then what can be done?

Management of amenorrhea

PLAN with patient

Dysmenorrhea

•Pain during or shortly before menstruation

•Primary dysmenorrhea

•A condition associated with ovulatory cycles

•Excessive release of prostaglandins causes pain

•Alleviating discomfort: various methods

•Secondary dysmenorrhea

•Acquired menstrual pain that develops later in life than primary dysmenorrhea, typically after age 25 years ; a/w pelvic pathology

Primary & secondary can coexist

Primary dysmenorrhea

•A condition associated with ovulatory cycles

•Excessive release of prostaglandins causes pain

•Alleviating discomfort: various methods

Pain usually begins at the onset of menstruation and lasts 8-48 hours

More common in women in their adolence and early teen years

Symptoms do not appear when ovulation is suppressed

Pain relief: heat, excercise, increase blood flow, relaxation techniques, TENS machine, natural diuretics (watermelon, cranberry, asparagus), oral contraceptives, NSAIDS

Secondary dysmenorrhea

•Acquired menstrual pain that develops later in life than primary dysmenorrhea, typically after age 25 years ; a/w pelvic pathology

Endometriosis, PID, uterine fibroids, or endometrial polyps are frequent causes

Treatment of Secondary Dysmenorrhea

•TREAT the underlying cause

•Hysterectomy

•Many measures for primary dysmenorrhea are helpful in secondary dysmenorrhea

Premenstrual Syndrome  (PMS)

•Premenstrual syndrome (PMS) occurs in luteal phase of menstrual cycle

•PMS: cluster of physical, psychological, and behavioral symptoms

•Experienced by 75% of women during some point in their lives

Ovarian function is necessary- help when supress ovulation

Premenstrual Dysphoric Disorder (PMDD)

•Severe variant of PMS

•Marked by five or more symptoms

•Symptoms interfering markedly with work or interpersonal relationships

Most common symptoms are:

-Psycologic: marked irritability, depression, anxiety, self depreviation thoughts, decrease in usual activity, overwhelming feeing

-physical: bloating, breast tenderness, weight gain

PMS/ PMDD Symptoms include:

•Psychologic, neurologic

•Respiratory

•Gastrointestinal, urinary

•Dermatologic

•Mammary

•Musculoskeletal

PMS & PMDD Management

•Education

•Diet and exercise/Lifestyle changes

•Nutritional supplements

•Herbal therapies

•Medications

Conservative measure are first used before medications…what are conservative measures?

Endometriosis

•Presence and growth of endometrial tissue outside of the uterus

•The overall incidence of endometriosis is 5% to 15% in reproductive-age women, 30% to 45% in infertile women, and 33% in women with chronic pelvic pain

•Major symptoms

•Pelvic pain

•Deep pelvic dyspareunia (painful intercourse)

•Management

•Drug therapy

•GnRH agonist therapy

•OCP’s; NSAIDS

•Surgical intervention

Symptoms:

Pelvic pain

Dyspareunia

Dysmenorrhea

Abnormal uterine bleeding

Infertility

Management:

Drug therapy- reduces lesions, improves pain, prevents growth

Surgical:

Surgical intervention- severe, acute or incapacitating

Conservative or definitive

Laser therapy

Alterations in cyclic bleeding

Infrequent menstrual cycle

Intermenstrual bleeding

Heavy Menstrual bleeding

(AUB)

Infrequent menstrual cycle

•characterized by intervals of 40-45 days; Treatment aimed at reversal of the cause

Intermenstrual bleeding

• any episode of bleeding, whether spotting, menses or hemorrhage, that occurs at a time other than the normal menses

Heavy Menstrual bleeding

• excessive menstrual bleeding, in either duration or amount

(AUB)

• any form of uterine bleeding that is irregular in amount, duration, or timing and is not related to regular menstrual bleeding

Menopause-Diagnosis

•Complete cessation of menses

•Physiologic characteristics

•Anovulation occurs more frequently.

•Menstrual cycles increase in length.

•Ovarian follicles become less sensitive to hormonal stimulation from FSH and LH.

•Ovulation occurs with less frequency.

•Progesterone is not produced by the corpus luteum.

•FSH values are elevated and estrogen levels drop.

Diagnostic-Absence of menstruation for 1 full year

Age of onset influenced by: general health, genetic factors, nutrition status, life style

Perimenopause: trabsition between normal menstration cycle (last 4-5 years before menaupuase)

Physical changes during the perimenopausal period

•Bleeding

•Genital changes

•Vasomotor instability

•Hot flush/flash

•Mood and behavioral responses

Menopause

•Health risks of perimenopausal women

•Osteoporosis

•Coronary heart disease

•Menopausal hormonal therapy

•Decision to use hormone therapy

•Side effects

•Treatment guidelines

•Bioidentical and custom-compounded hormones

•Alternative therapies

Health risks of perimenopausal women:

Osteoporosis: not having good nutrition balance, decrease excerise

Estrogen has a protective effect

Lack of estrogen has an effect on Vitamin D

Cardiovascular system:

Risk factors: smoking, obesity, family history, hypertensive, diabetes- damageing effect on heart vessles

Estrogen affect: lower LDL and increase HDL- more prone to CAD

Menopause: Care Management

•Plan of care and interventions

•Sexual counseling

•Nutrition

•Exercise

•Medications for osteoporosis

•Midlife support groups

•Nurses should be familiar with local resources and direct women to classes that supply appropriate information and support.