Care exam #2 - hormone regulation

sexual health

state of physical, emotional, mental and social well-being in relation to sexuality

why is sexual health important

effects morbidity and mortality

important to understand prevalence of sexual dysfunction, sexual history and its impacts on relationships and quality of life.

sexual health outcomes

maintain or enhance sexual health, increase knowledge, health promotion, satisfaction, self-concept, high-risk behaviors, prevent STIs

Sexual health assessment

confidential, nonjudgemental, understand patient expectations, cultural sensitivity, clarity, assess understanding and knowledge level

barriers to assessing or talking about sexual health

embarrasses, fear, lack of knowledge, lack of awareness, unclear beliefs

estrogen - female production

ovaries produce estrogen known as estradiol.

Peripheral tissue convert estradiol to less potent estrone and estriol

placenta uses estrogens during pregnancy

estrogen production - males

testes - convert small amount of testosterone to estradiol and estrone

peripheral tissues convert testosterone to estrogen production

physiological effects of estrogen

needed for growth and maturation of female reproduction, conception, bone health, heart health, coagulation

estrogen with bone health

blocks bone resorption and promotes deposition

estrogen with heart health

lowers LDL and increases HDL d/t metabolism in lover to increase amount of cholesterol excreted in bile

estrogen with coagulation

promotes by increasing factors II, VII, IX, X, XII and supresses by decreasing antithrombin

progesterone for women

secreted by ovary-corpus luteum; for proliferate endometrium to maintain pregnancy, suppress smooth muslce of uterus and GI tract, causes eoithelium in breast tissue to divide and grow, suppress CNS system and pituitary gonadotropins

progesterone for men

secreted by adrenal glands and testes needed for precursor to other hormones: testosterone and cortisol/masculinity

sexual dysfunction - women: physiological factors

diabetes, neuropathy, paralysis, hormones

sexual dysfunction - women: psychological factors

stress, anxiety, depression, anger

sexual dysfunction - men: physiological factors

ED, ejaculatory disorders, diabetes, prostate surgery, antihypertensive medications

sexual dysfunction - men: psychological factors

stress, antidepressants

physiological consequences of sexual dysfunction

unfulfilled sexual desire, unsatisfactory sexual responses, pain, STI, inability to create pregnancy

psychological consequences of SD

problems with relationships, low self-esteem, anxiety, depression

population at risk for SD

adolescents, disabilities, new unpartnered, sexual orientation

illnesses affecting sexual function

diabetes, cancer, neuropathy, spina bifida, unstable angina, HNT, HIV, substance use, depression

medications affecting sexual function

antihypertensives, antipsychotics, antidepressants, antianxiety, diuretics, oncological agents, illicit drugs

normal reproduction - menstruation

periodic uterine bleeding that begins approx 14 days after ovulation

occurs every 28 days and lasts 5 days

menstruation feedback system

hypothalamic-pituitary; ovarian and endometrial

abnormal reproduction - amenorrhea

absence of menstrual flow

abnormal reproduction - primary amenorrhea

hormonal abnormalities and genetic condition

treat with hormonal replacement therapy

abnormal reproduction - secondary amenorrhea

elevation of thyroid stimulating hormone or prolactin levels, treat with hormone replacement therapy or corrective surgery

abnormal reproduction - dysmenorrhea

pain during or shortly before mensturation

abnormal reproduction - primary dysmenorrhea

painful menstruation associated with the release of prostagladins in ovulatory cycles

abnormal reproduction - secondary dysmenorrhea

related to pathologic conditions; manifests later in reproductive years and may occur any time in the menstrual cycle

abnormal reproduction - primary dysmenorrhea management

hormonal contraceptives and nonsteroidal anti-inflammatory medications

regular exercise, diet changes, heat massage, relaxation

abnormal reproduction - secondary dysmenorrhea management

remove underlying pathology

hormonal contraceptives and nonsteroidal anti-inflammatory medications

regular exercise, diet changes, heat massage, relaxation

oligomenorrhea

cycles longer than 5-6 weeks, manage with hormonal therapy

metrorrhagia

intermenstrual bleeding; asses OCP being taken

menorrhagia

excessive bleeding in amount or duration

dysfunctional uterine bleeding

excessive uterine bleeding with no demonstrable cause

premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) patho

result of abnormal tissue response to the normal changes of the menstrual cycle

premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) clinical manifestations

pattern of symptom frequency and severity of over 100 physical, emotional, and behavioral symptoms

fluid retention, behavioral/emotional changes, premenstrual cravings, headache, fatigue, backache

premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) management

lifestyle changes often effecctive; not smoke, limit consumption of refined sugar, salt, red meat, alcohol, caffeine, nutritional supplements, selective serotonin reuptake inhibitors, NSAIDS, hormonal treatment

edometriosis

presence of growth of endometrial glands and stroma outside the uterus

can cause infertility, pelvic pain, dysmenorrhea, abnormal vaginal bleeding

polycystic ovary syndrome (PCOS) patho

most common endocrine disturbance affecting women - leading cause of infertility

multiple cysts form on one or both ovaries & produce excess estrogen

polycystic ovary syndrome (PCOS) clinical manifestations

obesity, hirsutism, irregular menes or amenorrhea, infertility

polycystic ovary syndrome (PCOS) diagnosis

often in adolescence when symptoms appear

polycystic ovary syndrome (PCOS) treatment

combined oral contraceptives to control irregular menstrual cycles and Insulin sensitizers

polycystic ovary syndrome (PCOS) goal

prevent diabetes and heart disease & restore fertility

what is menopause

ovarian follicles and estrogen decline and symptoms increase

menopause hormone replacements - benefits

supress symptoms #1 reason for use

prevent osteoporosis, prevent urogenital atrophy, prevent colorectal cancer

menopause hormone replacements - risks

heart disease, stroke, DVT, PE, cancers, gallbladder disease, urinary incontinence

individual risk profile assessment for menopause

age, time since menopause, symptoms and indication, cardiovascular risk, VTE, cancer history, unexplained vaginal bleeding, liver disease, is uterus present or absent

approved indications of estrogen MHRT

treatment of moderate to severe vasomotor symptoms

treatment of moderate to severe symptoms of vuvar and vaginal atrophy

prevention of postmenopausal osteoporosis

therapeutic use or clinical application of estrogen

contraceptive or noncontraceptive

menopausal hormone therapy, female hypogonadism, turners syndrome, acne

physiological and pharmacologic adverse effects of estrogen

endometrial hyperplasia/cancer

breat cancer

ovarian cancer

cardiovascular events

nausea

therapeutic use of clinical application of progesterone

a compound that acts like progesterone, the endogenous progesterone hormone

therapeutic use of clinical application of progesterone - non-contraceptive

Counteract the adverse effects adverse effects of hormone therapy of estrogen on the edometrium by suppress endometrial hyperplasia, amenorrhea, infertility, migraines, reduce fluid retention, for preterm labor

physiologic and pharmacologic adverse effects of progesterone

teratogenic effects, gynecologic effects, breast cancer risk

estrogen and progesterone as contraceptives - MOA

inhibit ovulation by suppressing both the pituitary from releasing FSH and the hypothalamus from releasing LH for no ovulation

estrogen and progesterone as contraceptives - effectiveness

not taken as scheduled, antibiotic interaction, overweight

nursing interventions - sexual health

begins with knowledge, therapeutic relationship, attitude, privacy,

health promotion of sexual health

sex ed, teaching self exams, responsible sexual behavior