NUR 221- Women's Health

uterus

uterus

muscular organ within which fertilized ovum may implant and develop

cervix

opening into uterus and neck of uterus

• external os

  • opening from vagina filled with thick mucus

  • prevents vaginal flora from ascending into the uterus

fallopian tubes

tubes from ovaries to uterus

ovaries

produce ova and estrogen and progesterone hormones

cycle may be from

21-45 days

if implantation does not occur

• corpus luteum atrophies

• uterine muscle contracts

• endometrium degenerates

FSH peaks

pre ovulation

Estrogen & LH peak

during ovulation

progesterone peaks

post ovulation

amenorrhea

absence of menstruation

• genetic

• hormone imbalance

metorrhagia

bleeding between cycles

dysmenorrhea

• painful menstruation caused by excessive release of prostaglandins as a result of endometrial ischemia

• beings few days prior to menses and lasts a few days after

• NSAIDs help

menorrhagia

increased amount and duration of flow

polymenorrhea

short cycles of less than 3 weeks (more cycles per year)

oligomenorrhea

long cycles of more than 6 weeks (less cycles per year)

oral contraception mechanism of action

inhibits ovulation

Adverse effects of combination OCS

clots, cancer, stroke, elevated BP

• thromboembolic disorders

• hypertension

• cancer

  • these 3 increase with age

drugs & herbs that reduce the effects of OCs

antibiotics, rifampin, ritonavir, antiepileptic drugs, St. John’s wart

Drugs whose effects are decreased by OCs

warfarin

Drugs whose effects are increased by OCs

theophylline, tricyclic antidepressants, diazepam, and chlordiazepoxide

one missed pill does not _____

reverse ovarian suppression

1-2 pills missed second or third week

skip placebo pills

3 or more pills missed second or third week

use an additional form of contraception for 7 days

progestestin-only oral contraceptives

• do not cause thromboembolic disorders, headaches, nausea, or most other common AE’s of OCs

• progestin-only preparations are less effective

• more likely to cause irregular bleeding

long-acting contraceptive example

Subdermal etonogestrel implants (Nexplanon)

Less common Long-Acting Contraceptive

Depo Medroxyprogesterone acetate (MPA)

• IM or SubQ shot, protects for 3 months

• only can be used for 2 years

  • causes bone loss due to low estrogen levels

Other & Last example of long-acting contraceptive

Intrauterine Device (IUD)

• check yo strings

Which pt would be at greatest risk of developing a venous thromboembolism (VTE) if a combination oral contraceptive were prescribed?

A. 25 year old who drinks 3-4 alcoholic drinks a day

B. 45 year old who has a family history of stroke

C. 22 year old who smokes 2 packs of cigarettes a dat

D. 29 year old who has used BC pills for 9 years

c

(major factors that increase risk for thromboembolism for women who take a combo of OCs are heavy smoking, history of thromboembolism, and thrombophilias)

The nurse teaches a patient about Camila (progestin-only). Which statement by the patient requires an intervention by the nurse?

A. “i might have irregular bleeding while taking this pill”

B. “these pills do not usually cause blood clots”

C. “i should take this pill at the same time every day”

D. “this pill works primarily by preventing ovulation”

D

The nurse instructs a patient in the use of combination oral contraceptives for birth control. The nurse determines that teaching is successful if the patient makes which statement?

A. “I’ll avoid herbal products such as St. John’s wort”

B. “birth control pills don’t have serious side effects”

C. “I can continue taking birth control before elective surgeries”

D. “I should take the pill with food to prevent an upset stomach”

A

PMS symptoms

• headache, irritability, hostility, anxiety

• mood swings, depression, trouble concentrating

• appetite changes, fatigue, edema, acne, backache

• lower abdomen bloating, constipation/diarrhea

• sleep pattern alterations, breast soreness

• decreased sexual desire

PMS nonpharmacologic treatment

• exercise, dietary changes

• stress-reduction exercises

PMS pharmacologic treatment

• antidepressants

• hormonal therapy

perimenopause stage

ovarian follicles become depleted, causing estrogen to diminish

• symptoms

  • short/long cycles, heavy/light bleeding, long/short duration

  • skipped periods/abrupt stops/vaginal dryness/hot flashes

  • insomnia, headaches, mood swings, memory lapses, decreased libido, joint aches

menopause stage

permanent end of spontaneous menstruation caused by cessation of ovarian function

• menstruation has stopped for 1 year

postmenopause

stage when body adapts to new hormonal environment

• production of estrogen and progesterone from ovaries stops

• stage of LH causes hot flashes, tachycardia, sleep disruption

hormone therapy for perimonopausal and menopausal symptoms

estrogen-progestin for females with intact uterus

boxed warning for pharamlogic therapy for perimenopausal and menopausal symptoms

lowest dose possible, shortest duration possible