Menstrual Cycle

Menstrual Cycle Disorders

What is the Menstrual Cycle?

• Definition: A sequence of hormonal and physiological changes that prepare the body for possible pregnancy.

• Cycle characteristics:

  • Begins on the first day of menstruation.

  • Typically lasts between 28 days but can range from 20 to 45 days.

  • Involves changes in the uterine lining and ovaries.

• Importance: The menstrual cycle is a significant indicator of reproductive health.

Amenorrhea: Primary

• Definition: Absence of menstruation in women who have not had their first period by a certain age.

• Causes:

  • Delayed onset of menstruation if menstruation has not begun by 15 years of age with normal growth and secondary sexual characteristics.

  • Failure to start menstruation by 13 years with no signs of sexual development.

  • Inability to menstruate if one year older than when mother or sisters began.

  • Turner syndrome (only 1 normal X chromosome): Incomplete development of reproductive organs.

  • Hormonal imbalances, systemic diseases, or hypothalamic-pituitary abnormalities leading to inadequate gonadotropin secretion.

  • Excessive exercise, malnutrition, and eating disorders (anorexia nervosa, bulimia) leading to decreased ovarian hormones, linked to insufficient body fat (McKinney et al., 2022, p. 190, 703).

Amenorrhea: Primary Management

• Approach:

  • Comprehensive medical history and physical examination.

  • Diagnostic tests, including:

  • Urine pregnancy test.

  • Pelvic ultrasound.

  • Serum FSH, LH, estradiol.

  • Serum prolactin.

  • Serum thyroid-stimulating hormone.

  • Referral to a genetic counselor if a genetic defect is suspected.

• Evaluation: Treatment depends on the underlying cause.

  • Counseling for eating disorders and recommendations to reduce excessive exercise.

  • Hormone therapy may induce menstruation if due to hormonal imbalance.

  • For reproductive tract or congenital abnormalities, normal menstruation and fertility may not be achievable, requiring psychological support (McKinney et al., 2022, p. 703; Gasner & Rehman, 2023, par. 28-32).

Nursing Considerations for Amenorrhea: Primary

• Concerns of patients regarding infertility and loss of femininity.

• Importance of adequate nutrition and discouraging rigorous dieting.

• Provision of emotional support and clarification about treatment.

Amenorrhea: Secondary

• Definition: Absence of menstruation after it has previously been established.

• Causes:

  • Pregnancy, poor nutrition, hormonal contraceptives, stress, hormone imbalances, heavy exercise, ovarian tumors.

  • Systemic diseases such as diabetes mellitus, tuberculosis, hypothyroidism, and CNS lesions.

• Assessment:

  • Detailed medical and obstetric history.

  • Hormone level labs.

  • Inquiries about exercise, stressors, dieting history, drug use, and hormonal contraceptives (McKinney et al., 2022, p. 703).

Amenorrhea: Secondary Management

• Management varies based on underlying cause:

  • Conduct pregnancy tests, especially in sexually active women; stop teratogenic drugs pending results.

  • Hormonal testing and treatment to improve menstrual cycle regularity.

  • Address anovulation and other abnormalities.

• Nursing Considerations:

  • Education on nutrition and exercise implications.

  • Emotional support, particularly regarding infertility concerns (McKinney et al., 2022, p. 703).

Abnormal Uterine Bleeding

• Definition: Any irregular bleeding that deviates from expected menstrual patterns.

• Characteristics:

  • Irregular timing, abnormal duration, or excessive blood loss.

• Causes:

  • Pregnancy complications (e.g., spontaneous abortion).

  • Lesions in the reproductive tract (both benign and malignant).

  • Breakthrough bleeding related to hormonal contraceptive use.

  • Conditions such as diabetes mellitus, uterine myomas or fibroids, hypothyroidism, blood coagulation disorders, inability to ovulate (McKinney et al., 2022, p. 704).

Management of Abnormal Uterine Bleeding

• Steps:

  • Determine ovulation presence through pregnancy and coagulation tests.

  • Conduct ultrasound assessments of the uterine lining.

  • Prescription of oral contraceptives with progestin and estrogen to stabilize the environment by stopping ovulation.

  • Laparoscopy to identify bleeding sources or dilation and curettage to remove abnormal tissue (polyps).

  • Hysterectomy for excessive abnormal tissue where deemed necessary.

  • Treatments for anemia if excessive blood loss occurs (McKinney et al., 2022, p. 704).

Nursing Considerations for Abnormal Uterine Bleeding

• Encourage patients to seek help when needed.

• Educate on how to track bleeding, using calendars or counting saturated pads.

• Advise on stress reduction and maintaining activity levels with caution against excessive exercise.

• Offer support and answer patient questions (McKinney et al., 2022, p. 704).

Pain Associated Disorders: Mittelschmerz

• Definition: A unilateral pelvic pain that occurs during ovulation.

• Causes:

  • Caused by the growth of the dominant follicle or its rupture.

  • Release of follicular fluid and blood into the peritoneal space contributes to pain (McKinney et al., 2022, p. 704).

• Management:

  • Pain may last for a few hours to two days.

  • Little to no bleeding may accompany the pain.

  • Analgesics are commonly used to manage discomfort.

Pain Associated Disorders: Primary Dysmenorrhea

• Definition: Menstrual pain (cramps) without other pathologic conditions.

• Characteristics:

  • Pain occurs in waves or spasms affecting lower abdomen, lower back, and legs.

  • Resolves within 48-72 hours after onset of menses.

• Causes:

  • Primarily occurs within hours after menstruation starts, more prevalent in younger women who haven’t given birth.

  • Excessive prostaglandin synthesis occurring during the late luteal phase.

  • Prostaglandins diffuse into endometrial tissue, causing muscle contractions, decreasing uterine blood flow and oxygen supply during contractions (McKinney et al., 2022, p. 704).

Management of Primary Dysmenorrhea

• Symptoms may include diarrhea, nausea, and vomiting.

• Treatment methods:

  • NSAIDs (nonsteroidal anti-inflammatory medications) such as ibuprofen (Motrin, Advil) and naproxen (Naprosyn, Anaprox) to reduce prostaglandin synthesis and manage pain.

  • Body positioning, stretching, and warm compresses as complementary non-pharmacologic interventions.

• Nursing Considerations:

  • Recognition that experiences of pain intensity vary significantly among women.

  • Not all women may suffer from Primary Dysmenorrhea, requiring tailored pain management plans (McKinney et al., 2022, p. 704).

Pain Associated Disorders: Endometriosis

• Definition: Abnormal growth of uterine tissue outside the uterus, leading to scar tissue and adhesions.

• Etiology:

  • Exact cause is unknown; potential factors include genetic predisposition, hormonal changes, immunistic changes, and environmental factors.

  • Approximately 10% of women in the population are affected by endometriosis (McKinney et al., 2022, p. 679, 705).

• Management:

  • History assessment focusing on cyclic pain, infertility, and dyspareunia (painful intercourse).

  • Physical examination near menses onset may reveal masses of endometrial tissue.

  • Treatment Options:

  • Medical treatments include hormone therapies like oral contraceptives (e.g., norethindrone/Micronor), testosterone derivatives (e.g., danazol/Danocrine), and estrogen agonists (e.g., elagolix/Orlissa).

  • Surgical options include lysis or vaporization of adhesions and hysterectomy (McKinney et al., 2022, p. 705).

Nursing Considerations for Endometriosis

• Acknowledge pain and provide supportive care.

• Educate patients about drug therapies and treatment options.

• Mental health consultations may be necessary (McKinney et al., 2022, p. 705).

Pain Associated Disorders: Premenstrual Syndrome (PMS)

• Definition: A collection of symptoms occurring in the second half of the menstrual cycle that can affect various aspects of life.

• Causes:

  • Etiology is not entirely known; hypotheses include hormonal imbalances (estrogen/progesterone), decreased beta-endorphins, low serotonin levels, and abnormal prostaglandin production (McKinney et al., 2022, p. 706).

• Management Strategies:

  • Dietary recommendations: Reduce caffeine/sodium intake, avoid alcohol, and consume at least 2000 mL of water daily.

  • Encourage regular physical exercise and maintain a consistent sleep schedule.

  • Stress relieving activities before sleep, such as reading.

• Nursing Considerations:

  • Education on lifestyle changes for symptom relief.

  • Assist in creating practical plans for coping with significant distress related to PMS (McKinney et al., 2022, p. 706).