chapter_006 powerpoint fall 2015

Chapter 6

Reproductive System Concerns

Copyright © 2016 by Elsevier Inc. All rights reserved.

2Copyright © 2016 by Elsevier Inc. All rights reserved.

Learning Objectives

Describe and differentiate signs and symptoms of common menstrual disorders.

Develop a nursing care plan for a woman with primary dysmenorrhea.

Describe premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD).

Relate the symptoms of endometriosis to the associated pathophysiology.

Develop a nursing care plan for a woman with endometriosis.

Summarize the therapies for menstrual disorders and menopausal symptoms, including risks and benefits.


Learning Objectives (Cont.)

Differentiate the various causes of abnormal uterine bleeding.

Identify health risks of perimenopausal women. Describe the common signs and symptoms of

perimenopause. Develop a teaching plan for managing

symptoms in menopausal women. Examine the risks and benefits of menopausal

hormone therapy. Summarize client teaching strategies for

prevention of osteoporosis.


Common Menstrual Disorders

Amenorrhea Absence of menstrual flow Clinical sign of a variety of disorders

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

• Absence of menses by age 16, regardless of presence of normal growth and development (primary amenorrhea)

• A 3- to 6-month absence of menses after a period of menstruation (secondary amenorrhea)

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


Common Menstrual Disorders (Cont.)

Hypogonadotropic amenorrhea Problem in central hypothalamic-pituitary axis

• Results from hypothalamic suppression Assessment Counseling and education

Exercise-associated amenorrhea Management of amenorrhea



Cyclic perimenstrual pain and discomfort (CPPD) This concept includes:

• Dysmenorrhea• Premenstrual syndrome (PMS)• Premenstrual dysphoric disorder (PMDD) • Symptom clusters that occur before and after the

menstrual flow starts CPPD is a health problem that can have a

significant effect on a woman’s quality of life.



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 • Diagnosis and treatment



Premenstrual syndrome (PMS) and premenstrual dysphoric disorder Cyclic symptoms occurring in luteal phase of

menstrual cycle• PMS: cluster of physical, psychologic, and behavioral

symptoms• Premenstrual dysphoric disorder (PMDD)

Severe variant of PMS• Management

Diet and exercise Herbal therapies



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 (Lobo, 2012b).

Major symptoms• Dysmenorrhea• Deep pelvic dyspareunia (painful intercourse)

Management• Drug therapy• Surgical intervention



Alterations in cyclic bleeding Oligomenorrhea Hypomenorrhea Metrorrhagia Menorrhagia (hypermenorrhea) Dysfunctional uterine bleeding


Menopause

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.


Physiologic changes

Menstrual cycles increase in length Ovarian follicles sensitivity to LH/FSH No corpus luteum development means

progesterone not produced Fsh elevates in attempt to make follicle

produce estrogen


Physical changes

Bleeding Genital changes Vasomotor instability Mood and behavior responses Osteoporosis CHD


Bleeding

Spotting-bleeding-spotting Common d/t corpus luteum functioning Estrogen production decreases but androgen

continues, and converts to estrone Androgens converted to estrone in liver and

fat cells Obese women commonly have increased

dysfunctional bleeding


Genital changes

Atrophy of the vagina and urethra d/t decreased estrogen

Vaginal tissue thins, decreased moisture, less lubrication/ smaller vagina

Sexually active women have less atrophy/dysparunia

Thin women symptoms /less estrogen Increased vaginal PH increased vaginitis


Treatment options for genital changes

OTC lubricants: k-Y, Astroglide, Lubrin, Moist again Consider vaginal estrogen creams Allow time / foreplay Keep sexually active to stimulate natural lubrication


Vasomotor instability

Fluctuating estrogen: hot flashes, night sweats, hot flush

Hot flashes: 75-90 % of women lasts 1-5 years

May be precipitated by alcohol, crowded rooms,hot drinks, spicy foods, stress

Night sweats : may cause insomnia, fatigue, loss of sleep, soak linen


Treatment options for vasomotor changes

Layer clothing Avoid spicy, hot foods, alcohol HRT 90% Progesterone 80% Soy 45% Antidepressants 50% Deep breathing 50% Black cohosh phyoestrogens


Mood and behavioral responses

No concrete evidence estrogen causes mental health problems

Epidemiological studies have not found an association with depression

Women c/o fatigue, insomnia, depressed mood, emotionally labile

Life stressors: teenagers, aging parents, widowed, divorced, major illness/disability

Cultural status: aging issues, loss of status, function, role identity


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.


Nursing Assessment

Menstrual history Risks for osteoporosis, CHD Women’s perception of this stage Knowledge base sexuality Support Cultural influences Practices/ remedies the women has tied


Risks and HRT

Health risks Osteoporosis Coronary heart disease

Menopausal hormonal therapy Decision to use hormone therapy Side effects Treatment guidelines Bioidentical and custom-compounded hormones Alternative therapies


Hormone Replacement Therapy

HRT most effective tx for menopausal symptoms

Should not be taken for disease prevention Short term 1-3 years benefits may outweigh

risks Cumulative risks

Increased risk of blood clots/stroke during first year

Increased BR CA after 4 years Women with high risk of BR CA shouldn’t take


Nursing assessments

Ability to cope with stressors Persons perception/understanding of life

cycle Support system Coping mechanisms Cultural implications: in US, loss of youth and

value; in India, Far East, South pacific Island increased status


Health risks: osteoporosis

Ageing causes progressive in bone mineral density

Osteoporosis: generalized metabolic disease characterized by bone density and incidence of bone fractures

Osteoporosis affects 25 million women older than 45


Sobering thoughts….

During 1st 5-6 years after menopause women lose 6X more bone than men

Increased osteoporosis related fractures in the last 20 years

Of those with hip fractures12-20 die within 1 year

50% unable to return to independent living


Women at risk

Post menopausal Caucasian, Asian Small bones, thin Family history Smoking Excess alcohol Deficient calcium intake High phosphorous (soda) Steroid dependency


Preventing Osteoporosis

Osteoporosis: Weight bearing exercises Calcium, magnesium, Vit D

milk, yogurt, cheese, Non dairy sources legumes, leafy green vegetables, tofu, nuts and foods where bones are consumed such as sardines and salmon

Supplements bisphosphonates Dexa scan screening for women at risk, or over 65


Loss of height often first sign


Coronary heart disease

Increased risk after menopause Other risk factors: obesity, smoking,

sedentary lifestyle, high cholesterol, family history, diabetes mellitus, hypertension, alcohol abuse


CHD prevention

Diet Exercise Lipid management (medications) Estrogen decreased LHL and total

cholesterol, increases HDL, and has direct anti atherosclerotic effects on the arteries


Key Points

Menstrual disorders diminish the quality of life for affected women and their families.

Amenorrhea is most commonly a result of pregnancy.

Dysmenorrhea is one of the most common gynecologic problems in women.

PMS is a disorder with symptoms that begin in the luteal phase of the menstrual cycle and end with the onset of menses.


Key Points Endometriosis is characterized by secondary

amenorrhea, dyspareunia, abnormal uterine bleeding, and infertility.

The perimenopause is a normal developmental phase during which a woman passes from the reproductive to the nonreproductive stage.

During the perimenopause women seek care for symptoms that arise from bleeding irregularities, vasomotor instability, fatigue, genital changes, and changes related to sexuality.


Key Points (Cont.)

Menopausal hormonal therapy, if used, should be taken at the lowest effective dose for the shortest possible time.

Alternative therapies are beneficial in relieving discomforts associated with menstrual disorders and menopause.


Key Points (Cont.)

Osteoporosis, a progressive loss of bone mass that results from decreasing levels of estrogen after menopause, can be prevented or minimized with lifestyle changes and medication.

Postmenopausal women are at increased risk for coronary artery disease because of changes in lipid metabolism.

Sexuality and the capacity for sexual expression continue after menopause.


Question

1. A woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the past 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to:

a. Endometriosis b. Premenstrual syndrome (PMS) c. Primary dysmenorrhea d. Secondary dysmenorrhea

chapter_006 powerpoint fall 2015

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