Transcript
Clinical manifestations
Pelvic pain that radiates to the groin
Low backache, abdominal pain,
Diarrhea, headache, nausea, vomiting, anorexia, breast tenderness
Pain lasts for 2-3 days and begins with menstruation
Pain on a scale of 4-10
Risk Factors
Early age at menarche
Long/heavy menstrual periods
Smoking
Family history
Prevention
Lifestyle changes
Balanced diet avoiding sugar, salty foods, caffeine, alcohol & cigarettes
Exercise/ stress relieving activities
Pharmacologic therapy
Hormonal therapies
Ovulation suppression using Depo-povera, danazol, NSAIDS for cramping, SSRIS for mood balance, Diuretics for bloating
Lifespan
Adolescents:
begins within the first four menstrual periods
Occurs each menstruation in teens and 20s
Decreases over time/ after childbirth
Older Adults:
Menopause can trigger it as a result of irregular progesterone and estrogen levels, high estrogen levels can release prostaglandins stimulating strong uterine contractions
Menstrual Dysfunction
Primary Dysmenorrhea- pain associated with menses, it is caused by the release of prostaglandins that prompt contractions of the uterus needed to expel menstrual fluid and tissue, inflammatory mediators prolong contractions and decrease blood flow. Common in young women with NORMAL menstrual function
Secondary Dysmenorrhea- the result of diseases or abnormalities in the pelvic area, can be caused by congenital malformations, tumors, cysts, PID, infections, endometriosis, cervical stenosis
Endometriosis- most common cause of secondary dysmenorrhea, cells from the endometrial tissue implant and grow outside the uterus. Respond to estrogen and progesterone and mature each month opening and bleeding into the pelvic cavity causing pain, fibrosis and adhesions
Dysfunctional Uterine Bleeding (DUB)- heavy uterine bleeding that is irregular and painless, it is linked to disordered hormonal processes that prevent maturation of the ovarian follicles
Primary Dysmenorrhea
Secondary Dysmenorrhea
Clinical Manifestations
Begins in a women’s 20s or 30s following a history of painless menstruation
dull lower abdominal pain that radiates to the thighs
bloating, a heavy feeling In the pelvis
pain starts before menstruation and peaks right before
pain begins earlier than menstruation and last longer
heavy/ irregular menstrual flow
vaginal discharge, dyspareunia
Risk factors
Early age at menarche
Long/heavy menstrual periods
Smoking
Family history
Endometriosis
Prevention
Lifestyle changes
Balanced diet avoiding sugar, salty foods, caffeine, alcohol & cigarettes
Exercise/ stress relieving activities
Pharmacologic therapy
Hormonal therapies
Ovulation suppression using Depo-povera, danazol, NSAIDS for cramping, SSRIS for mood balance, Diuretics for bloating
Iron supplements to replace iron lost during menstruation
Lifespan
Adolescents :
Not common
If pain begins at menarche and steadily worsens, it can be a congenital malformation
Young adult:
Occurs in 20s-30s
Endometriosis
Clinical manifestations
Pain in the lower back, pelvis, rectum or during intercourse, abnormal menstruating
Causes secondary dysmenorrhea
Risk Factors
Menarche before age 11, cycle less than 27 days, heavy or prolonged menses, sedentary lifestyle, family history, high fat diet
Prevention
No prevention, healthy diet may be beneficial
Pharmacologic therapy
Hormones: Gnrh, depo-provera, progesterone
Treatment
Laparoscopic surgery, endometrial ablation
DUB Dysfunctional Uterine bleeding
Clinical manifestations
Little or no pain
Profuse bleeding preceeded by long stretches of amenorrhea (no period)
Oligomenorrhea, menorrhagia, metrorrhagia, menometrorrhagia, postmenopausal bleeding
Risk Factors
Age, women in their teens/ early 20s
Women approaching menopause
Stress, extreme weight changes, obesity, thyroid disease
Medications: HRT, hormonal birth control
Prevention
No prevention, healthy weight
Pharmacologic therapy
COCs for 3-6 months
Depo-provera for the first 12 days of each month to regulate uterine bleeding
Conjugated estrogens
NSAIDS to lessen bleeding
Oral supplements to replace iron lost from bleeding
Treatment
Therapeutic Dilation & curettage:
Cervical canal is dilated and uterine wall is scraped, can be used to diagnose DUB, contraindicated in women who take anticoagulant drugs
Endometrial Ablation:
Destroys the uterine lining, stops bleeding completely
Should not be used in women who were recently or want to become pregnant or postmenopausal, effects the ability to detect endometrial cancer
Hysterectomy:
Removal of the uterus, when medical management is unsuccessful, malignancy is present or no longer wishes to bear children
Lifespan
Adolescence:
Difficult to diagnose due to not having a baseline for normal period, period > 8 days and a cycle that is less than 21 days or greater than 45 days is abnormal, patients may have different perceptions of ‘heavy bleeding’
Patients with heavy bleeding should be tested for bleeding disorders, anemia: large blood clots & hourly changes of feminine products are symptoms
Pregnant Women:
common for pregnant women to bleed during first trimester, implantation bleeding / postcoital bleeding
Bleeding in early pregnancy can also be a sign of miscarriage or ectopic pregnancy when accompanied by abdominal pain, cramping
Bleeding in late pregnancy can be an indication of placental abruption, placenta previa or preterm labor
Older Adults:
Postmenopausal women with DUB stop bleeding,
Bleeding can be caused by medications: HRT, Tamoxifen or a sign of cancer, fibroids or polyps
Definitions for DUB
Amenorrhea- absence of menstruation
Primary- absence of menstruation by age 14 with no physical signs of puberty
Cause: incomplete formation of genital organs, changes to the hypothalamus or pituitary gland, genetic disorders, poor nutrition
Secondary- when a previously menstruation woman does not spot or bleed for 3 times that of her normal cycle
Cause: severe weight loss, poor diet, thyroid disorders, pre-menopausal woman, pregnancy, breastfeeding, contraception use
Oligomenorrhea- light or infrequent menstruation, cycles are longer than 6-7 weeks
Cause: hormonal imbalances
Menorrhagia- excessive or prolonged menstruation
Cause: imbalance of estrogen and progesterone, ovarian dysfunction, uterine fibroids, cancer RISK FOR ANEMIA
Metrorrhagia- bleeding between menstrual period
Cause: mild spotting at ovulation, breakthrough bleeding due to combination oral contraception RISK FOR ANEMIA
Menometrorrhagia- irregular excessive prolonged menstruation
Causes: endometriosis, uterine fibroids, cancers RISK FOR ANEMIA
Postmenopausal bleeding- caused by endometrial polyps, endometrial hyperplasia, uterine cancer
Laboratory tests: To assess for causes of DUB/ Dysmenorrhea
Pregnancy test- whether pain/bleeding is due to pregnancy
FSH & LH test- measure the function of the pituitary gland on the menstrual cycle
Progesterone/estradiol levels- ovarian function
Thyroid stimulating hormone- thyroid dysfunction
CBC- infection or anemia
Coagulation studies- von Willebrand disease
Diagnostic Tests:
Pap test for cervical dysplasia or cancer
Cervical/ vaginal cultures- stI
Ultrasound- depth of endometrium, intrauterine, ectopic pregnancy, ovarian cysts, cancer
Hysteroscopy- scope in the uterine cavity to inspect endometrial lining
Sonohysterography- saline is injected into the uterine cavity and an ultrasound assesses for polyps/myomas
Colposcopy- large electronic microscope used to inspect cervix and identify areas for biopsy
Laparoscopy- diagnose structural defects, caused by scarring, endometriosis, tumors and cysts
Assessment:
Assess menstrual history, age at with menses began, obstetric history, past pregnancies and childbirth, surgeries
Physical:
Percuss abdomen to determine size of pelvic structures, palpate for masses , tenderness, organ enlargement, Collect samples for pap smear, draw blood for hemoglobin and hematocrit testing
Planning:
Pain/ discomfort will be reduced to an acceptable level
Patient will increase intake of iron rich foods/ fluids
Implementation:
Relieve acute pain- application of heat over abdomen, Relieve anxiety- provide information, promote sexual function- orgasms help relieve symptoms
