12.menstrual disorders & others


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12.menstrual disorders & others

  1. 1. Menstrual disorders and others Amenorrhea & dysmenorrhea Dysfunctional bleeding and PMS PID & Endometriosis and Menopause
  2. 2. Amenorrhea • Definition: absence of menses during women’s reproductive years. • Primary amenorrhea: - By 14 year of age, the adolescent has not had menses and show no growth and development of secondary sexual characteristics - By16 year of age the adolescent has not had menses, but growth and development of secondary sexual characteristics are normal • Secondary amenorrhea: menses are absent for three or more cycles or 6months or longer in women with previously established menstruation
  3. 3. Etiology and pathophysiology • Primary A: structural abnormalities; imperforated hymen - endocrine problems; prepubertal ovarian failure, hypopituitalism - congenital disorder; absent uterus - eating disorder, extreme weight gain or loss, excessive stress, chronic illness • Secondary A: pregnancy, lactation, menopause, thyroid problem, stress, excessive exercise, malnutrition, kidney failure
  4. 4. Assessment findings • History tacking; whether the client has ever had regular and cyclic menstrual pattern, past illness, pregnancy history, medication, nutrition and diet • Physical examination; Wt, Ht, visible sign of genetic problem or endocrine disease, eating disorder, look for characteristics of secondary sex development and evaluation of the reproductive tract • Dx: Karyotyping, pregnancy test, ultrasound, hormonal study • Tx: Depending on the cause, estrogen therapy,
  5. 5. Dysmenorrhea • Painful menstruation(50% menstruating women) • Primary dysmenorrhea: pain accompany menstruation for which no accompany pelvic disorder or other problem exists. • Secondary dysmenorrhea: painful menstruation is result of an underline pelvic or uterine disorder
  6. 6. Etiology and pathophysiology • Primary dysmenorrhea: Increased production of prostagrandins Prostagrandins contribute to increase in uterine contractions pain • Secondary dysmenorrhea: pelvic infection, endometriosis, uterine fibroid, congenital reproductive abnormalities • Findings: women report sharp and intermittent suprapubic pain that may radiate to back and legs, accompany headache nausea and vomiting, fatigue, dizziness History and Physical exam. Bimanual pelvic Examination Laboratory test: blood count, urinalysis, cervical culture for STIs, ultrasound of the pelvis • Tx: Eliminating or controlling the underline cause Oral contraceptives
  7. 7. Dysfunctional uterine bleeding • Abnormal or irregular bleeding not related to pregnancy, infection, or tumor • Common cause: hormonal disturbance leading to anovulatory menstrual cycles • Findings: health history, physical examination, diagnostic testing to identify the cause
  8. 8. Premenstrual syndrome(PMS) • Regular premenstrual physical or emotional symptoms that interfere with daily living and functioning at home and work. • Sx: pain, anxiety, irritability, mood swings, fatigue, palpitation, crying, forgetfulness, fl uid retention. Weight gain and breast tenderness • Etiology is unknown but several theories involve; Vit. deficiency, mineral deficiency, prostaglandin imbalance • Tx: Balance level of hormones or serotonin, life style change, decrease alcohol and caffeine intake, increase vit. B, calcium, exercise, Aerobic
  9. 9. Pelvic inflammatory disease(PID) • PID, a serious complication stemming from previous infections(STIs), can result from infection of internal upper reproductive tract uterus(endometritis), fallopian tube(salpingitis), ovarries(oophoritis), or peritoneum • Cause to infertile(100,000 women) and lead to death(150 women)
  10. 10. Etiology and pathophysiology • Harmful bacteria move upward from the vagina or cervix • Bacterium; Chlamydia & gonorrhea that infection result scarring and obstruction of the fallopian tubes ectopic pregnancy or infertility • Risk factors: young, low income low educational status, history of criminal abortion(D&E), history of PID or STD, IUD insertion, smoking, more than one sexual parterner
  11. 11. Spread of gonorrhea or chlamydia
  12. 12. Assessment findings • Sx: Mild to severe, asymtomatic, abdominal pain, low abdominal tenderness, bilateral tenderness • Mild sx; vaginal discharge, mild persistent abdominal and back pain • Severe Sx; sudden and severe pelvic pain, high fever chills ,heavy vaginal discharge or bleeding, feeling of abdominal fullness, abdominal mass(when abscess of present)
  13. 13. • Dx: difficult because the symptoms are similar to many other disease. - Physical and pelvic examination - Bacterial vaginal smear and cervical culture are used to identify the causative organism. - Blood analysis(erythrocyte sedimentation rate;ESR), pelvic sonogram, laparoscopy • Tx: depending on present symptoms • Hospitalization IV+ antibiotics 24-48hrs. • Laparoscopy to drain the abscess • Women must be counseled to complete all prescriptions and to receive follow up evaluation • Nurses should educate and counsel client about criminal abortion due to unwanted pregnancy • Criminal abortion; by non professional or woman own perform illegal abortion.
  14. 14. Endometriosis • Endometriosis is a benign uterine condition in which endometrial tissue attaches to sites outside the endometrial cavity.(ovaries, fallopian tubes uterosacral ligaments, peritoneum • This tissue responds to hormones during the menstrual cycle and undergoes change similar to normally site uterine endometrial tissue • All ethnic groups occurs, Asians appear to be at increase risk • Endometriosis is not life threatening, it interferes with a client’s ability to work and can cause much pain and discomfort(dysmenorrhea)
  15. 15. Etiology and pathophysiology • Unknown; several theories - during menstrual cycle, tissue back up through the fallopian tubes and attaches and implant in peritoneal cavity - immune and hormonal problem - tissue travel from the uterus to lymphatic and blood vessel
  16. 16. Assessment findings • Sx: asymtomatic - Dysmenorrhea, infertility, pelvic pain, dyspareunia, irregular and heavy bleeding, - Symptoms may be associated with menstrual cycles; premenstrual back pain abdominal pain, rectal pain, diarrhea, fatigue, abdominal bloating, urinary problem • Dx: history, physical examination, pelvic examination, Laparoscopy or laparotomy can be used to visually inspect and identify this disorder for definitive diagnosis.
  17. 17. • Tx: Depends on the extend and location of endometrial growth, the client’s age, desire for pregnancy, and severity of symptoms. - Relive or reduce pain, shrink or slow endometrial growths - Hormone therapy; oral contraceptives, progesterone drugs - Surgery and pre and post operative care • Nug care:The nurse should provide information about the use of nonphamacologic comfort measure - Nurses need to aware the strong association between reported pelvic pain and sexual abuse. - Women should be encouraged to see her health provide routinely and maintain life style that include proper diet, physical activity, adequate sleep, and stress management
  18. 18. Pelvic relaxation • Muscle of the pelvic floor support the abdominal and pelvic organs and ligaments, muscle, and connective tissues support the pelvic itself • These structures become stretched or damaged due to childbirth, lack of restoration after postpartum periods • The median age for women seeking care for these disorders is 61yrs • Most common disorders are cystocele, rectocele, uterine prolapse, uterine displacement • Pelvic strengthening exercise(Kegel’s exercise)
  19. 19. Pelvic relaxation
  20. 20. Cystitis • An infection of the bladder. Bacterial(E-Coli) growth in a woman’s urinary tract is relates primarily to sexual intercourse and urethral manipulation during oral sex or masturbation(honeymoon cystitis) • Dx: urine analysis, urine culture and sensitivity test  proffer antibiotics • Tx: increasing fluid intake(cranberry juice) • Treat promptly and prevent development of upper UTI
  21. 21. Urinary incontinence • The inability to control urination. • This gender associated difference may be attributable to pregnancy, child birth, menopause. • Old women are more likely than younger women • There are 3 types - Stress incontinence: after cough, sneeze, running - Urgent incontinence: strong urge to void immediately before urine is lost - Mixed incontinence: combination of stress and urge UI • Dx: Client may keeps bladder diaries for short periods(23days) • Tx; Kegel’s exercise - Bladder training
  22. 22. Perimenopause • Perimenopause include premenopause, menopause, postmenopause • As long as 7-10 yrs, women age 45-60yrs, average 51yrs old • This time begins with the last menstrual cycle leading to menopause and extends to 1 year after the last menses • Menopause is end of menstruation, dysfunction of ovary(cessation of ovarian follicle) • Menopause is not disease, menopause is natural process in women’s life cycle • Biomedical aspect, menopause as disease due to estrogen deficiency • Estrogen deficiency accompany symptoms; hot flashes, vaginal dryness, emotional changes Hormonal replacement therapy
  23. 23. • In Western culture, with its strong emphasis on female youth and beauty, menopause may be a difficult adjustment for some women. • But Oriental culture, with its respect of old persons and their wisdom, so less upset of loss of youth and beauty. • Nurses can assist women in dealing with this transition use self help remedy. • Women are finding meaning in their lives in a wide variety of role • Cessation of menses free women from periods fear of pregnancy, and contraceptive concerns. • Many women are menopause as a time of few child care responsibilities and increase opportunities to pursue other goals