course materials

1. Assignment: Amenorrhea and Dysmenorrhea
Assignment: Amenorrhea and DysmenorrheaAssignment: Amenorrhea and
DysmenorrheaResponse One:Amenorrhea and DysmenorrheaAmenorrhea, the absence of
menstrual flow, is often attributed to anatomic abnormalities, genetic disorders, endocrine
disorders, medication use, illegal drug use, or oral contraceptives. The disorder can be
divided into primary and secondary disorders. Primary amenorrhea is when menarche
never occurred, whereas secondary amenorrhea is the result of a cessation of menstruation
in an individual who previously experienced a menstrual cycle (Hubert and VanMeter,
2018). Dysmenorrhea results from painful menstruation and also has primary and
secondary features. Primary dysmenorrhea occurs when ovulation starts, and secondary
dysmenorrhea develops from pelvic disorders such as endometriosis, uterine polyps or
tumors, or pelvic inflammatory disease (Hubert and VanMeter, 2018).Common Presenting
SymptomsPrimary amenorrhea symptoms include the absence of menstruation in which an
individual has never had a menstrual cycle. The main symptom is absence of the menstrual
cycle, but can also include headache, visual changes, nausea, extra facial hair, hair loss,
changes in breast size, and milky fluid or discharge from the breasts (American Academy of
Family Physicians, 2020). Secondary amenorrhea is the cessation of menstruation in an
individual who previously experienced menstrual cycles. The primary symptom is missing
several menstrual cycles in a row, and the same symptoms of primary amenorrhea.ORDER
NOW FOR ORIGINAL, PLAGIARISM-FREE PAPERSPatients experiencing primary and
secondary dysmenorrhea may experience discomfort the day before and during the first 24-
48 hours of menses which can be cyclic, acyclic, and/or accompanied by urinary or bowel
symptoms; nausea, vomiting, diarrhea, headaches, and muscle cramps can also accompany
the disorder (Sachedina and Todd, 2019). Secondary dysmenorrhea symptoms include
progressively worsening pain, chronic pelvic pain, midcycle or acyclic pain, and irregular or
heavy menstruation (Sachedina and Todd, 2019). Assignment: Amenorrhea and
DysmenorrheaDiagnosisPrimary amenorrhea is routinely diagnosed by performing a
history and physical on the patient and collecting a series of labs for evaluation. Providers
routinely perform a pregnancy test initially to rule out pregnancy as the underlying cause of
amenorrhea. Other labs for evaluation include serum luteinizing hormone (LH), follicle-
stimulating hormone (FSH), and thyroid – stimulating hormone (TSH), and prolactin levels
(Klein, Paradise, and Reeder, 2019). Providers may decide to perform a pelvic ultrasound or
magnetic resonance imaging (MRI) to identify abnormal reproductive anatomy or to detect
an androgen-secreting tumor (Klein et al., 2019). If the pregnancy test is negative,

2. evaluation of the hormone levels will assist in diagnosing the cause of amenorrhea, such as
hypothalamic dysfunction, outflow tract obstruction, ovarian insufficiency, or chromosomal
defects.Secondary amenorrhea is routinely diagnosed in a similar manner beginning with a
complete history and physical, review of medications, including contraceptives and illicit
drugs. Patients are also given a pregnancy test and blood collected to evaluate the same
hormonal levels as primary amenorrhea. If the pregnancy test is negative, evaluation of the
hormone levels is performed to discover a diagnosis. Depending on the results of the
hormone levels, the cause of secondary amenorrhea can be attributed to hypothalamic
disorder, hyperandrogenism, metabolic syndrome, primary ovarian insufficiency, natural
menopause, or chronic disease. Patients could also have other disorders which would be
visualized on an ultrasound of MRI, including neoplasm, polycystic ovarian syndrome, or
tumors of the adrenal or ovaries (Klein et al., 2019). Assignment: Amenorrhea and
DysmenorrheaPrimary and secondary dysmenorrhea are diagnosed in a similar fashion as
amenorrhea. The health care provider should begin with a complete history and physical
including the age of menarche, duration of menses, amount of bleeding, time elapsed
between onset of menarche and dysmenorrhea. An evaluation of pain should include the
onset, duration, severity, aggravating and alleviating factors, and when it occurs in relation
to the menstrual cycle, dyspareunia, history of sexually transmitted or pelvic infections, and
sexual violence (Sachedina and Todd, 2019). Providers would also complete an examination
of the pelvis to determine the exact location of the pain and internal pelvic examination for
the determination of tenderness on palpation.Standard Treatment PlanThe standard
treatment plan for primary amenorrhea depends on the underlying cause. If the individual
does not have any underlying conditions, obstruction or congenital abnormalities, then the
provider may recommend waiting for the menstrual cycle to start especially if there is a
family history of late onset menstruation. Individuals with genetic or chromosomal
abnormalities may require surgery. For secondary amenorrhea, birth control pills or other
hormonal medications may be required to restart the menstrual cycle, or medication to
stimulate ovulation. Estrogen replacement therapy is an option for women with an
imbalance of hormonal levels. Patients experiencing a pituitary tumor may be prescribed
medications to shrink it. Surgical management is uncommon but can be performed in the
presence of uterine scarring by performing a hysteroscopic resection in order to restore the
menstrual cycle (Eunice Kennedy Shriver National Institute of Child Health and Human
Development, 2017).Treatment for primary and secondary dysmenorrhea can include
Nonpharmacological and pharmacological regimens such as application of heat, exercise, or
medications such as nonsteroidal anti-inflammatory (NSAID) medications such as
Ibuprofen or Advil, and oral contraceptives (Hubert and VanMeter, 2018).Link(s) to Routine
Screening and Treatment GuidelinesRoutine screening is not recommended for amenorrhea
or dysmenorrhea. In primary amenorrhea, individuals are not evaluated for the condition
unless there is an absence of menses and secondary sexual characteristics by the age of
fourteen; or the absence of menses by the age of sixteen, regardless of the presence of
normal growth and development (Lowdermilk, Perry, Cashion, and Alden, 2016). For
secondary amenorrhea, evaluation is not completed unless the individual has missed
several menstrual cycles in a row unless they are determined to be pregnant.Primary and

3. secondary dysmenorrhea have the same guidelines as amenorrhea. Routine screening is not
recommended. Individuals are evaluated if they exhibit symptoms. Treatment guidelines
depend upon the causative factors for the discomfort. Individuals can be referred to the
following links for treatment options for primary or secondary
dysmenorrhea:https://www.nichd.nih.gov/health/topics/amenorrhea/conditioninfo/treat
mentshttps://www.uptodate.com/contents/evaluation-and-management-of-primary-
amenorrhea?topicRef=104218&source=see_linkhttps://www.uptodate.com/contents/dys
menorrhea-in-adult-women-treatment Assignment: Amenorrhea and
Dysmenorrheahttps://www.acog.org/patient-resources/faqs/gynecologic-
problems/dysmenorrhea-painful-periodsResponse TwoBreast CancerBreast cancer is the
malignant growth of abnormal cells in the breast tissue. Most breast cancers begin in the
milk ducts that supply milk to the nipple while others may originate in the glands that
produce breast milk. Less common breast cancers include phyllodes tumors and
angiosarcoma (American Cancer Society, 2020). The majority of breast cancer cases occur
in women over the age of fifty. Familial history s a strong genetic predisposition of the
development of breast cancer and is connected to the BRCA-1 and BRCA-2 genes. Hormonal
connection, specifically Estrogen is also strongly ed. Experiences such as early onset of
menstruation and late onset of menopause, nulliparity, or advanced age with first childbirth
all increase length of time to high level Estrogen exposure, increasing risk for developing
breast cancer (Hubert &VanMeter, 2020). Early detection is key in treating breast cancer
and the prevention of breast cancer spreading to other organs of the body.Presenting
SymptomsMost patients present due to an abnormal mammogram. However, the presence
of a breast mass undetected on a mammogram or formed between screenings account for
45% of identified breast cancer masses (Joe, 2020). The classic characteristics of a
cancerous mass are hard, singular, non-moveable with irregular boarders. If the mass
advances the patient may present with axillary adenopathy or changes in the skin to include
erythema and dimpling of the skin known as peau d’orange (Joe, 2020). A patient may also
notice retraction of the nipple or a discharge from the nipple (Hubert & VanMeter, 2018). If
a breast mass is identified during a self-breast exam or due to visual changes to the breast
or axillary area, the patient will need to see a physician to determine the nature of the mass
and malignancy.Routine DiagnosisA majority of breast cancer masses are identified via
mammography studies. Supplemental mammographic views and possible ultrasound
conduction will be used for further identification and characterization. The BI-RADS (Breast
Imaging Reporting and Data System) is used to determine the likelihood of a mass being
cancerous. If a mammogram is given a zero, further imaging studies are used for
characterization. A BI-RADS score of 4-5 denotes that a malignant is highly suspected and
further diagnostic studies such as a biopsy is needed (Esserman & Joe, 2019). Part of the
course of diagnosis in breast cancer is also to determine the stage of malignancy and the
extent of the disease, such as metastasis.Standard Treatment PlanTreatments are
individualized depending on the stage of progression of the disease and other factors such
as risk factors for recurrence and if the patient has other comorbidities. Early stage breast
cancer patients may undergo surgery to remove the mass (lumpectomy) or to remove the
breast (mastectomy) depending on what option is right for them (Taghian, & Merajver,

4. 2020). In addition, a patient may also be treated adjuvant therapy such as chemotherapy
and radiation to resolve any undetected micrometastases that remain after surgery. Other
forms of treatment include hormone therapy. If a tumor proves to be responsive to
estrogen, then the estrogen hormone stimulation is removed. This is done by way of
removal of the ovaries in premenopausal patients and by hormone blocking agents in post-
menopausal women (Hubert & VanMeter, 2018).Links to Routine Screening and
TreatmentBreast self-examination is recommended for all women over the age of 20 and for
men at high risk for breast cancer (see Surprise Nugget section for more information on
male breast cancer). The U.S. Preventive Services Task force recommends biennial
screening mammography for women ages 50-74 years, and earlier if at higher risk for
breast cancer. All screening recommendations can be found at
https://uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-
screening. Additional screening tools such as step-by-step instructions on completing a
breast self-examination can be found at
https://www.breastcancer.org/symptoms/testing/types/self_exam. Routine visits to a
primary care physician related to women’s health is also recommended for routine
screening and education.Surprise NuggetThe incidence of male breast cancer has
increased 26% in the past 25 years (Gradishar & Ruddy, 2020). Male breast cancer is often
linked with a family history in a first-degree relative and often presents in the same fashion
as female breast cancer. Alterations in estrogen and androgen rations may also increase risk
for male breast cancer. These alterations could result from hepatic dysfunction, obesity,
thyroid disease, marijuana use, and inherited conditions such as Klinefelter syndrome. In
Klinefelter syndrome, there is an inheritance of an additional X chromosome causing
atrophic tested, gynecomastia, increased levels of follicle-stimulating and luteinizing
hormones, and a decrease in testosterone. It is recommended that men with Klinefelter
syndrome understand the affiliation and how to conduct self-examinations for breast cancer
(Gradishar & Ruddy, 2020) Assignment: Amenorrhea and Dysmenorrhea