This document discusses various menstrual disorders including amenorrhea, dysmenorrhea, dysfunctional bleeding, premenstrual syndrome, pelvic inflammatory disease, endometriosis, pelvic relaxation disorders, cystitis, urinary incontinence, and perimenopause. It defines each condition, discusses etiology and pathophysiology, assessment findings, diagnosis, and treatment. Nursing considerations are provided for educating women on prevention and management of these common gynecological issues.

1. Menstrual disorders and
others
Amenorrhea & dysmenorrhea
Dysfunctional bleeding and PMS
PID & Endometriosis and
Menopause

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. 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. 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. 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. 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. 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. 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. 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. 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. Spread of gonorrhea or chlamydia

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. • 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. 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. 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. 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. • 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. 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. Pelvic relaxation

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. 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. 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. • 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