Dysfunctional uterine bleeding (DUB)
Nursing diagnosis
*Anxiety= *Sexual dysfunction= conception is possible during DUB. take birth control. & orgasms help relieve symptoms.
Medications for DUB
*Oral contraceptives (combined w/estrogen & progesterone) *Progesterone *medroxyprogesterone (Provera)= regulate uterine bleed & hormonal balance *Levonorgestetrel-releasing intrauterine device (IUD) (Mirena)=progesterone. effective for chronic bleeding. *oral iron supplements=to replace lost iron in menses
Types of DUB
*amenorrhea (ame- none) *oligomenorrhea (oligo- few) *menorrhagia *metrorrhagia *postmenopausal bleeding
Diagnostis tests for DUB
*pap test=identify cervical carcinoma *Pelvic ultrasound= identify luteal cysts or ovarian tumors *endometrial biopsy= tissue for histological exam *CBC=rule out systemic disease *Coagulant factors= PT/PTT to rule out clotting disorders *Thyroid function studies= (menorrhagia) *serum progesterone levels *endocrine studies= evaluate pituitary & adrenal function
Surgery for DUB
*therapeutic D&C=cervical canal dilated & uterine wall scraped. *endometrial ablation=endometrial layer destroyed w/laser or thermal balloon or electrocautery. *Hysterectomy=surgical removal of the uterus
Menorrhagia
excessive or prolonged menses.may result from thyroid disorders, endometriosis, pelvic inflammatory disease, functional ovarian cysts, uterine fibroids,polyps, clotting disorders, & anticoagulant meds. can lead to hemorrhage, excessive blood loss, fatigue & anemia.
Postmenopausal bleeding
may be caused by cervical polyps, endometrial polyps, endometrial hyperplasia, or uterine cancer.
endometriosis
abnormal location of endometrial tissues.
Metrorrhagia
Bleeding in-between menses. irregular and prolonged. may be caused by hormonal imbalances, pelvic inflammatory disease, cervical or uterine polyps, uterine fibroids, or cervical or uterine cancer.
Oligomenorrhea
scant menses related to hormonal imbalances (emotional upsets and stress) & contraceptive devices.
Risk factors for DUB
stress, extreme weight changes, use of oral contraceptive agents or IUDs, and perimenopausal status. DUB is usually related to hormonal imbalances or pelvic neoplasms (benign or malignant). may occur in early to late adulthood.
Amenorrhea
the absence of menses. *Primary amenorrhea=16yo or 14yo absence of menarche. caused by structural abnormalities, hormonal imbalances, polycystic ovary disease, or imperforate hymen (complete coverage of vagina opening), anorexia nervosa, bulimia, excessive athletic training. *Secondary amenorrhea= menarche occured but ceases for at least 6mos. caused by anorexia nervosa, bulimia, excessive athletic activity, large weight loss, ovarian tumors, breastfeeding, menopause.
Dysfunctional uterine bleeding (DUB)
vaginal bleeding, painless but abnormal in amount, duration or time. Is often caused by a hormonal imbalance between estrogen & progesterone, stess, extreme weight changes, contraceptives, IUD, perimenopausal status
Medroxyprogesterone (Depo-Provera)
progestin. Hormone for dysfunctional uterine bleeding.inhibits the effects of estrogen on uterus, thus restoring hormonal balance. for DUB, secondary amenorrhea & contraception use.Adverse effects= breast tenderness, breakthrough bleeding. weight gain, depression, hypertension, n/v, dysmenorrhea (painful cramps), & vaginal candidiasis. ↑risk of thromboembolic disease. ↓bone & mineral density.
