Ch. 6 Reproductive System Concerns

GnRH agonists, androgen derivatives

2 main classes of meds used to suppress endogenous estrogen levels (treatment of endometriosis):

osteoporosis

A condition in which the body's bones become weak and break easily. Women at risk are likely to be Caucasian or Asian, small boned, and thin

obese

A moderately __ girl may have early onset menstruation, whereas delay of onset is known to be related to malnutrition

A

A nurse counseling a client with endometriosis understands which statement regarding the management of endometriosis is not accurate? A. Bone loss from hypoestrogenism is not reversible. B. Side effects from the steroid danazol include masculinizing traits. C. Surgical intervention is often needed for severe or acute symptoms. D. Women without pain and who do not want to become pregnant need no treatment.

C

A patient has been prescribed Danazol (Danocrine) therapy for treatment of endometriosis. Which side effect should the patient be monitored for as a part of this ongoing therapy? A. Increased breast size and fullness B. Increase in heart-protective cholesterol C. Migraine headaches D. Weight loss

heart disease, breast cancer

A study by the National Institute of Women's Health documented an increase in __ __ with the use of continuous combined estrogen plus progestin (MHT) There is also a risk for __ __ in women who are taking hormone therapy

b

A woman reports that her menstrual period occurs every 28 days. The nurse would determine that ovulation in this woman would occur at which time? a. Day 10 b. Day 14 c. Day 18 d. Day 22

Secondary dysmenorrhea

Acquired menstrual pain that develops later in life than primary dysmenorrhea (after 25 years). Is associated with pelvic pathology ( endometriosis, pelvic inflammatory disease, endometrial polyps, fibroids.)

Asherman syndrome

Adhesions resulting from curettage or infection obliterate the endometrial cavity, and congenital partial obstruction of the vagina

1200 800-1000

Adults 50 and older need __ mg of calcium and __-__ international units of vitamin D daily

1000 400-800

Adults younger than 50 need __ mg of calcium and __-__ international units of vitamin D dailiy

Caucasian

African American and Hispanic women experience menopause earlier than __ women

anorexia nervosa

Amenorrhea is one of the classic signs of __ __, and the interrelatedness of disordered eating, amenorrhea, and altered bone mineral density has been described as the female athlete triad

C

An effective relief measure for primary dysmenorrhea is to: A. Reduce physical activity level until menstruation ceases. B. Begin taking prostaglandin synthesis inhibitors on the first day of the menstrual flow. C. Decrease intake of salt and refined sugar about 1 week before menstruation is about to occur. D. Use barrier methods rather than the oral contraceptive pill (OCP) for birth control.

lifestyle changes (Not smoke; limit consumption of refined sugar, salt, red meat, alcohol, caffeinated beverages; include whole grains, legumes, seeds, nuts, veges, fruits, and vege oil in diet; eat 3 small meals and 3 small snacks a day high in carbs and fiber; use natural diuretics) Calcium, vitamin B6, primrose, regular exercise Yoga, acupuncture, hypnosis, light therapy, chiropractic therapy, massage therapy

Are often the most effective treatment of PMS-

vaginitis

As women age, vaginal pH increases, lactobacillus growth can be depressed, and other bacteria tend to multiply which can lead to __

metrorrhagia

Bleeding between menstrual periods

Protects the pelvic structures Accommodates the growing fetus during pregnancy Anchors the pelvic support structures

Bony pelvis: primary purposes

layered clothing, ice packs, ice water, fans, avoid spicy food, sleep in cotton clothes, avoid heavy blankets, avoid caffeine, exercise, natural diuretics, kegal exercises, lubricants, yoga

Comfort measures for menopausal symptoms:

gallbladder

Conjugated estrogens are associated with an increased incidence of __ disease, and women with a known history of it should not use MHT

A pattern in which the woman's symptoms are present 5 days before menses begins This pattern must occur for at least 3 menstrual cycles in a row Symptoms must end within 4 days after menses begins The pattern is cyclic Symptoms must interfere with some normal activities

Diagnosis of PMS must include:

dyspareunia

Difficult or painful intercourse Can be due to vaginal dryness and shrinking

bazedoxifine

Drug used for hot flashes and osteoporosis

Ospemifene

Drug used for vaginal dryness and atrophy

Biphosphates, Calcitonin, Paloxifene, Parathyroid hormone, estrogen therapy

Drugs used to prevent/treat osteoporosis:

Secondary dysmenorrhea

Dull, lower abdominal aching radiating to the back or thighs

breakthrough bleeding

Endometrial bleeding that occurs at inappropriate times during the use of hormonal contraceptives (common in the first three cycles on OCPs)

pelvic pain, dysmenorrhea, dyspareunia, abnormal menstrual bleeding, infertility pelvic heaviness, pain radiating to thighs, *sharp, shooting pain* abnormal bleeding, pain during exercise

Endometriosis signs/symptoms:

dysfunctional uterine bleeding (DUB)

Excessive uterine bleeding with no demonstrable organic cause

GnHR

Exercise-related amenorrhea is probably due to diminished secretion of __

hysterectomy

For women who do not want to preserve their ability to have children, the only definite cure of endometriosis is __

Delayed

Girls who exercise strenuously before menarche can have __ onset of menstruation until about age 18.

ginseng

Has been claimed to be helpful in alleviating hot flashes (not proved) Prolonged use can increase BP

Increase nutritional intake Decrease the intensity/duration of training Gain 2-3% in body weight Exercise reduction

If exercise-related amenorrhea is suspected, there are several options for management:

Cyclic perimenstrual pain and discomfort (CPPD)

Is a useful concept to describe women's experiences of discomfort during the menstrual cycle This concept includes dysmenorrhea, premenstrual syndrome (PMS), and premenstrual dysphoric disorder (PMDD)

false

Is the following statement True or False? The testes need a temperature that is warmer than body temperature for normal sperm development.

1-3

It is estimated that as many as 10% of women with dysmenorrhea have severe enough pain to interfere with their functioning for __-__ days a month.

20

It takes an average of __ menstrual cycles before ovulation occurs regularly

heating pad hot bath massaging lower back soft rhythmic rubbing of the abdomen biofeedback transcutaneous electrical nerve stimulation (TENS) progressive relaxation Hatha yoga acupuncture meditation exercise decrease salt/refined sugar 7-10 days before menses natural diuretics

Management of primary dysmenorrhea:

51-52

Median age of menopause

Diuretics, prostaglandin inhibitors (NSAIDs), progesterone and OCPs Serotonergic-activating agents, SSRIs (first line therapy to decrease emotional premenstrual symptoms)

Medications used to treat PMS:

Prostaglandin synthesis inhibitors NSAIDs (not acetaminophen)

Medications used to treat primary dysmenorrhea:

hormonal therapy

Menopausal __ __, if chosen, should be used at the lowest effective dose for the shortest possible time.

pregnancy

Most commonly and most benignly, amenorrhea is a result of __

asparagus, cranberry juice, peaches, parsley, watermellon

Natural diuretics to help reduce edema and related discomforts:

A: anxiety C: craving D: depression H: hydration O: other (irritability, tension, dysphoria)

PMS s/s

primary

Pain usually begins at the onset of menstruation and lasts 8-48 hours during __ dysmenorrhea. This problem is more common in late teens and women in their early 20s. Backache, weakness, sweats, GI symptoms, nervous system symptoms

Anovulation occurs more frequently. Menstrual cycles increase in length. Ovarian follicles become less sensitive to hormonal stimulationfrom FSH and LH. Ovulation occurs with less frequency. Progesterone is not produced by the corpus luteum. FSH values are elevated.

Physiologic characteristics of menopause

coronary artery disease

Postmenopausal women are at increased risk for __ because of changes in lipid metabolism.

40

Regardless of treatment, endometriosis recurs in approximately __% of women

primary dysmenorrhea

Results from *increased prostaglandin production* during the luteal phase of the menstrual cycle. PGF2x increases the amplitude and frequency of uterine contractions and causes vasospasm of the uterine arterioles, resulting in ischemia and cyclic lower abdominal cramps

Inadequate calcium excessive caffeine intake vitamin D deficient smoking excess alcohol intake greater phosphorus intake than calcium steroid therapy hypogonadism hyperthyroidism diabetes personal history of fracture after age 50 low bone mass female advanced age family history abnormal absence of menses caucasian, asian

Risk factor for osteoporosis:

obesity, cigarette smoking, elevated cholesterol, elevated BP, diabetes, family history, alcohol abuse, effects of aging cardiovascular system

Risk factors for coronary heart disease:

headaches, nausea and vomiting, bloating, ankle and foot swelling, weight gain, breast soreness, brown spots on the skin, eye irritation with contact lenses, and depression

Side effects associated with estrogen use

Danazol (Danocrine)

Suppresses FSH and LH secretion, thus producing anovulation and hypogonadotropism Decreased secretion of estrogen and progesterone and regression of endometrial tissue (endometriosis tx) Side effects include masculinizing traits, amenorrhea, hot flashes, vaginal dryness, insomnia, and decreased libido Adversely effects lipid levels, contraindicated in women with liver disease

hot flashes (most common), dry skin, brittle hair, insomnia, vaginal dryness, mood swings, skipped periods

Symptoms of menopause:

perimenopause

The __ is a normal developmental phase during which a woman passes from the reproductive to the nonreproductive stage and is marked by irregular menstrual cycles.

46

The average age for the onset of the perimenopausal transition:

endometriosis

The condition usually develops in the third or fourth decade of life (can happen in adolescents) Familial tendency

No interest in daily activities and relationships Fatigue or slow energy Feelings of sadness or hopelessness, possible suicidal thoughts Feelings of tension or anxiety Feeling out of control Food cravings or binge eating Mood swings with periods of crying Panic attacks Irritability or anger that affects other people Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain Problems sleeping Trouble concentrating

The diagnosis of PMDD requires that a woman notes at least 5 of these conditions:

mood disturbances

The most common symptoms of PMDD include __ __

P (preterm births)

The number of preterm pregnancies ending > 20 wga or viability but before the completion of 37wga

Postmenopause

The time after menopause

surgical menopause

This condition is an immediate result of a radical hysterectomy, that is performed before natural menopause

IUD placed to deliver progesterone Danazol Antifibrinolytic NSAID Hysterectomy Thermal Ablation Endometrial ablation

Treatment for heavy menstrual bleeding:

A

What symptom described by a woman is characteristic of premenstrual syndrome (PMS)? A. "I feel irritable and moody a week before my period is supposed to start." B. "I have lower abdominal pain beginning the third day of my menstrual period." C. "I have nausea and headaches after my period starts, and they last 2 to 3 days." D. "I have abdominal bloating and breast pain after a couple days of my period."

Monitor hemoglobin Conjugated estrogens q4-6 hours until bleeding stops (Dilation and curettage if the bleeding does not stop) Oral conjugated estrogen followed by progesterone to initiate withdrawal bleeding A combined OCP is given for 21 days after IV therapy Women should maintain a cyclic low dose of OCP for 3-6 months

When profuse uterine bleeding occurs-

40

When women are in their __s, anovulation occurs more often, menstrual cycles increase in length, and ovarian follicles become less sensitive to hormonal stimulation from FSH and LH

B

Which finding is associated with endometriosis? A. Chandelier sign B. Chocolate cyst C. Chadwick sign D. Blood in the cul-de- sac

C

Which finding is not associated as a health risk with menopause? A. Osteoporosis B. Coronary heart disease C. Breast cancer D. Obesity

A, B, C, E

Which of the following are examples of differences between primary and secondary dysmenorrhea? (Select all that apply.) A. The pain associated with primary radiates to the back and thighs. B. With primary, the pain originates at the beginning of menses. C. With secondary, the pain can occur also during ovulation. D. With primary, the patient often complains of abdominal bloating. E. With primary, the patient often presents with systemic symptoms such as dizziness and headache.

A

Which statement is true with regard to premenstrual dysphoric disorder (PMDD)? A. It can manifest symptoms similar to those of panic disorders. B. Symptom presentation is acute, is episodic in nature, and varies as the disorder progresses, leading to a chronic phase. C. There are no physical symptoms of PMDD until the disease is well progressed. D. A symptom-free period occurs in the follicular phase of the menstrual cycle.

orgasm

With age, it takes longer to reach __

A

With regard to dysfunctional uterine bleeding (DUB), the nurse should be aware that: A. It is most commonly caused by anovulation. B. It most often occurs in middle age. C. The diagnosis of DUB should be the first considered for abnormal menstrual bleeding. D. The most effective medical treatment involves steroids.

B

With regard to the diagnosis and management of amenorrhea, nurses should be aware that: A. It probably is the result of a hormone deficiency that can be treated with medication. B. It may be caused by stress or excessive exercise or both. C. It likely will require the client to eat less and exercise more. D. It often goes away on its own.

MHT

Women who decide to stop __, a recurrence of symptoms will occur whether the medication is tapered of discontinued abruptly

Aerobics

__ and strength training have posiitve effects on midlife women's health, including cardiorespiratory function, weight, bone density, and QOL

Estrogen

__ has a favorable effect on circulating lipids, decreasing LDLs and increasing HDLs. (Postmenopausal women are at a greater risk for coronary heart disease because of this)

PMS

__ is a disorder with symptoms that begin in the luteal phase of the menstrual cycle and end with the onset of menses.

PMDD

__ is a more severe variant of PMS, and its most common symptoms are associated with mood disturbances.

Endometriosis

__ is characterized by pelvic pain, dysmenorrhea, dyspareunia, abnormal menstrual bleeding, and infertility.

bone density testing (BDT)

__ is recommended for women who are age 65 and older or in younger women who are at risk for osteoporosis

1/2

__ of all women 50 and older will break a bone due to osteoporosis in their lifetime

Weight-bearing exercise

__ such as walking and stair climbing, may delay bone loss and increase bone mass at any age

Osteoporosis

__, a progressive loss of bone mass that results from decreasing levels of estrogen after menopause, can be prevented or minimized with lifestyle changes and medication.

Dysmenorrhea

__, pain during or shortly before menstruation, is one of the most common gynecologic problems in women.

endometriosis

a condition in which patches of endometrial tissue escape the uterus and become attached to other structures in the pelvic cavity

premenstrual dysphoric disorder (PMDD)

a severe form of PMS that markedly interferes with social relations, work, or education

Amenorrhea

absence of menstruation

amenorrhea

absence of menstruation

Anovulation

absence of ovulation

height

after menopause ___ decreases.

osteoporosis, heart disease

are the major health risks of perimenopausal women:

Uterine Leiomyomas (Fibroids)

benign uterine tumors that can occur singularly or in multiples and can range in size from microscopic lesions to large tumors filling entire abdominal cavity

oral contraceptive pills (OCPs)

birth control medication that uses low doses of female hormones to prevent conception by blocking ovulation decreased prostaglandin synthesis

heart

diseases of the __ are the leading cause of death for US women

female athlete triad

disordered eating, amenorrhea, osteoporosis

1. NSAIDs 2. Progesterone or OCP 3. Testosterone (Danocine, Danazol(acne, oily skin)) 4. GnRH analogs (Lupron, Leuprolide (hot flashes, osteoporosis))

endometriosis treatment:

Menorrhagia (hypermenorrhea)

excessive menstrual bleeding monitor hemoglobin and hematocrit**

rhagia

excessive or unusual

oligo

few

rhea

flow

GnRH agonists

have an inhibitory action of LH and FSH and ovarian function decreases greatly causes a medically induced menopause, resulting in anovulation and amenorrhea Shrinkage of already established endometrial tissue, significant pain relief, and interruption in further lesion development to follow (endometriosis tx)

surgical exploration (laparoscopy)

how to accurately diagnose endometriosis?

Abnormal uterine bleeding (AUB)

is any form of uterine bleeding that is irregular in amount, duration, or timing and is not related to regular menstrual bleeding.

menopausal hormone therapy (MHT)

medication therapy in which women take low doses of estrogen, which is often combined with progestin (synthetic form of progesterone) to counter symptoms associated with menopause

meno

menstrual related

climacteric

midlife transition in which fertility declines

dys

not or pain

OCPs

one of the most common causes of oligomenorrhea

luteal phase

period of corpus luteum activity (days 14-28)

phytoestrogens

plant sources of estrogen

kegal exercises

repetitious contraction and relaxation of the pubococcygeal muscle to improve vaginal tone and urinary continence

Hypogonadotropic amenorrhea

results from hypothalamic suppression as a result of stress or a sudden and severe weight loss, eating disorders, strenuous exercise, or mental illness

oligomenorrhea

scanty or infrequent menstrual flow characterized by intervals of 40-45 days or longer

bioidentical hormones

structurally identical hormones to those produced by the ovary have not been studied to confirm whether appropriate absorption occurs or if predictable levels can be detected in blood and tissue more expensive, not covered by third party payers

premenstrual syndrome (PMS)

syndrome involving physical and emotional symptoms occurring in the 10 days before menstruation can include irritability, headache, tender breasts, and anxiety

vagina, urethra

the __ and __ are estrogen-sensitive tissues, and low levels of estrogen can cause atrophy of both women who are sexually active have less vaginal atrophy and fewer problems related to intercourse

4-5

the average duration of the perimenopausal stage-

L (living children)

the number of currently living children

T (term births)

the number of pregnancies ending at >37 weeks gestational age (wga), AKA- Term

A (abortions)

the number of pregnancies ending before 20 wga or viability

Menopause

the time of natural cessation of menstruation; also refers to the biological changes a woman experiences as her ability to reproduce declines

G (gravidity)

the total number of pregnancies

P (parity)

the total number of pregnancies that have reached viability

depression

there is no causal association between menopause and __

decrease or discontinue meds known to affect menstruation, correct weight loss, deal more effectively with psychological stress, address emotional distress, alter exercise routine

things to consider when treating amenorrhea

metro

time

a

without, none