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Maternity Chapter 6

This chapter provides information on menstrual cycle experiences.

Adolescence menstrual cycle Irregular bleeding, both in length of cycle and amount, is the rule rather than the exception in early adolescence.
Amenorrhea --the absence of menstrual flow, --is a clinical symptom of a variety of disorders. --it is not a disease, but often the sign of one. --also a result of pregnancy --can result from endocrine disorders, medications, drug abuse and oral contraceptives
Exercise-associated amenorrhea associated with many factors, including body composition (height, weight, and percentage of body fat); type, intensity, and frequency of exercise; nutritional status; and the presence of emotional or physical stressors --Athletic women are affected
Treatment of amenorrhea Identify the cause and take care of it. for example, if it's caused by exercise, increase nutritional intake or decrease exercise intensity.
Cyclic perimenstrual pain and discomfort (CPPD) it includes -dysmenorrhea, -premenstrual syndrome (PMS), -premenstrual dysphoric disorder (PMDD) -other symptoms Symptoms occur cyclically and can include mood swings and disconforts
Dysmenorrhea --pain during or shortly before menstruation --is one of the most common gynecologic problems in women of all ages. --many have it in the 1st 3 years after menarch --severe symptoms associated with early menarche, nulliparity, and stress
Description of dysmenorrhea pain in general: Pain is usually located in the suprapubic area or lower abdomen. Women describe the pain as sharp, cramping, or gripping or as a steady dull ache; pain may radiate to the lower back or upper thighs.
What is Primary Dysmenorrhea? condition associated with abnormally increased uterine activity --is due to myometrial contractions induced by prostaglandins in the second half of the menstrual cycle.
Cause of primary dysmenorrhea Excessive release of PGF2α increases the amplitude and frequency of uterine contractions and causes vasospasm of the uterine arterioles, resulting in ischemia and cyclic lower abdominal cramps.
Onset of primary dysmenorrhea Primary dysmenorrhea usually appears within 6 to 12 months after menarche when ovulation is established. --Declines with ages, and occurs only during ovulation
Management of primary dysmenorrhea heat massage exercise changes in diet (decrease salt, sugar and red meat) NSAID (if does doesn't stop the pain, then other issues are present... seriously)
Secondary Dysmenorrhea >>acquired menstrual pain that develops later in life than primary dysmenorrhea, typically after age 25. >>caused by other unnatural problems :( associated with pelvic pathology, such as adenomyosis, endometriosis,etc.
Description of secondary dysmenorrhea pain: >>dull, lower abdominal aching radiating to the back or thighs. >>Often women experience feelings of bloating or pelvic fullness.
Treatment of secondary dysmenorrhea: Find the problem and fix it.
Premenstrual Syndrome (PMS)----symptoms? PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses. Symptoms include fluid retention (abdominal bloating, pelvic fullness, edema of the lower extremities); behavioral or emotional changes (depression, crying spells, irritability); premenstrual food cravings; and headache, fatigue, and backache.
premenstrual dysphoric disorder (PMDD) worst than PMS
Treatment of PMS or PMDD Healthy diet use natural diuretics limit intake of sugar, salt and redmeat EXERCISE (especially in the luteal phase) >>Medication used if above steps do not workk in 1-2months
Endometriosis characterized by the presence and growth of endometrial glands and stroma outside of the uterus.
Treatment of endometriosis If pain is experienced, use NSAIDS. If pain is severe, use Oral Contraceptive Pills(OCPs) with low estrogen to progesterone ratio >>Pain comes back when OCPs are stopped >>Danazol (Danocrine) can be used
TAH Total Abdominal Hystorectomy Used to treat endometriosis if woman if willing to give up child bearing capacity Endometriosis recurs regardless of treatment
OLIGOmenorrhea >>used to describe decreased menstruation, either in amount, time, or both. >>However, oligomenorrhea more correctly refers to infrequent menstrual periods characterized by intervals of 40 to 45 days or longer.
HYPOmenorrhea scanty bleeding at normal intervals.
Asherman syndrome condition in which adhesions resulting from curettage (removal of tissue) or infection obliterate the endometrial cavity, and congenital partial obstruction of the vagina. ->> leading to HYPOmenorrhea
Metrorrhagia intermenstrual bleeding, refers to any episode of bleeding, whether spotting, menses, or hemorrhage, that occurs at a time other than the normal menses.
Mittlestaining >>a small amount of bleeding or spotting that occurs at the time of ovulation (14 days before onset of the next menses) >>is considered normal.
Menorrhagia (hypermenorrhea) excessive menstrual bleeding, in either duration or amount.
Causes of menorrhagia -Must be investigated when reported by patient -Could be an early pregnancy loss -Hematocrit and hemoglobin test should be done always -avoid use of aspirin
Dysfunctional Uterine Bleeding >>Falls under Abnormal uterine bleeding (AUB) “excessive uterine bleeding with no demonstrable organic cause, genital or extragenital” (Lobo, 2007a).
Profuse bleeding with hemoglobin less that 8g/dl (hematocrit of 23% or 24%) Requires hospitalization and administration of conjugated estrogens (e.g., Premarin), 25 mg intravenously. Repeat if bleeding continues. >>12 to 24 hours later, dilation and curettage (D&C) may be done to control severe bleeding and hemorrhage.
After hospitalization due to menorrhagia, what can be done? oral conjugated estrogen 2.5mg given daily, followed by progesterone 10mg given in the final 10 days to initiate withdrawal bleeding. or OCP is given for 21 days after intravenous therapy. Patient maintained on cyclic low-dose OCPs for 3 to 6 months
Onset of menopause after 40s median is 51
Dyspareunia (painful intercourse)in women after menopause occurs because the vagina becomes smaller, the vaginal walls become thinner and drier, and lubrication during sexual stimulation takes longer.
Menopause Can only be identified 1 year later
Menopause symptoms like hot flashes mostly reported by Hispanics and AA Asians report the least (could be culture)
dowager's hump vertebrae can no longer support the upper body in an upright position indicates osteoporosis
Created by: ekm