Download common gyne problem

Eman Abu Alfawaris
Menstrual disorder
1.Oligomenorrhea:
A. episodic of the period occurring at intervals > 35 days
B. usually associated with an -ovulation
C. The period is an irregular, and infrequent
D. Causes:
1- polycystic ovarian syndrome
2- endocrine disorder as thyroid dysfunction diabetes
3-idopathic
2. Polymenorrhea:
*
A. episodic menses occurring at intervals < 21 days
B.The period is become more frequent and profuse
C. usually associated with an-ovulation.
3.Amenorrhea:
it is the absent of menstrual period, and can be classified as false,
physiological, or pathological
a- false amenorrhea:
it is occur when the menarche happens but no menstrual flow is seen ,
because the hymen is not perforated.
b-physiological amenorrhea: it is normally occurring in the certain
women’s life as,
 Prepuberty
 pregnancy
 postmenopausal
 Lactation
C .Pathological amenorrhea: It is classified as
1- Primary amenorrhea: is defined as the
failure of any menstrual loss by the age of 16 years or 3years after
the first sign of puberty
2- Secondary amenorrhea is defined as a 6-month or 3 month
absence of menses without any physiological reason.
Causes:
1-congental disorder : such as
A-absent of the ovaries, uterus
B- hyperplasia of the uterus
C-chromosomal abnormalities as Turner's syndrome
2- endocrine disorder: such as
a- hypothalamus: Froehlich's syndrome that have the following sign and
symptoms
- hursutism
- obesity
- lethargy
- mental dullness
- genital hypoplasia
C-pituitary gland:
 Sheehan’s syndrome that characterized by :
-pituitary atrophy
-genital atrophy
- sterility
d- thyroid : hyper or hypothyroidism
e- adrenal
- Addison's syndrome
- Cushing syndrome
f- ovaries: ovarian cyst , or atrophy
3- systematic disorder:
 As tuberculosis renal disease, malnutrition( not get enough calories,
vitamins, and minerals)
4- psychological disturbance:
the most common causes are:
Stress
Bereavement or grief
Social isolation
Depression
anorexia nervosa
5-Some medications, such as phenothiazines, chemotherapy, and hormonal
contraceptives, may also induce amenorrhea.
5.Life style:
-athletes who running , dancing , accompany by poor diet which usually
result in appropriate weight loss or failure to gain weight during growth
Investigation of amenorrhea
*The gynecologist usually avoid any unnecessary test if :
a- amenorrhea is transient
b-age is less than 17 in primary amenorrhea
* other wise the following test are usually done:
1- blood test
2- chest x-ray
3-Measurement of hormone:
 Follicle stimulating hormone (FSH),
 luteinizing hormone (LH), thyroid
 stimulating hormone (TSH), prolactin,
 estradiol and testosterone
 Skull x-ray
 Vaginal cytology
 Urine analysis for 24 hrs to estimate hormone level
 May be do ( laparoscopy, ultrasonography)
 Progestogen challenge test determines whether the endometrial has
been exposed to estrogen and is a more physiological
method than measuring estradiol levels.
1.ultrasound
2.CT scan of pituitary
-Genetic karyotyping to detect chromosome abnormalities.
Management:

Discontinue causative medications if desired.

Nutritional, exercise, or psychological counseling as indicated.
o
Recommend decreased exercise in athletes to increase body fat
stores and decrease stress.
o
Recommend weight reduction if obese.

Hormonal replacement therapy to regulate cycle.

Treatment of tumor or other underlying cause.
Nursing Interventions
 Meeting Nutritional Requirements
1-Explore patient's body image, knowledge of the food groups,
behavior regarding meals, and exercise routine; point out
misconceptions, dangerous behavior, and ideas for improvement.
2- Monitor weight gain, increase in body fat, and return of menstrual
cycles.
 Reducing Anxiety
1-Provide emotional support for patient and family , and Assess emotional
status, areas of stress, and coping ability
2-Describe diagnostic tests and who will give results to patient
3-Point out ineffective coping mechanisms and teach relaxation techniques
and more positive coping mechanisms such as assertiveness.
 Patient Education and Health Maintenance
1-Teach patient the physiology of the normal menstrual cycle and possible
causes for amenorrhea.
2-Teach proper use and adverse effects of prescribed medications.
3-Teach patient to chart menstrual periods on a calendar and maintain
regular gynecologic and medical follow-up visits.
4.Dysmenorrhea:
 Dysmenorrhea: is painful menstruation; most common of
gynecologic dysfunctions.
 Types of Dysmenorrhea
1-PrimaryDysmenorrhea(spasmodic)
2-SecondaryDysmenorrhea(congestive)
1-PrimaryDysmenorrhea(spasmodic):
 dysmenorrheal occurs almost exclusively in ovulatory cycles, and
associated with out organic disease as lesion , PID ( Pelvic
inflammatory disease ).
Characterization of the Primary Dysmenorrhea
it is start just before the onset of the period and last for 2-3 days
2-it is colicky or dull in nature, felt centrally in the lower midabdomen and may
radiate to the back and inner aspects of the thighs
3- it may associated with other symptoms such as ,nausea, vomiting, headache,
backache, diarrhea, chills, tiredness, nervousness, and sever cramp
4- most common in single, infertile women
Causes of Primary dysmenorrhea:
 Prostaglandin production will Increased myometrial
contractility
 Decreased endometrial blood flow
 Vasopressin.
 Causes by hormonal, and psychological factors
Treatment of primary dysmenorrhoea
 Analgesics e.g. paracetamol
 Non-steroidal anti-inflammatory drugs (NSAIDs) as -mefenamic
acid (PonstanJ), ibuprofen , diclofens sodium .
*NSAIDs work by direct inhibition of the cyclooxygenase
system reducing prostaglandin production.
 Combined oral contraceptive pill (COC) :suppresses ovulation
 Exercise to increase endorphin release, which decreases pain
perception, and to suppress prostaglandin release.
2.Secondary Dysmenorrhea(congestive)
 Secondary Dysmenorrhea characteristic:
- It is the pain caused by some physical condition like polyps or fibroid
in the uterus
- It is started later in the life than primary dysmenorhea, rarely before
30 yrs of age.
- Pain in the lower abdomen and back , usually start 3 -4 days the
period and disappear when the period start or continue thought the
Causes of Secondary dysmenorrhoea:
 Idiopathic
 Endometriosis
 pelvic inflammatory disease
 Pelvic venous
 congestion
 Cervical stenosis
 Intrauterine device.
 Ovarian cyst , uterine fibroids
Patient Education and Health Maintenance
 Explain to the patient possible causes of dysmenorrhea.
 Teach patient non pharmacologic methods to reduce pain.
1. Apply heating pad to lower mid abdomen or back or take warm tub baths.
2.Exercise regularly (30 minutes, three times per week).
3.Teach patient to use prescribed medications effectively by taking
medication at beginning of discomfort and repeating as necessary,
especially on first day of menses and teach patient adverse effects of
medications .
 Encourage patient to reduce stress through adequate sleep, good
nutrition, exercise, and coping with stressors.
 Discuss patient's feelings toward menstruation (hygienic issues,
inconvenience, female identity).
5.Menorrhagia:
 it is a heavy, regular and prolonged bleeding defined
as a menstrual blood loss greater than
80 ml either the amount of blood loss is excessive or the number of days is
extended. It lead to iron deficiency anemia .
The average blood lost per period is 35-50 ml.
- IT caused by the following causes :
-Idiopathic
- Endometrial polyps
-Fibroids
- Congenital anomalies
-bleeding disorders
- hormonal imbalance
- intrauterine contraceptive devices
-pelvic infection (often heavy and painful menses).
-coagulation disorder .
- endometrial polyps.
Treatment:
 Iron supplement is necessary
 Diagnostic curettage may also be therapeutic in several cases
 Hysterectomy may be indicated in women approaching menopause.
6.Dysfunctional uterine bleeding (DUB):
 is defined as heavy and often irregular
bleeding, which occurs in the absence
of :
-any pelvic pathology
-Infection
- pregnancy
- bleeding disorder
-Hormonal therapy
-Trauma
-tumors
Management
 Treat underlying anemia with iron, possible transfusions (only
significant complication).
 Progesterone therapy to stop acute bleeding.
 Hormonal contraceptives to control chronic bleeding
 Dilation and curettage.
 Hysteroscopy endometrial resection (removal of diseased or
abnormal tissue) or endometrial ablation (application of heat to
endometrial to induce scarring) when above methods are not helpful.
 Hysterectomy in refractory case.
Patient Education and Health Maintenance:
 Teach the patient the cause of DUB and about the diagnostic process
to rule out pathologic causes of abnormal bleeding.
 Teach the patient to prevent anemia by eating a diet high in iron, and
by consuming vitamin C or citrus fruit to enhance absorption of iron.
 Teach about hormonal therapy and what adverse effects to expect,
and what to expect of bleeding. Bleeding should stop within 2 to 7
days after short-term progesterone therapy, and should stop within
first week of hormonal contraceptives but should start again in
fourth week as regular menstrual period.
 Advise patient to keep a calendar or log of menses.
7.Metrorrhagia: bleeding from uterus between regular menstrual
periods; significant because it is usually a symptom of disease.