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What is primary dysmenorrhea?
one of the most common gynecologic problems occurring most often in women in their teens and early 20s
Treatment for primary dysmenorrhea
- Oral contraceptives
- Dietary changes
What is premenstrual syndrome?
- a collection of symptoms that are cyclic in nature
- change in NT - serotonin
- changes in fluid shifts
What are therapies for premenstrual syndrom?
- Nutrition - Ca and Mg supplements
- Drug therapy - hormone therapy, SSRIs
- CAM - chaseberry supplements
What is endometriosis?
- endometrial tissue implantation outside the uterine cavity
- on ovaries, cul de sac of Douglas, scarring on surrounding tissue
- major cause of infertility and very painful
- unknown cause
Interventions for endometriosis
- drug therapy - contraceptives to decrease stimulation to tissues
- androgenic agents
- CAM - heat packs, relaxation, massage, Ca, Mg, meditation
What is dysfunctional uterine bleeding?
bleeding that is excessive or abnormal in amount or frequency - endometrial overgrowth
What is dysfunctional uterine bleeding associated with?
- endocrine disturbances
- polycystic ovary disease
- long-term drug use
- anatomic abnormalities
Collaborative management of dysfunctional uterine bleeding
- hormone manipulation
- - dilation and curettage procedure - uterus scraping
- - laser or balloon endometrial ablation - removal of built up uterine cells
- - mymectomy - removal of fibroids
- - hysterectomy
What is menopause?
normal biologic event marked for most women by the end of menstrual periods - 12 months of no periods
S/S of menopause
- hot flashes
- night sweats
- dry vagina
How are symptoms of menopause managed?
- Hormone replacement therapy - lowest dose for shortest amount of time
- healthy lifestyle
- physically active
- Ca, vitamin D
- good nutrition
What changes occur that indicate perimenopause?
- changes in ovarian function
- can happen over several years - gradual
What is vulvovaginitis?
- vaginal discharge and itching
- inflammation of the lower genital tract resulting from a disturbance of the balance of hormones and flora in the vagina and vulva
What are the S/S of vulvovaginitis?
- change in vaginal discharge
What causes vulvovaginitis?
What is toxic shock syndrome (TSS)?
- S. aureus produces endotoxins that into bloodstream, causing extreme illness
- Don't leave your tampons in too long
S/S of TSS
abrupt onset of high temp, HA, sore throat, vomiting, diarrhea, generalized rash and hypotension
How is TSS managed?
- Restoring fluid, electrolytes
- change your tampons
- use a clean, new tampon each time
What is uterine prolapse?
downward displacement of the uterus
At what age is uterine prolapse most common?
- Elderly women
- Can also occur in women who just had a baby
What are S/S of uterine prolapse?
- Pressure in the pelvis
- Bowel or bladder problems
Treatment for uterine prolapse
- surgery - suspend uterus or hysterectomy
What is a bladder prolapse into the vagina?
What is a rectum prolapse into the vagina?
What is a fistula?
abnormal opening between two adjacent organs or structures
Types of fistulas?
Causes of fistulas?
- Traumatic child birth
What are benign neoplasms?
- Ovarian cyst
- uterine leiomymomas
What is a uterine leiomyoma?
a fibroid that causes heavy bleeding and risk usually increases with age
Management of uterine leiomyoma
- radiological procedure that stops blood supply to the fibroid
- total hysterectomy
- laparascopic removal
What are cervical polyps?
pedunculated tumors on stalks arising from the mucosa and extending to the opening of the cervical os
What is endometrial cancer?
a reproductive cancer of which adenocarcinomas are the most common type
What are the S/S of endometrial cancer?
- Main symptom is postmenopausal bleeding
- CA-125 tumor marker
- chest x-ray for metastasis
Management of endometrial cancer
- Radiation therapy - intercavity brachytherapy or external
- drug therapy
- hormone therapy
What is cervical cancer?
progression from totally normal cervical cells to premalignant changes in appearance of cervical cells to changes in function and ultimately to cancer
What is the most advanced premalignant stage with a cancer spot in cervical cancer?
carcinoma in situ
Where is preinvasive vs invasive cervical cancer located?
- preinvasive is only in the cervix
- invasive is spread to other structures
What is the HPV (Gardasil) vaccine for?
- protection against the highest risk/most common HPV's responsible for most cancers
- 3 injections over 6 months
Clinical manifestations of cervical cancer
- often asymptomatic
- painless vaginal bleeding - classic symptom
- water, blood-tinged vaginal discharge that may become dark and foul smelling as disease progresses
- leg pain along psiatic nerve
- flank pain
- unexplained weight loss
- pelvic pain
- rectal bleeding
- chest pain
Diagnostic for cervical cancer
What is ovarian cancer?
serous adenocarcinoma - most common
What are S/S of ovarian cancer?
- often asymptomatic and not detected until end stages
- vague abdominal discomfort
- looks like gallbladder disorders
- ovarian antibody CA-125
What is vulvar cancer?
cancer of the female external genitals - most are squamous cell
S/S of vulvar cancer
- irritation or itching in perianal area
- sore that won't heal
What test is performed to identify abnormal cells in vulvar cancer, and what is used for tissue biopsy?
- Toluidine blue
- Keyes dermal punch
Post-op care after vulvectomy
- Wound care
- Promote urinary and bowel elimination
- Managing pain
- Addressing sexuality
- Treatment with common cancer treatments
Fallopian tube cancer
- rarest of all gynecologic cancers
- most common symptoms - postmenopausal bleeding, increased abdominal pain, water vaginal discharge, leukorrhea
- treatment - total abdominal hysterectomy and bilateral salpingo-oophorectomy with omentectomy