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What is the term for the first menstrual flow? When do physical changes occur? When is the usual onset of puberty? What is the cycle like during menarche? What is the education needed for girls going through menarche?
- approx. 2 years before menarche
- onset: 8-13 years
- length is irregular and unpredictable
- pads/tampons; hygiene needs
When is puberty complete?
when the menstrual cycle becomes regular
What is the most common reproductive problem?
What 3 dysfunctions cause menstrual irregularities?
- hypothalmic dysfunction
- pituitary dysfunction
- ovarian dysfunction
What is amenorrhea? What is menorrhagia? Metrorrhagia? Dysmenorrhea?
- amenorrhea: primary-no menses by age 14 with no sex characteristics; no menses by age 16 with sex characteristics; secondary- no menses in 6 moths in a woman who has had a normal menstrual cycle
- Menorrhagia: menstrual bleeding that is excessive in number of days and amount of blood
- Metrorrhagia: bleeding between periods or after menopause
- Dysmenorrhea: painful menstruation
What is PMS/PMDD?
premenstrual syndrome; a combination of emotional and physical symptoms that occur during the luteal phase(2 weeks before menstruation) and diminish after menstruation begins;
What are the physical and emotional symptoms of PMS?
- Physical: migraine, vertigo, syncope; rhinitis, hoarseness; N/V, constipation, abdominal bloating, increased appetite; urinary retention, oliguria, acne, mammary swelling, tenderness; joint or muscle pain
- Emotional: irritability, lethargy, depression, low morale, anxiety, sleep disorders, cryig spells, hostility, decreased concentration
What is the difference between PMS and PMDD?
- PMS: 1-3 symptoms that occur in luteal phase of at least 3 consecutive cycles; symptoms are relieved when menstruation begins
- PMDD: 5 or more symptoms; relieved by menstruation; occurring during most cycles over past year; markedly interferes with work, school and or relationships
What is the treatment of PMS?
- psychological evaluation: psychological symptoms present during entire cycle but intensify during premenstrual time is not PMS/PMDD but indicates an underlying metal disease that needs psychiatric evaluation
- Lifestyle changes: exercise, complex carbs, adequate sleep, dietary supplements (1200 ca;cium/200-400mg magnesium)
- Pharmocological: calcium, prostaglandin inhibitors; selective serotonin re-uptake inhibitors (current theory is PMS due to decreased serotonin levels); ovulation suppression only f SSRIs are ineffective
What are the different kinds of menstrual irregularities?
- Hypoenorrhea: normal intervals but decreased flow
- Oligomenorrhea: cycle > 40 days; irregular flow
- Polymenorrhea: cycle< 22 days; flow may or may not be not be normal
- menometrorrhagia: regular or irregular flow; excessive bleeding either in amount or duration
What are STDs?
- Spread through sexual contact; intimate contact with genitals, mouth or rectum
- may cause pain, scarring or genitourinary structures, infertility, birth defects, nervous system damage, cancer, damage to other organs, death
- Can have profound social and psychological impact
- more than 50 diseases and syndromes associated with STDs
What is the best way to prevent STDs?
What is the teaching involved with education of STDs?
- Teach signs and symptoms
- explain diagnostic studies
- teach methods to prevent spread of infections (condoms)
- explain treatments
- importance of completing treatment
- importance of treating partners
What is PID
- Pelvic Inflammatory disease
- Infection of upper reproductive tract
- can spread spread to peri area; chlamydia and gonorrhea are most common causes
- Complications: infertility, ectopic pregnancy, chronic pelvic pain
- Treatment: antibiotic therapy, treat sexual partner, pain management
What are the manifestations of PID?
fever, pelvic pain, abnormal vaginal discharge, nausea and vomiting, irregular vaginal bleeding
What are the common causes of Toxic shock syndrome?
- Staphylcoccus aureus
- super absorbent tampons
- Diaphragm or cervical cap (esp. if left in place >48 hours)
What are the s/s of toxic shock syndrome? Treatment? Prevention?
- Fever >102
- Rash on trunk
- desquamation of the skin, usually palms and soles
- watery discharge
- severe myalgia
- inflamed mucous membranes
- Treatment: supportive therapy- IV, renal dialysis, vasopressors, intubation, antibiotics
- early diagnosis & treatment are vital to prevent death; recurrence is 40-50%;
- Prevention: changing tampons frequently and not at night; do not use super absorbent tampons
What is aids? genital worts/HPV? Genital herpes? Hep B? Chlamydia? Gonorrhea? Syphilis? Trichomoniasis? Candida vaginitis? bacterial vaginosis?
- Aids: viral, antiviral therapy
- Genital Warts/ HPV: viral, Trichloroacetic acid
- Genital herpes: viral, acyclovir
- Hep B: viral, no specific treatment
- Chlamydia: Bacterial, Doxycycline, azithromycin
- Gonorrhea: bacterial, ceftriaxone, proazithromycin, doxycycline
- Syphilis: bacterial, penicillin G
- Trichomoniasis: protazoan, metronidazole
- Candida Vaginitis: fungal, miconazole, fluconazole
- Bactrial vaginosis: metronidazole, clindamycin, meconazole
What is menopause?
- Climacteric: change of life
- Three stages-
- 1. Perimenopause: 2-8 years; onset with symptoms of menopause; ends one year after last menstrual cycle; contraception
- 2. Menopause: 12 months after last menstrual cycle
- 3. postmenopause: time after menopause
WHat influences the onset of menopause?
- woman's health
- life style
- genetic factors
What are the symptoms of menopause? treatment?
- irregular periods
- hot flashes (vasomotor instability)
- night sweats
- sleep disturbances
- vaginal dryness
- mood changes
- decreased interest in sex
- hair loss
- irregular heartbeat/palpitations
- Treatment: lifestyle changes (sleep 8 hours, balanced diet, exercise, avoid caffeine, alcohol and smoking; Alternative medications (herbs, acupuncture, biofeedback, hypnosis)
- Hormone therapy; Hot flashes (dress in layers); night sweats ( sleep in cotton); sleep disturbances (calm environment) vaginal dryness ( lubricants, hormone)
What is premature menopause? treatment?
- Spontaneous premature menopause
- may be d/t anorexia, chemo, radiation or oophorectomy
- 1% of women under 40
- sharp decline in estrogen
- rise in FSH
- 5-10% spontaneously reverse
- Treatment: estrogen, progesterone until normal age of menopause
What is menopause hormone treatment?
- recommendations based on Woman's health initiative and heart and estrogen/progestin replacement study and follow up studies
- Recommendations: use HT only to treat severe menopausal vasomotor symptoms; progestrone and estrogen only for women with uterus
- estrogen only for women without uterus
- use diet and exercies to control coronary artery disease
- HT may be effective for osteoporosis, but not first line
- use for shortest time possible at the minimal dose to control symptoms
- short term 4-6 years
- use HT for premature menopause until normal age of menopause
- risks should be explained to woman
What is osteoporosis?
- loss of bone mass
- greater risk for vertebral/hip fractures
- Diagnosis: DXA scan
- Symptoms: back pain, loss of height, stooped posture, bone fractures
- Risk reduction: diet high in calcium and vitamin D; weight bearing exercise, avoid smoking and limit alcohol
What are bisphosphonates?
- they inhibit re-absorption of bone
- aldendronate (fosamax)
- ibandronate ( boniva)
- Risedronate (acetonel)
- Zoldronate (Reclast)
What are estrogen-receptor modulators
- binds with estrogen receptors
- produces estrogenlike effects on bone; reduces resorption of bone
- Raloxifene (evista)
What is the hormone therapy for osteoporosis?
- conjugated estrogen + medroxyprogesterone acetate ( Premphase)
- Conjugated estrogen (premarin)
What are the major malgnant breast disease risk factors?
- *age, 85% occur in women over 40
- BRCA-1-BRCA 2 gene mutation
- biopsy confirmed atypical hyperplasia
- dense breast tissue
- HC of breast cancer
What are the additional risks for malignant breast cancer?
- High endogenous estrogen or testosterone levels
- high bone density
- family hx of breast cancer
- exposure to chest radiation
- exposure to estrogen- early menarche, late menopause, hormone therapy
- exposure to carcinogens
- excessive alcohol
- exposure to DES
What are the stages of breast cancer?
- Stage 0: cancer limited to duct, no metastasis
- Stage 1: tumor <2cm, micrometastais
- stage 2: spreading to lymph nodes but not distant sites
- stage 4: cancer has spread to distant organs or distant lymph nodes
What is the treatment for breast cancer?
- dependent on stage and type
- Surgical: lumpectomy, partial, simple, or modified radical mastectomy, breast reconstructions
- Hormone therapy: some tumors require estrogen to grow, antiestrogen meds ( tamoxifen, fulvestrant, anastrozole
- Targeted therapy: tratuzumab targets breast tumor
What is a Pap smear?
- A papanicolau smear is a screen for cervical cancer
- should begin at 21 ( earlier may lead to unnecessary evaluation and treatment)
- should be done every 3 years until 65
- age 30-65, every 5 years with screening with a combination of cytology and HPV testing
What are the risk factors for cervical cancer? treatment?
- HPV infection (highest risk)
- early sexual activity (before 16)
- inadequate cervical screening
- multiple sex partners
- in utero exposure to DES
- birth control pills > 5 years
- given birth tp 3 or more children
- Treatment: based on stage and desire for future pregnancies
What is gynecological cancer?
- endometrial ( hallmark symptom is vaginal bleeding post menopausal)
- Ovarian (most fatal gyn cancers; hardest to diagnose)
What is endometriosis?
- endometrial tissue outside of the uterine cavity( issue responds to hormonal changes; most common site is pelvis)
- cause is unknown
- symptoms: pelvic pain, dysmenorrhea, menorrhagia, infertilty, dyspareunia(painful sex)
What is the treatment for endometriosis?
- Meds: NSAID; combined oral contraceptives; progestins; danzol; gonadotropin releasing hormone (GnRH [ leuprolie, goserelin) narfarelin])
- surgical: removal of the endometrial implants outside of the uterus
What is PCOS?
- polycystic ovarian syndrome
- symptoms: menstrual disorders
- hirutism( abnormal growth of hair)
- multiple follicular ovarian cysts producing excess estrogen
- oily skin, acne
- pelvic pain
- male-pattern baldness
- elevated levels of estrogen, testosterone, LH
- decreased levels of LSH
What is the treatment of PCOS?
- weight loss
- Pharm: combined oral contraceptives or cyclic progesterone (regulate periods, reduce acne & hirsutism)
- clomiphene citrate (first line drug to induce ovulation if pregnancy desired )
- metformin: increases insulin sensitivity; decreases insulin levels --> lower androgen levels-->improved ovulation
- pioglitazone ( increases insulin sensitivity; decreases insulin levels; harmful for developing infant
- Spironalactone ( decreases hirsutism and acne; harmful to fetus
What are the long term implications for PCOS?
- Physical; increased risk for: type 2 diabetes, dyslipidemia, hypertension, cardiovascular disease, endometrial, breast, ovarian cancer, sleep apnea, infertility, menstrual disorders
- Psychological: body image; depression
What is pelvic relaxation?
- Cystocele: downward placement of the bladder
- Rectocele: anterior wall of rectum sags forward
- uterine prolapse
what is the most common gyn surgery?
What is uterine ablation?
- destroy innermost layer of endometrium
- treatment of DUB (dysfunctional uterine bleeding) permanent sterilization
What are the other common gyn surgeries?
- salpingectomy, oophorectomy, vulvectomy ( labia, clitoris),
- pelvic exonerations for recurring cervical cancer: (anterior [uterus, ovaries, falopian tubes, vagine, bladder, urethra, pelvic lymph nodes])
- posterior[ uterus, ovaries, fallopian tubes, descending colon, rectum, anal canal]
- total [ all of the above])