Menstrual Cycle Disorders. Menopause Chapter 32

1. Menstrual Cycle Disorders.Menopause Chapter 32

2. Types of Menstrual Disorders 1. Amenorrhea 2.Dysmenorrhea 3.Premenstrual Syndrome

3. A.Primary Amenorrhea • Occurs if the girl passes the age by which menstruation has normally started from 9 to 15 years. • Primary amenorrhea may be suspected if the girl is more than one year older than the ages at which her mother and sister had menarche.

4. Etiology for Primary Amenorrhea • Turner’s Syndrome( Amenorrhea associated with absence of breast or pubic hair development) • When secondary sexual characteristics are present the cause may be: • Incomplete development of uterus, ovaries, and fallopian tubes. • Intrauterine exposure to diethylstilbestrol is associated with abnormal development of uterus. • Hormonal Imbalances,systemic diseases,and hypothalamic pituitary abnormalities.

5. Continued • Excessive exercise • Malnutrition or eating disorders such as Anorexia Nervosa and Bulimia

6. Therapeutic Management • Depend on the cause • Counseling for eating disorders and reducing excessive exercise • Hormonal therapy for hormonal imbalances • If cause cannot be treated provide psychological support to the clients.

7. Secondary Amenorrhea Definition : Cessation of menstruation for six months or more in a woman who has established a pattern of menstruation or absence of mense for duration of three normal cycles.

8. Etiology of Secondary Amenorrhea • Systemic Diseases such as D.M,Hypothyroidism,CNS lesions • Hormonal Imbalances. • Strenous aerobic exercise • Poor Nutrition • Use of Oral Contraceptives • Ovarian tumors • Stressors such as divorce, death, moving of a job change may result in secondary amenorrhea

9. Assessment • A thorough medical and OB history • Laboratory Testing of hormones levels • Questions about eating habits,HX of dieting and current exercise pattern and stressors. • Any use of hormonal contraceptives and antihypertensive (cause secondary Amenorrhea)

10. Treatment of Secondary Amenorrhea • Identify and correct the underlying cause • Pregnancy test to rule out pregnancy before starting treatment for secondary amenorrhea • Test level of hormones related to MC • Therapy to improve timing of the cycle • Treatment of anovulation • Identifying other abnormalities that may be related to the disorder such as poly cystic ovary syndrome

11. Nursing Consideration • Teaching Includes • Importance of adequate nutrition and discourage vigorous dieting • Avoid strenuous exercise • Effective weight control may reduce factors related to polycystic ovary syndrome • Provide emotional support and explanation of proposed treatment

12. Pain associated with MC. • 1.Mittelschmerz • 2. Primary Dysmenorrhea • Mittelschmerz: middle pain, unilateral pelvic pain that occurs midway between menstrual period or at ovulation,pain is sharp last from few hours to 2 days slight vaginal bleeding may occurs • Mild analgesics is sufficient treatment

13. Primary Dysmenorrhea • Menstrual pain without an identified pathologic process, often occurs in woman younger than age 20 • Woman affected often have a mother or sister with primary dysmenorrhea • Manifestations; colicky or spasmodic pain begin within hours of onset of menses may radiated to lower back or legs and resolves over 12-72 hours • Occurs in ovulatory cycles and most common in young ,nulliparas woman

14. Etiology: • Excessive production of endometrial prostaglandins (particularly E2) during the late luteal phase of the MC .Lead to excessive contraction and ischemia which leads to cramping and pain Diarrhea nausea and vomiting may also occur

15. Therapeutic Management of Dysmenorrhea • Oral contraceptives and NSAIDs such as Ibuprofen act as prostaglandin inhibitors • Nursing Considerations: • Non pharmacologic pain relief measures such as: 1.Frequent rest period 2.Application of heat to the lower abdomen 3.Moderate exercise and well balanced diet 4. Avoidance of stress

16. PMS(Premenstrual Syndrome) • It is a group of symptoms that occur during the second half of the MC & cause varied types and severity of problems in a woman’s work. • 5-10% have severe symptoms psychiatric in nature called premenstrual dysphoric disorders (PMDD)

17. Symptoms of PMS • Physical Symptoms • Headach, Diziness • Abdominal bloating or swelling, swelling of extremeties • Weight gain • Breast tenderness • Hot flashes • Abdominal cramps • Generalized muscle and joints pain • Fatigue • Appetite changes, food craving • Sleep changes, excessive or insomnia • Reduced sexual interest

18. Behavioral Symptoms of PMS • Depression or sadness • Feeling of hopelessness • Marked anxiety • Confusion, forgetfulness, poor concentration • Accident prone • Irritability and anger • Emotional lability, tearfullness or crying easily, lonliness and mood instability • Reduced interest in normal daily activity • Social avoidance • Lethargic or energetic

19. Etiology of PMS • Cause unknown but theories suggests; • Imbalance between estrogen and progesterone • Low level of beta endorphins • Low serotonin levels • Abnormal production of PG

20. Diagnosis of PMS • Diagnosis of PMS depends on the following criteria : • 1.Signs & symptoms must be cyclic & recur during the luteal phase (after ovulation)of the MC. • 2.The woman should be free during the follicular phase of the MC & the cycle must include seven symptom free days.

21. 3. Symptoms must be severe enough to impact the woman’s work ,life style,& personal relationships. • 4. Diagnosis should be based on prospective symptom recording by the woman (symptoms as they occur). • woman can use calendar or diary to record her PMS symptoms occurrence and severity on it.

22. Therapeutic Management of PMS • Based on symptoms after ruling out other problems • Varied dietary measures may provide relief • Vitamin B6(pyridoxine) 100 mg/day may be prescribed • Supplements of calcium(1200mg/day) have some effectiveness & Magnesium(200-400mg/day) is minimally effective. • Carbohydrates rich food & beverages may improve the mood and reduce food cravings in some women

23. Reducing caffeine & taking vitamin E(400IU/day) during luteal phase reduce breast pain (Mastalgia) • Antidepressant medications (Prozac) for women with physical ,emotional & cognitive symptoms . Oral contraceptives to suppress ovulation • Danazol relieves mastalgia and other PMS symptoms • Drugs to reduce anxiety

24. Nursing Considerations • 1.Complete History& physical examination • 2.Educate family about life style changes that may help • 3.Restrict salt and sweet foods • 4.Support from family

25. Menopause • Menopause means the end of menstruation .The entire process frequently called change of life , is correctly termed the Climacteric period.

26. Perimenopause includes: • 1.Premenopause: (irregular menses) early part of climacteric before mense ceases • 2.Menopause(end of mense ,range of age 45-50 years) • 3.At least one year after menopause Post menopause period after menoupause

27. Physiologic changes • During premenopuuse phase • Irregular menstrual cycle because ovaries are less responsive to gonadotropines • Decreased estrogen lead to • 1. Regression of reproductive tract organs: • Labia become thin and pale • Atrophy of vaginal mucosa • Decreased lubrication of vagina • Dysparunea • Frequent vaginal infection(atrophic vaginitis) • Atrophy of bladder and urethra(atrophic Cystitis) • Atrophy of breast ,uterus andovaries

28. 2. increased low density lipoprotein and decreased high density • 3. Hot flashes and flushes from vasomotor instability which mostly occurs at night and leads to sleep disturbances • 4.Psychologic response • Grieve • Depression mood swings and irritability and agitation • Insomnia and Fatigue

29. Therapy for Menopause • HRT include estrogen and progesterone • ERT only estrogen • Contraindication for HRT • Breast cancer • Blood coagulation disorders • Smoking, hypertension,DM ,CVS, renal and liver disease

30. Nursing Considerations • Teach woman about benefit and side effect of hormone replacement therapy. • Helping woman understand the response • Promote comfort: • 1.Using water soluble lubricants to relieve vaginal dryness and dyspareunia • 2. Drinking at least 8 glasses of water • 3.Kegel exercise • 4. Wiping from front to back