Chapter 74 Gynecological Disorders

• one of the most common gyno problems
• occurring in teens and early 20s
• Occurs when Ovulation is established

• Painful Uterine cramping with spasmodic lower abdominal pain that begins with the onset of menstrual flow and lasts 12-48 hours
• The pain radiates to the lower back and thighs
• N/V, fatigue and nervousness may occur with the pain.

• Postaglandin synthetase inhibitors
•      ibuprofen, (NSAIDS), naproxen
• Oral Contraceptives (suppress ovulation)
• Complementary and alternative therapy
•       Acupressure, aerobic exercise, swimming, application of heat or cold, massage, biofeedback and relaxation

• A collections of symptoms that are cyclic in nature
• Affects women 30-40
• Severity increases with aging until menopause

• Emotional Sypmtoms: irritability, easily precipitated crying spells, low self esteem, anxiety and depression
• Physical Manifestations: breast tenderness, bloating, fluid retention, increased appetite and food cravings, insomnia, fatigue, hot flashes, headaches and musculoskeletal discomfort
• Cognitive Problems: short-term memory problems, difficulty concentrating and unclear thinking

• most effective assessment is to have women keep a menstrual chart
• instruct to keep for 3 months, showing length of cycle, duration of bleeding and occurrence of symptoms
• If woman has PMS symptoms will occur during the luteal phase (ovulation to menstruation). Symptom free period is at least 7 days.

Management is focused on eliminating the pts own unique symptoms

NSAIDS, antidepressants, oral contraceptives, decreased caffeine in the diet

end on menses until the ovulation

Absence of menstrual periods

menstruation that has failed to occur by age 16

Relatively uncommon and is associated with congenital factors caused by ovarian, endometrial functions, and anatomy

If there are no other signs of puberty, the primary amenorrhea could be Hormonal

If pt has gone through puberty in every other way she may have a structural anomaly.

menstruation that started but has stopped and has not returned for at least 3 months

• Pregnancy
• Lactation
• Menopause

thorough medical and ob history as well as surgery history (Hysterectomy?)

• stress, strenuous exercise or anorexia (low body fat), some meds (antidepressants)
• pregnancy, breast feeding, menopause

based on the causes

• Manifestation not disease
• vaginal bleeding that occurs after 12 month cessation of menses after the onset of menopause
• Gynecologic Cancers occur in 20-40% of these women
• Never Normal to Have Postmenopausal Bleeding!!

• Atrophic Vaginitis
• Cervical Polyps
• Endometrial Hyperplasia

vaginal mucosa is thin and dry and easily traumatized by intercourse and infection causing spotting

usually soft, red, oval tissue masses that appear within the cervical canal.

Benign but bleed very easy, Need to be removed

• tissue overgrowth
• bleeding caused by declining ovarian function that leads to prolonged estrogen stimulation producing the hyperplasia that eventually breaks down and bleeds

• assess risk factors
• menstrual history and family hx
• clients age at menopause
• frequency and amount of bleeding
• previous bleeding episodes
• GI or GU symptoms
• H&H, urine and stool samples
• Start with things like R/O rectal Bleed

managed by the use of Estrogen via the vagina evaluate for HRT

hystorectomy

• usually a benign problem of endometrial tissue implantation outside the uterine cavity.
• Manifestations include pain, dyspareunia, painful defecation, sacral backache, hypermenorrhea and infertility
• most common: pain before the onset of menstrual flow

endometriosis that implants and grows around the ovary

scarring and adhesions that exacerbates the problem

pregnancy and menopause

pain and infertility

it is on the bowel and under the diaphragm

Laparoscopy

• Mild analgesics and NSAIDS for pain relief
• Hormonal therapies to suppress ovulation (Danocrine, Cyclome, Lupron) DO NOT TAKE FOR LONGER THAN 8 MONTHS

• application of heating pad to the abdomen or sacrum
• relaxation techniques
• yoga
• biofeedback

• Laparoscopic removal of the endometriosis and adhesions
• Removal of the uterus if fertility is not an issue

• Nonspecific term used to describe bleeding that is excessive or abnormal in amount or frequency without predisposing anatomic or systemic conditions (>80ml per menstrual cycle)
• Usually around 30 very heavy bleeding w/o specific Dx

• hot flashes
• headache
• night sweats
• insomnia
• anxiety
• short term memory loss
• decreased concentration
• osteoporosis
• depression

• freeze or burn the endometrium
• saves the uterus but not the fertility
• Patient wont have periods uterus could not stand pregnancy
• (if spot is missed, can have spotty bleeding irregular times)

• Dilation and Curettage (not as commonly used these days)
• Endometrial Ablation
• Hysterectomy

pt goes 12 consecutive months without a period

inflammation of the lower genital tract which results when there is a disturbance of the balance of hormones and bacterial interaction in the vagina.

• result of menopause
• Trichomonas vaginalis (treat Abx)
• Yeast
• changes in normal flora (good bacteria)
• foreign bodies
• chemical irritants
• diabetes

• topical hydrocortisone to treat the itching
• assess for irritants
• treat with Abx if infection is cause
• laser therapy if severe

• caused by microabrasions related to tampon use
• Staph produces toxin
• abrupt onset of high fever, fever, headache, sore throat, vomiting, diarrhea, generalized rash, and hypotension

• Vancomycin
• PCN
• Teach good hand washing
• Change tampon frequently
• avoid super absorbent
• CDC reportable disease

stages of uterine prolapse are described by the degree of decent

• Kegel Exercises (may prevent)
• Pessaries (simple ring inserted in vagina
• Surgery (hysterectomy with the repair of the vagina and surrounding tissue)

• dyspareunia
• backache
• pressure in the pelvis
• bowel or bladder problems

• child birth large babies
• obesity
• multiple pregnancies
• weakening of pelvic support due to lack of estrogen
• age-gravity

• protrusion of the bladder through the vaginal wall due to weakened pelvic structures
• difficulty empting bladder
• urinary frequency and urgency
• Stress urinary incontinence

• pelvic scan
• post void residual (most accurate)
• bladder scan

protrusion of rectum through a weakened vaginal wall

• Myomast (fibroids) that are benign
• They develop in the Myometrium
• risk increases with age
• Etiology not really known
• Usually no pain only seek help because the heavy bleeding

• assess for anemia
• uterine artery embolization
• Myomectomy
• hysterectomy (leimyomas are the most common reason for hysterectomy)
• If not too large physician may watch if patient wants to become pregnant

• pedunculated tumors on stalks arising fro the mucosa and extending to the opening of the cervix
• removal is simple office procedure
• blled very easy if touched

• reproductive cancer (most common GYN cancer)
• main symptom is postmenopausal bleeding
• usually Dx in women  and older
• Growth typically slow

• Transvaginal US
• endometrial biopsy
• once Dx is made testing for metastasis is done

• total abdominal hysterectomy
• stage II Radical Hysterectomy with bilateral pelvic lymph node dissection remove appendix and check bowel
• radiation may be scheduled for stage I or II
• Will have NG to wall suction

• client often asymptomatic
• classic symptom painless bleeding
• leg pain, flank pain
• later unexplained weight loss, pelvic pain, dysuria, hematuria

HPV causes most cervical cancers

• repeat pap
• colposcopy
• endocervical curettage biopsy

• LEEP
• local ablation using Loop Electrosurgical Excision Procedure

radiation or chemo

• most are epithelial tumors that grow on the surface of the ovaries
•  grow rapidly and spread quick
• more people die from this than any other reproductive cancer