Menstrual Cycle and Discomfort

Menstrual Cycle Concerns

• Amenorrhea is the absence of menstrual flow.
• Pregnancy will most likely result in amenorrhea.
• Assessments includes history and examinations.
• Hypogonadotropic amenorrhea is a problem is the central hypothalamic-pituitary axis causing hypothalamic suppression.
• Stress, exercise, and weight loss can be improved with counselling and patient education.

Cyclic Perimenstrual Pain and Discomfort (CPPD)

• CPPD was developed by a research team at AWHONN.
• CPPD includes dysmenorrhea, premenstrual syndrome (PMS) and premenstrual dysphoric disorder.
• CPPD can significantly impact on quality of life for women.

Dysmenorrhea

• Dysmenorrhea includes pain during or before menstruation.
• Dysmenorrhea is the most common gynecological problem in women of all ages.
• Primary dysmenorrhea includes abnormally increased uterine activity and physiological alteration.
  • Symptoms can be alleviated with nonsteroidal anti-inflammatory drugs.
• Secondary dysmenorrhea includes menstrual pain acquired later in life after age 25 associated with pelvic pathology.
  • Diagnosis and treatment includes pelvic examination, ultrasound examination, dilation and curettage, endometrial biopsy, laparoscopy, and treatment directed at removal of underlying pathology

Premenstrual syndrome (PMS)

• PMS includes cyclic symptoms occurring in the luteal phase of menstrual cycle.
• PMS symptoms include physical, mood, and behavioral symptoms which are poorly understood.
• 85% of women experience PMS symptoms and 5-14% report disabling symptoms.
  • Treatments include diet, exercise, and herbal therapies.

Premenstrual dysphoric disorder (PMDD)

• PMDD includes cyclic symptoms occurring in last 7-10 days of the menstrual cycle.
• PMDD is a severe variant of PMS with emphasis on mood affectation.
  • Treatment includes counselling, medication, and alternative therapies such as hypnosis and acupuncture.
• 3 - 8% of women get PMDD.
• Severe mood shifts in PMDD includes both psychiatric and medical syndrome.

Endometriosis

• Endometriosis exists when endometrial is present outside of the uterus.
• Symptoms include pelvic pain, dysmenorrhea, and deep pelvic dyspareunia (painful intercourse).
  • Treatment includes drug therapy and surgical intervention.
• Adhesions on/around the uterus and fixed retroverted position of uterus contribute to infertility in severe cases.
• Endometriosis has a familial link.

Alterations in cyclic bleeding

• Alterations includes oligomenorrhea (very few periods of bleeding), metrorrhagia (abnormal/irregular), and menorrhagia (hypermenorrhea).
• Abnormal uterine bleeding also referred to as Dysfunctional Uterine Bleeding (DUB) includes O pelvic pathology, perimenopause, and menopause.

Toxic Shock Syndrome

• A staph infection is causing coagulation defect and is rare can can cause death.
  • Caustive factors include: Diaphragm / cervical caps (6-8 hours only) and tampons

Vaginal Infections/Candidiasis

• Vulvovaginal candidiasis, or yeast infection, is the the most common type of vaginal infections, and the most common organism is Candida albicans.
  • Common symptoms include vaginal pruritis.
• Diagnosis and screening includes physical examination, vaginal pH

Management of Vaginal Infections/Candidiasis

• Over the counter agent
• Methods of comfort

Factors effecting pre-disposal

• Antibiotic therapy
• Diabetes
• Pregnancy
• Obesity
• Diets high in refined sugars
• Use of corticosteroids
• Immunosuppressed states

Bacterial Vaginits

• bacterial vaginosis syndrome in which normal H2O2-producing lactobacilli are replaced with high concentrations of anaerobic bacteria.
  • Thin;gray;white or green vaginal discharge
  • Foul-smelling; fishy vaginal odor; especially after intercourse
  • Possible; some vaginal itching; burning during urination and Up to 84% of women have no symptoms
• Treatment: OTC remedies, Metronidazole*, Clindamycin*

Sexually Transmitted Infections(STIs)

• STIs include more than 30 infectious organisms transmitted sexually.
• STIs cause personal and financial burdens.
  • Prevention includes change in behaviours, identification of risk factors and techniques for effective counseling using safer sex practices.
    • Knowledge of partners STI Status.
    • Condom Use including male compliance, negotiation of use, and female condom.
    • Abstinence from Activities with Fluid Exchange and avoidanal-oral, anal-genital intercourse, anal-digital activites, direct contact with lesions and practices that increase tissue damages.

Sexually transmitted bacterial infections.

• Most common and fastest-spreading STI is Chlamydia.
  • Infections are often often silent and highly destructive and hard to diagnose.
    • Screening includes asymptomatic and pregnant women and comparisons of diagnostic procedures with drug therapy.
• Second most common STI is Gonorrhea.
  • Women are often asymptomatic.
  • Symptoms menstrual irregularities and rectal complications.
  • Treatment includesantibiotic therapy.
  • Transmission with neiserria gonorrhoae includes genital -genital, oral - genital, anal - genital, vagina - rectum. Syphilis-Treponema Pallidum
• It is a motile spirochete
  • Transmission is by entry in subcutaneous tissue through microscopic abrasions that can occur during sexual intercourse.
  • Also transmitted kissing, biting, or oral-genital sex.
  • Transplacenta transmission may occur any time during pregnancy.

Syphilis

• Syphilis leads to serious systemic disease and even death.
  • Infection manifests itself in distinct stages,

Syphilis Stages

• Primary: 5-90 days
  • Pailless chancre shores appear at the site of infection can include mouth; anus; rectum vagina penis
    • Its easily cured with penicilin
• Secondary: 6 weeks to 6 months
  • Includes sore through; fever and swollen lymph glands. headaches, fatigue, muscle aches, wart-like patches around skin folds, genitals and loss of Appetite.

Diagnosis & Management of Syphilis

• Screening includes pregnant women, serological tests and false positives.
• Management includes penicillin and sexual abstinence during treatment.
• Congenital Syphilis may occur following vertical transmission of T.pallidum from infected mother to featus in utero.
  • Neonates may be infected during passage through the infected birth canal during delivery.
    • Deformed Bones
    • Severe Anemia
    • Enlarge Liver and Spleen
    • Jaundice
    • Brain and nerve problems (Blindness and Deafness)
    • Skin rashes

Pelvic Inflammatory Disease (PID)

• PID is single most frequent serious infection encountered by women.
• Results from ascending spread of microorganisms from vagina and endocervix to upper genital tract
  • Includes high risks of ectopic pregnancy, inferlity, persistant pelvic pain as well as prevention, history, criteria for diagnosos, histpitaltion and education, acute, subacte and chromic symptoms depending on type of infection.

Sexually transmitted viral infections

• Sexually transmitted viral infections.
• Human papilomavirus (HPV).
  • Most prevalant viral.
  • STI seen in ambulatory health care settings.
    • Screening and diagnosis with History of known exposure. Physical inspection.

Management of HPV

• Screening and diagnosis includes History of Known Exposure, Phiscal inspectipn and Pap Smear.
• Management includes. No therapy has been shown to eradicate at; Medication's for Discomfort and Counseling and education.
• Herpes Simplex Virus (HSV)- Includes Herpes Simplex Virus 1 and 2. The formmer is usually transmitted Non sexually and the latter sexually.

HSV

• The Management is a Chronic, Reccuirng disease With No Cure.
• Management Directed toward Specific Treatment During Infection, Prevention, self help measures and paycho logical support,
• Initial infection is characterized by Multiple Painful Lesions
  • Also Fever chills; malaise; and severe dysuria
  • Recurrent Episodes Commonaly have only local symptoms Association with

Viral hepatitis

• Hepatitis B virus (HBV) is sexually transmitted.
  • It is most threatening to fetus and neonate.
  • Is disease of liver; often a silent infection
    • Transmitted parenterally, perinatally, orally (rarely), and through intimate contact Vaccination series.
• Hepatitis C (HCV) is mainly a blood-borne infection that is also sexually transmitted. - the Most common blood-borne infection becoming a major public health problem worldwide. - 250,000 people are considered infected in Canada. - Risk factor for pregnant women is history of injecting intravenous drugs.

Human Immunodeficiency Virus (HIV)

• Human Immunodeficiency Virus (HIV) occurs 25 % more in women through heterosexual Transmissions.
• HIV occurs Primarly Through The exchange of body fluids
• Symptoms include includes fever, headache, night sweats, malaise, generalized lymphadenopathy, myalgias, nausea, diarrhea, weight loss, sore throat, and rash.

Diagnosis & Management of HIV

• Screening and diagnosis with Antibody testing
• Prevention is Key
• Counseling for HIV testing is offered early in pregnancy and Rapid testing is the preferred method.
• Perinatal transmission has decreased as Nurses must consider confidentiality and documentation. - Cesarean delivery if labs shows level of HIV is high. - Admin of anti-HIV drugs during labor and delivery as needed to infant post delivery and don't breastfeed.

Distinguishing Between Bacterial and Viral STIs

• Bacterial STIs, such as Chlamydia, gonorrhea, and syphilis, can be treated and cured with antibiotics
• Viral STIs, such as genital warts, HIV, and herpes cannot be cured but symptoms can be managed and controlled.
• Health Promotion includes Disease Prevention is Primary Strategy with patient through health promotion education.
• Education assistance with decreasing the instances of outbreak or transmission to others