Reproductive Health Disorders: Study Guide

Reproductive Health and Disorders: Study Notes

• This self-study focuses on pharmacology and nursing interventions for reproductive health disorders.
• Key areas explored include endometriosis, menopause, benign prostatic hyperplasia, and erectile dysfunction.

Endometriosis Interventions

• Treatment approaches are tailored to the patient's unique circumstances and wishes.
• Influencing factors for endometriosis treatment include the patient's age, desire for pregnancy, symptom severity, and disease extent/location.
• Rapid treatment escalation occurs if the patient is in assessment due to infertility issues.

Endometriosis Drug Therapy

• Drug therapy focuses on managing the condition rather than curing it.
• Pain management includes using NSAIDs like diclofenac (Voltaren).
• Estrogen production can be inhibited to shrink endometrial tissue.
• Progestin (such as medroxyprogesterone) can suppress ovulation.
• Adverse effects of Danazol (Cyclomen) can include weight gain, acne, hot flashes, hirsutism, and high cost.

Endometriosis Hormonal Treatments

• Hormonal contraceptives manage hormones responsible for endometrial tissue buildup.
• Hormonal contraceptives, especially continuous cycle regimens, help reduce/eliminate pain associated with mild to moderate endometriosis.
• Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists lower estrogen levels and prevent menstruation, causing endometrial tissue to shrink.
• Progestin-only contraceptives may halt menstrual periods and endometrial implant growth.
• Danazol blocks ovarian-stimulating hormones, preventing menstruation and symptoms; serious side effects and potential harm to a developing baby cause Danazol to not be the first choice.

Endometriosis Surgical Interventions

• Diagnostic laparoscopy definitively diagnoses the condition and removes lesions.
• Surgical options involve removal of the uterus (hysterectomy), fallopian tubes (salpingectomy), ovaries (oophorectomy), and endometrial implants.

Menopause Overview

• Menarche: the 1st menstrual cycle, happens around age 12-13, peak fertility.
• Perimenopause: the period around 8-10 years before menopause when estrogen is steadily declining and symptoms begin to occur.
• Menopause: ovaries stop releasing eggs, the average age is 51, there hasn't been a period for 12 consecutive months.
• Postmenopause: years following menopause, estrogen levels decline steadily.

Menopause Collaborative Care: Drug Therapy

• Hormone therapy (estrogen) is used for those without ovaries or estrogen, and progesterone for those with a uterus.
• Estrogen plus progestin increases the risk of breast cancer, stroke, heart disease, and emboli.
• Estrogen-only (Premarin) increases stroke and emboli risk, but reduces the risk for hip fractures and has no risk for heart disease, breast or colorectal cancer.
• HT therapy is considered when managing symptoms for less than 5 years, using the lowest effective dose for the shortest duration.

Menopause Collaborative Care: Adverse Effects

• Estrogen adverse effects: nausea, fluid retention, headache, and breast enlargement.
• Progesterone adverse effects: increased appetite, weight gain, irritability, depression, spotting, and breast tenderness.
• Estrogen common regime: daily dose that is increased for symptom relief
• Progesterone regime: given for 12 days of the momth on a cyclical or continuous regime.

Menopause Collaborative Care: Medications

• SSRIs like paroxetine (Paxil), fluoxetine (Prozac), venlafaxine (Effexor XR), or gabapentin (Neurontin) can decrease hot flashes.
• SERMs like raloxifene (Evista) may prevent bone loss.
• Biposponates are used to decrease osteoporosis risk like Fossamax (alendronate) and Risedronate (Actonel).

Menopause Collaborative Care: Lifestyle

• Lifestyle adjustments include avoiding fluctuations in body temperature, maintaining a cool environment, and limiting caffeine/alcohol.
• Loose clothing, relaxation techniques, and vitamin E may provide relief.
• Smoking cessation is recommended.
• Bone loss prevention: diet with calcium & vit D, and complex carbohydrates and vitamin B complex.

Benign Prostatic Hyperplasia (BPH) Collaborative Care Goals

• BPH collaborative care aims to restore bladder drainage, relieve symptoms, and prevent/treat complications.

Benign Prostatic Hyperplasia (BPH): Mild Symptom Management

• For mild symptoms, strategies include "watchful waiting," dietary changes, avoiding medications, restricting evening fluids, and timed voiding schedules.

BPH Drug Therapy: Alpha-Adrenergic Blockers

• Drug therapy often uses alpha-adrenergic receptor blockers.
• Tamsulosin (Flomax) is the most commonly used.
• These drugs promote smooth muscle relaxation in the prostate, facilitating urinary flow with improvement in 2 to 3 weeks.
• Side effects may include orthostatic hypotension, dizziness, retrograde ejaculation, and nasal congestion.

BPH Drug Therapy: 5-Alpha Reductase Inhibitors

• These medications inhibit type 2 isoenzyme.
• Finasteride (Proscar) reduces prostate gland size.
• Improvement takes roughly 6 months.
• Dutasteride (Duragen): inhibits type 1 & 2 isoenzyme, decreases libido and adverse effects include decreased volume of ejaculate, and erectile dysfunction.

BPH Minimally Invasive Therapies

• Transurethral needle ablation: radiofrequency is used offering greater precision.
• Transurethral microwave thermotherapy is an outpatient procedure using microwaves to destroy prostate tissue.
• Laser prostatectomy is also performed.

Benign Prostatic Hyperplasia (BPH): Invasive Therapy

• Transurethral resection (TURP): obstructing prostate tissue is removed using resectoscope inserted through urethra.
• TURP has excellent outcome with 80-90% success rate.
• TURP is relatively low risk
• Is performed under spinal or general anaesthesia and requires hospital stay

TURP

• Bladder is irrigated continuously with three-way catheter for first 24-36 hours to prevent mucus and blood clots.
• Complications include bleeding, clot retention, and dilutional hyponatremia.
• Patients must stop anticoagulants before surgery.

Benign Prostatic Hyperplasia (BPH): Post-Operative Care

• Postoperative care involves bladder irrigation to remove blood clots and ensure proper drainage.
• Antispasmodics such as Belladonna and Opium are administered postoperatively.
• Teach Kegel exercises.

Benign Prostatic Hyperplasia (BPH): Nursing Implementation

• Postoperative care includes observing for signs of infection and dietary intervention, and using stool softeners.
• Key instructions include managing incontinence, consuming 2 to 3 liters of fluids daily, recognizing signs and symptoms of UTI, preventing constipation, avoiding heavy lifting, and refraining from driving or intercourse as directed.

Erectile Dysfunction (ED) Collaborative Care

• Common treatments include oral drug therapy, vacuum constriction devices, intra-urethral devices, penile implants, and sexual counseling.

Erectile Dysfunction (ED) Drug Therapy

• Phosphodiesterase inhibitors: used to treat erectile dysfunction
• Sildenafil (Viagra) is the first oral drug treatment that causes relaxation of the smooth muscle in the corpora cavernosa permitting inflow of blood.
• Some drugs like vardenafil (Levitra) and tadalafil (Cialis) have longer durations of action.
• Sildenafil and tadalafil, under trade names Revatio® and Adcirca®, are also used to treat pulmonary hypertension.

Erectile Dysfunction (ED) Drug Timing

• Viagra onset time: 30 min duration: 4 hours
• Cialis onset time: 15 min duration: 36 hours
• Levitra onset time: 30 min duration: 5 hours

Infertility Testing

• Female testing includes ovulatory, tubal patency, and postcoital studies.
• Male testing focuses on disorders of the hypothalamic-pituitary system, testes and ejaculatory system.

Infertility Causes

• Male infertility can be related to infections, medication, radiation or substance use.

Infertility History

• Surgery, injuries, hot tubs, sexual practices, weight training, tight undergarments, and stress levels all can play a role.

Infertility Treatments

• IUI (intrauterine insemination): sperm is transferred with sperm from partner or donor.
• ART (artificial reproductive technology) is used to harvest and fertilize an oocyte, and then transfer the embryo to the uterus.
• Infertility causes emotional and financial strain.