Hormone Regulation In-Class Notes PDF

Concept Reproduction & Hormone Regulation EXEMPLARS: SEXUAL DYSFUNCTION, UTERINE DYSFUNCTION, INFERTILITY & MENOPAUSE Sarah Ball Ph.D., RNC-OB, C-EFM Objectives: Define sexual health Discuss factors associated w...

Concept Reproduction & Hormone Regulation EXEMPLARS: SEXUAL DYSFUNCTION, UTERINE DYSFUNCTION, INFERTILITY & MENOPAUSE Sarah Ball Ph.D., RNC-OB, C-EFM Objectives: Define sexual health Discuss factors associated with and consequences of sexual dysfunction for males and females. Describe the causes, evaluation and treatment of menstrual disorders. Student will identify and describe the physiologic and physical changes and characteristics during the Perimenopausal period Student will be able to summarize three key precautions a patient should be educated on during hormone replacement therapy  Sexual Health “State of physical, emotional, mental & social well-being in relation to sexuality” Have a positive & respectful approach to sexuality & sexual relationships – Knowledge about sexuality and sexual behavior – Ability to express one’s full sexual potential – Ability to make autonomous decisions about one’s sexual life – Sexual pleasure as a source of physical, psychological, cognitive, and spiritual well-being – Ability to express sexuality through communication, touch, emotional expression, and love – Right to make reproductive choices – Ability to access sexual health care Why is Sexual Health Important? Effects Morbidity and Mortality To understand the prevalence of sexual dysfunction Dysfunctions may indicate disease, be side effects of medications, treatments. Association of sexual history with current medical problem Association of sexual health with happiness and overall health Primary Prevention Outcomes Maintain or enhance sexual health Increase knowledge and understanding Health Promotion Enhance satisfaction Enhance self-concept Decrease high-risk behaviors Prevent STIs Prevent Unwanted Pregnancy Assessment Establish confidentiality Non-judgmental Understand patient’s expectations Integrate cultural sensitivity Clarity with terminology Assess patient’s understanding and knowledge level  Barriers to Assessing or Talking about Sexual Health Embarrassed Fear Lack of knowledge Lack of awareness of the prevalence of sexual dysfunction Unclear values or belief system Belief that sexual history is not pertinent to health problems. Assessment Questions Are you sexually active? With whom do you have sex: men, women, or both? How many sexual partners do you have (or have you ever had)? How do you feel about the sexual aspects of your life? Have you noticed any changes in the way you feel about yourself? How has your illness, medication, or surgery affected your sex life? It is not unusual for people with your condition to be experiencing some sexual changes. Have you noticed any changes, or do you have any concerns? Are you in a relationship in which someone is hurting you? Has anyone ever forced you to have sex against your will? Tell me what you know about safe sex practices, use of contraceptives, or prevention of sexually transmitted infections. Tell me the safe sex practices that you follow.  Assessment Questions Cont. Do you have any other sexual questions or concerns that I have not addressed? Physical examination – Routine part of physical in some organizations – Performed if previous exam was 12 months or longer – Note * Suspicion of infertility, pregnancy, STI or requesting contraception Reports of discharge, change in shape or size, presence of lump Change in urinary function Screening Pap smear Anatomic & Hormonal Events Estrogen (endogenous estradiol) Progestin (endogenous progesterone) Luteinizing (LH) Follicle-stimulation hormone (FSH) Produced by: WOMEN Ovaries-produces Estrogen known as ”estradiol”, Peripheral Tissue-convert “Estradiol” to less potent “Estrone” & “Estriol” Placenta-during pregnancy Estrogens MEN Testes- convert small amount of Testosterone to Estradiol & Estrone Peripheral Tissues-convert testosterone to estrogen production Physiologic Effects of Estrogen Hormone needed for: – Growth and maturation of female reproduction – Conception – Bone Health blocks bone resorption promotes deposition – Heart Health d/t metabolism in liver amount of cholesterol excreted in bile lowers LDL cholesterol increases HDL – Coagulation Promotes by increasing Factors II, VII, IX, X, XII Suppresses by decreasing antithrombin Progesterone WOMEN- secreted by ovary- corpus luteum Hormone needed for: Proliferate endometrium to maintain pregnancy. During pregnancy progesterone suppress smooth muscle of uterus and GI tract Causes epithelium in breast tissue to divide and grow Suppress CNS system and pituitary gonadotropins ❖ Common Side Effects: breast tenderness, bloating and depression MEN- secreted by adrenal glands and testes Hormone needed for: Precursor to testosterone/ Masculinity Reproductive Conditions  Sexual Dysfunction (SD) Women: As many as 40% of women in America suffer from SD Physiological factors: diabetes, neuropathy, paralysis, hormones Psychological factors: stress, anxiety, depression, anger Men: Physiological Factors: erectile dysfunction, ejaculatory disorders, diabetes Prostate surgery can affect ejaculatory function Antihypertensive medications Psychological factors: stress, antidepressants Consequences of SD Physiological – Unfulfilled sexual desire, unsatisfactory sexual responses, pain, STI infection, inability to create pregnancy Psychosocial – Problems with relationships, low self-esteem, anxiety, depression Population at Risk for SD Adolescents Disabilities: Cognitive, Developmental & Physical Newly unpartnered Sexual orientation Illness & Medications affecting Sexual Function ILLNESS MEDICATIONS Diabetes mellitus Antihypertensives Cancer Antipsychotics – Prostate, Breast, Colon, Ovarian Antidepressants – Testicular, Rectal Antianxiety Neuropathy Diuretics Spina Bifida Oncological agents Unstable Angina Recreational or illicit drugs Uncontrolled Hypertension HIV Substance abuse Depression Reproduction: Normal Menstruation – periodic uterine bleeding that begins approximately 14 days after ovulation – Controlled by the feedback system of three cycles: hypothalamic – pituitary; ovarian and endometrial – Usually occurs every 28 days and lasts 5 days  Reproduction Abnormal Amenorrhea – Absence of menstrual flow – Management depends on cause Primary – Laboratory studies determine hormone abnormalities & any genetic condition – Treat underlying disorder and hormone replacement therapy Secondary – Laboratory studies evaluation of thyroid stimulating hormone or prolactin levels – Treatment may include hormone replacement therapy or corrective procedure such as surgical removal of pituitary tumors  Reproduction Abnormal Dysmenorrhea – Pain during or shortly before menstruation Primary – Painful menstruation associated with the release of prostaglandins in ovulatory cycles Secondary – Related to pelvic pathologic conditions. – Manifests later in reproductive years and may occur any time in the menstrual cycle  Reproduction Abnormal Dysmenorrhea Management Primary – Hormonal contraceptives and nonsteroidal anti-inflammatory medications – Regular exercise, diet changes, heat massage, and relaxation such as yoga Secondary – Remove underlying pathology – Same pain relief measures as primary dysmenorrhea Alterations in Cyclic Bleeding Oligomenorrhea: – cycles longer than 5-6 weeks – Management with hormonal therapy Metrorrhagia: – intermenstrual bleeding – Assess if OCP taken at same time day or change RX Menorrhagia: – excessive bleeding in amount or duration – Management depends on cause. Dysfunctional Uterine Bleeding: – excessive uterine bleeding with no demonstrable cause – Management different possible treatments from RX to surgery With all what is an assessment to consider? Premenstrual Syndrome (PMS) Premenstrual Dysphoric Disorder (PMDD) Pathophysiology –result of abnormal tissue response to the normal changes of the menstrual cycle – exact mechanism is unknown Clinical Manifestations – Pattern of symptom frequency and severity of over 100 physical, emotional, and behavioral symptoms – Symptoms include fluid retention, behavioral/emotional changes, premenstrual cravings, headache, fatigue, backache Premenstrual Syndrome (PMS) Premenstrual Dysphoric Disorder (PMDD) Management – Lifestyle changes often effective—allow a woman with PMS to exert control over her life Not smoke Limit consumption of refined sugar, salt, red meat, alcohol, caffeine – Nutritional supplements – Selective serotonin reuptake inhibitors – NSAIDs – Combined hormonal treatment Endometriosis Characterized by the presence and growth of endometrial glands and stroma outside of the uterus Can cause infertility, pelvic pain, dysmenorrhea, abnormal vaginal bleeding Polycystic Ovary Syndrome (PCOS) Most common endocrine disturbance affecting women – leading cause of infertility Multiple cysts form on one or both ovaries & produce excess estrogen Clinical manifestations: – Obesity – Hirsutism – Irregular menses or amenorrhea – Infertility Polycystic Ovary Syndrome (PCOS) Diagnosed – Often in adolescence when symptoms appear Treatment – Combined oral contraceptives to control irregular menstrual cycles; – Insulin sensitizers may be used to decrease insulin resistance, Goal – Prevent diabetes and heart disease – Restore fertility  Menopause Ovarian Follicles decline Estrogen declines Symptoms Menopause: Hormone Replacement Therapy Benefits Suppress symptoms #1 Reason used Prevent osteoporosis Prevent urogenital atrophy Prevent colorectal cancer *Last 3 use other treatments then HRT’s with potential adverse effects Menopause: Hormone Replacement Therapy Risks Heart Disease Stroke Deep vein thrombosis, Pulmonary embolism Cancers; breast, ovarian, uterine, lung Gallbladder disease Urinary incontinence Individual Risk Profile Assessment (pg 113) Do the benefits outweigh the risks? Approved Indications of Estrogen MHRT Treatment of moderate to severe vasomotor symptoms Treatment of moderate to severe symptoms of vulvar & vaginal atrophy Prevention of postmenopausal osteoporosis *Consider alternative therapies *Minimize adverse effects by assessments Estrogen & Progesterone Routes of Administration Oral-Convenient, Transdermal-absorbed from skin directly to bloodstream Intravaginal- for local & systemic effects Parenteral- acute/ emergency Therapeutic Use or Clinical Application of Estrogen Contraceptive Non-contraceptive – Menopausal Hormone Therapy – Female Hypogonadism (absence of ovarian estrogen) – Turners Syndrome – Acne Physiologic and Pharmacologic Adverse Effects of Estrogen Endometrial Hyperplasia/Cancer Breast Cancer Ovarian Cancer Cardiovascular Events Nausea Other: gallbladder dz, jaundice, headache & chloasma  Therapeutic Use or Clinical Application of Progesterone Progestins compound that acts like progesterone, the endogenous progesterone hormone. Contraceptive Non-contraceptive – Counteract the adverse effects of hormone therapy of estrogen on the endometrium by suppress endometrial hyperplasia – Amenorrhea – Infertility d/t inadequate corpus luteum – Hormone-induced migraine headaches – Reduces fluid retention associated with premenstrual cycle – Preterm Labor- Hydroxprogegesterone Acetate Physiologic and Pharmacologic Adverse Effects of Progesterone Teratogenic effects on fetus-high doses Gynecologic effects –breakthrough bleeding Breast Cancer Risk- when combined with estrogen in postmenopausal women  Estrogen & Progesterone as Contraceptives Mechanism of Action: inhibit ovulation by suppressing both the Pituitary from releasing FSH and the Hypothalamus from releasing LH= no ovulation Personal Preference + Consistency=Effectiveness Effectiveness can decrease when: Not taken as scheduled Antibiotic interaction Overweight  Pharmacologic Education Drug Schedule Drug Interaction Most Combination 28-day cycle Rifampin(tb) 21 day start with first Ritonavir (HIV) day=protected Antileptics 21 day start on Sunday =NEED St. John Wart protection first month Antibiotics Prolong Use- increase thrombosis especially smokers Need to change dose or second protection Surgery- stop 4 weeks prior Pregnancy- stop immediately Progestin Only- less effective Education of Effects with Other Medications Medication Metabolism Complication/Effects Other Medication Effects Potential impairment r/t hepatic metabolism Warfarin can clearance of following drugs: Hypoglycemia Agents Theophylline (oral and insulin) Tricyclic antidepressants Diazepam Nurses Action: Chlordiazepoxide May need to dose of medications Nurse Action: Know S&S of toxicity May need to dose of these medications Nursing Diagnosis Nursing Diagnosis relating specifically to Sexuality – Ineffective Sexuality Pattern – Sexual Dysfunction Other Nursing Diagnosis – Knowledge deficit – Interrupted family processes – Ineffective Coping – Pain – Anxiety – Fear – Disturbed Body Image – Risk for other or self-directed violence – Social Isolation Nursing Interventions Begins with Knowledge – Sexual Development across the lifespan – Sexual Orientation, Gender Roles, Gender Identity Therapeutic Relationship Attitude – Curiosity to explore a patient’s behavior, manner or response – Integrity- ok to admit varying beliefs – Be willing to explore sexual issues and concerns with patient Provide privacy Give clients privacy to meet sexual needs alone or with a partner within physically safe limits Knowledge of Illnesses and Medications that affect Sexual Function Nursing Interventions:Health Promotion Sex Education Teaching self-examinations – Self-breast examination – Testicular self-examination Responsible sexual behavior – Prevention of sexually transmitted infections – Prevention of unwanted pregnancies – Avoidance of sexual harassment or abuse