TOPIC 4.
REPRODUCTIVE & SEXUAL CONDITIONS
MENSTRUAL DYSFUNCTIONS
DYSMENORRHEA (MENSTRUAL CRAMPS)
painful menstruation
Cause: release of prostaglandins causing smooth muscle contraction & pain in the uterus
Mild : no interference w/ normal activities)
Moderate : some interference
Severe : interference w/ majority of ADL
Primary Dysmenorrhea
Occurs in the absence of disease
Causes: Increased production of prostaglandins → uterine muscle contractions → ischemia & pain.
Secondary Dysmenorrhea
Occurs as a result of underlying reproductive system disorders
Example: Endometriosis, uterine fibroids, Pelvic inflammatory disease (PID), Ovarian cysts
Assessment Findings:
Lower abdomen cramping pain
“Aching, pulling” sensation of vulva & inner thighs
Pain radiating to lower back or thighs
Nausea or vomiting, Headache, dizziness
Fatigue, diaphoresis
Pallor (in severe cases)
Mild diarrhea (for some)
Mild breast tenderness
Abdominal distention
Therapeutic Management
Analgesics
NSAIDs (Nonsteroidal Anti-inflammatory Drugs)
Ibuprofen or Naproxen Sodium: inhibit prostaglandin synthesis.
Hormonal therapy
Regulate menstruation & reduce endometrial proliferation.
Warm compress to lower abdomen
Regular physical exercise, Balanced Diet
MENORRHAGIA
abnormally heavy menstrual flow
Causes
Estrogen-progesterone imbalance (anovulatory cycles) ; extreme proliferation of endometrium
Endometriosis
Anemia, Blod dyscrasia (clotting defect)
PID infections
Bleeding disorders
Breakthrough bleeding (Oral contraceptive & IUD use)
Uterine fibroids (leiomyomas)
Assessment Findings:
Blood loss >80 ml
Menstrual periods >7 days
Sanitary pads saturated < 1 hour
Therapeutic Management
Hormonal therapies:
Combined estrogen-progesterone
Progesterone during luteal phase to prevent proliferative growth
Tranexamic acid: Antifibrinolytic agent ; reduce bleeding
Iron supplements for anemia
METRORRHAGIA
A.k.a. intermenstrual bleeding.
irregular bleeding between menstrual periods
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Causes
Oral contraceptives
Vaginal irritation (infection)
↓ progesterone & endometrial sloughing (dysfunctional uterine bleeding , luteal phase defect)
Hormonal Imbalance
Uterine Abnormalities( Fibroids, Polyps , Adenomyosis or endometriosis
Malignancy or Precancerous Lesions
Endometrial, Cervical cancer
Assessment Findings
Irregular spotting or bleeding b/w menstrual periods
Bleeding after intercourse or menopause
Prolonged duration of bleeding
Possible pelvic pain or cramping
Signs of anemia if bleeding is prolonged (fatigue, pallor, dizziness)
Therapeutic Management
Hormonal Therapy
Antibiotics for infection
Iron Supplements for anemia
Evaluation of early signs malignancy
ENDOMETRIOSIS
abnormal growth of endometrial cells outside the uterus
Sites: ovaries, fallopian tubes, cul-de-sac of Douglas, pelvic peritoneum
Causes:
Retrograde menstruation:
Menstrual blood flows backward/reflux through the fallopian tubes into the pelvic cavity
Excessive endometrial production
Risk Factors:
Nulliparous
Hereditary/Familial tendency
Deficient immunologic response
Excessive estrogen production
Failed luteal menstrual phase
Assessment Findings
Uterus is displaced by tender, fixed, palpable nodules.
Palpable nodules in the cul-de-sac or on the ovary
Dysmenorrhea
Dyspareunia
Abnormal bleeding
Possible infertility
Therapeutic Management
Combined oral contraceptives
Danazol (Danocrine)
synthetic androgen; shrinks abnormal tissue
Leuprolide acetate (Lupron)
GnRH agonist
Reduce estrogen ; lessen endometrial tissue growth
Laparotomy w/ excision by laser surgery
PREMENSTRUAL DYSPHORIC DISORDER
Severe form of premenstrual syndrome (PMS)
Occurs 1–2 wks. Before menstruation
Cyclic, recurring emotional, behavioral & physical symptoms interferes w/ daily life, work & relationships.
Exact cause :unknown
Causes:
Hormonal fluctuations
Neurotransmitter changes (serotonin)
Vitamin B- deficiency
Genetic or psychosocial factors
Poor renal clearance (water retention )
Hypoglycemia ↑ epinephrine
↓calcium levels
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Assessment Findings:
Emotional/ behavior
Mood swings, irritability, anger
Anxiety, tension
Depression, hopelessness, tearfulness
Difficulty concentrating
Social withdrawal
Physical
Fatigue, muscle or joint pain
Abdominal bloating, weight gain
Headache or migraines
Appetite disturbance
Therapeutic Management
Exercise, stress reduction
↑ vitamins, calcium
Limit caffeine, salt, sugar & alcohol
Adequate sleep
SSRIs (Selective Serotonin Reuptake Inhibitors)
Paroxetine (Paxil)
Anti depressant
Oral contraceptives
NSAIDs
MENOPAUSE
Cessation of menstruation
45 - 55 y/o (average 50)
Causes:
Decline in ovarian function :
↓ Estrogen & progesterone
Cessation of ovulation
End of reproductive capability
Stages of Menopause
1. Perimenopause (Climacteric Phase)
2. Transitional phase
Begins years before menopause.
Ovarian function starts to decline.
Irregular menstrual cycles, hormonal fluctuations.
3. Menopause
Absence of menstruation 12 consecutive months.
4. Postmenopause
Period after menopause.
Symptoms of menopause may continue.
Risk increases for osteoporosis, heart disease, etc.
Assessment Findings
Hot flashes, Night sweats
Palpitations
Fatigue
Headaches
Osteoporosis, Joint & muscle pain
Mood swings, Anxiety or depression
Poor memory or concentration
Vaginal dryness, Dyspareunia (pain during intercourse)
Decreased libido
Therapeutic Management
Hormone replacement therapy
Lubricating jelly (ky jelly) →vaginal dryness
Low-dose estrogen or testosterone (↑sexual libido)
Balanced diet
Intake of calcium & vitamin D (prevent osteoporosis)
Regular exercise
Lifestyle modification
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UTERINE DISORDERS
UTERINE FIBROIDS
A.k.a. Uterine leiomyoma, uterine myoma, fibromas
Benign (non-cancerous) tumors
Develop from smooth uterine muscle tissues
Women of reproductive years
Causes/ Risk Factors
↑ female steroid hormones (Estrogen , progesterone)
Genetic predisposition
Early menarche
Nulliparity
Types:
1. Intramural: w/in muscular wall(myometrium)
2. Subserosal: beneath outer layer of the uterus
3. Submucosal: beneath inner lining (endometrium)
4. Pedunculated: attached by stalk inside or outside uterus
Assessment Findings:
Heavy , prolonged menstrual bleeding (menorrhagia)
Lead to Iron Deficiency Anemia
Pelvic pain or pressure
Lower back pain
Dysmenorrhea
Dyspareunia
Frequent urination
Constipation
Abdominal bloating/fullness
Infertility or recurrent miscarriage ( some cases)
Diagnostic Tests
Transabdominal or Transvaginal UTZ
Hysterosonography
Hysteroscopy
Endometrial Biopsy
Therapeutic Management
NSAIDs
Hormonal Therapy
Gnrh Agonists (E.G., Leuprolide)
Temporarily Shrink Fibroids
Induce Pseudo-Menopausal State
Iron Supplements
Surgical Management
Hysteroscopic or Abdominal Myomectomy
▪ Surgical removal of fibroids; preserves uterus
Hysterectomy
UTERINE CANCER (ENDOMETRIAL CANCER)
Malignant growth of cells of the uterus
Common: endometrium lining
Causes /Risk Factors
Excessive estrogen
Obesity
Nulliparity
Early menarche / late menopause
Postmenopausal women (>50 y/o)
Diabetes & hypertension
Family hx of cancer
Tamoxifen use for breast cancer
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Assessment Findings
Abnormal uterine bleeding (early sign)
Postmenopausal bleeding
Dyspareunia
Pelvic pain or pressure (late sign)
Enlarged uterus (Advanced stage)
Weight loss, fatigue,weakness (late stage)
Diagnostic Tests
Transvaginal Ultrasound
▪ Measures endometrial thickness
Endometrial biopsy (most definitive)
▪ Confirms presence of cancer cells
Hysteroscopy
▪ Direct visualization of uterine cavity
Pap smear
▪ Detect abnormal cells
CT scan / MRI
▪ Determines spread (staging)
Therapeutic Management
Hormonal therapy (e.g., progesterone)
▪ Counteract estrogen effects
Radiation therapy
▪ Kill cancer cells ; shrink tumors
▪ Prevent recurrence post surgery
Chemotherapy
▪ Kills/destroy cancer cells.
▪ For advanced stages, metastatic cancer
Surgical Management
Total Hysterectomy w/ Bilateral Salpingo-oophorectomy
▪ Removal of uterus, fallopian tubes & ovaries
Nursing Interventions
Postoperative Care
Monitor: VS, Surgical site , Drainage & bleeding
Prevent complications:
Deep Vein Thrombosis (DVT) → encourage early ambulation
Infection → maintain aseptic technique
Manage pain
Radiation Therapy Care
Monitor for: Skin irritation , Fatigue , Diarrhea or urinary symptoms
Provide skin care instructions
OVARIAN DISORDERS
POLYCYSTIC OVARY SYNDROME (PCOS)
Hormonal disorder characterized by:
Hyperandrogenism (excess male hormones)
Ovulatory dysfunction (irregular or absent ovulation)
Polycystic ovaries (multiple immature follicles)
Causes:
Hormonal imbalance
↑ Androgens (male hormones)
↑ Luteinizing hormone (LH)
Insulin resistance
Risks Factors:
Family hx of PCOS
Obesity
Sedentary lifestyle
Insulin resistance or prediabetes
History of irregular menstruation
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Assessment Findings
Irregular menstruation, Amenorrhea
Infertility, Anovulation
Hyperandrogenism
Hirsutism (excess hair growth on face/body)
Acne, Oily skin
Acanthosis nigricans (darkened skin patches)
Weight gain / obesity
Diagnostic Tests
UTZ
▪ Reveals multiple small follicles
Fasting blood glucose / OGTT
▪ Detect insulin resistance
Therapeutic Management
Lifestyle Modification (First-line)
▪ Weight reduction , Diet , exercise
Oral contraceptives
▪ Regulate menstruation ; reduce androgen levels
Metformin
▪ Improves insulin sensitivity
Anti-androgens
▪ Reduce hirsutism , acne
Ovulatory drugs
▪ For infertility treatment
OVARIAN CANCER
Malignant tumor of the ovaries (common in epithelial cells)
Risk Factors
Age (>50 y/o)
Family hx of ovarian or breast cancer
Nulliparity
Early menarche / Late menopause
Infertility
Long term use of fertility drugs
Obesity
High-fat diet
Assessment Findings
Early Symptoms
Abdominal bloating
Pelvic or abdominal discomfort
Urinary urgency or frequency
Late Symptoms
Ascites (abdominal swelling)
Weight loss
Nausea; vomiting
Bowel changes
Palpable abdominal mass
Diagnostic Tests
Transvaginal ultrasound
▪ Identifies ovarian masses
Elevated CA-125 tumor marker
CT scan / MRI
▪ Determine extent of disease
Biopsy
▪ Confirms diagnosis
Therapeutic Management
Surgical Management (Primary Treatment)
Total hysterectomy w/ bilateral salpingo-oophorectomy
Chemotherapy after surgery
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Nursing Interventions
Assess:
Abdominal girth (ascites)
Nutritional status
Respiratory difficulty (due to ascites)
Postoperative Care
Monitor: VS, Surgical site ,Fluid balance
Prevent complications: Infection , DVT → encourage early ambulation
Pain management
Chemotherapy Care
Monitor: CBC (risk for infection, anemia)
Manage side effects:
Nausea/vomiting → antiemetics
Hair loss
Health Teachings
Regular check-ups
Awareness of early S/Sxs
Healthy lifestyle
CERVICAL DISORDERS
CERVICAL POLYPS
Benign (noncancerous) growths of endocervical canal (lining of the cervix).
Small, soft, red or purple
May protrude to cervical opening.
Causes/Risk Factors
Chronic Cervicitis (inflammation/infection of cervix )
↑estrogen
20–50 y/o
Multiparity
Assessment Findings
Often Asymptomatic
If symptoms are present:
Abnormal vaginal bleeding
Intermenstrual bleeding
Postcoital bleeding
Diagnostic Tests
Pelvic examination
▪ Visible polyp protruding from cervix
Speculum examination
▪ Direct visualization
Pap smear
▪ Rule out malignancy
Biopsy / Polypectomy (definitive)
▪ Confirms benign nature
Therapeutic Management
Polypectomy
▪ Removal of polyp
Cauterization
▪ done after polypectomy
▪ application of heat or chemicals to the site of polyp removal
▪ stop bleeding & prevent recurrence
Antibiotics for infection
Nursing Interventions
Assess Vaginal bleeding ,discharges , signs of infection
Post-procedure Care
Monitor : Bleeding , Signs of infection
Advise to avoid: sexual intercourse temporarily , avoid tampon use
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CERVICAL CANCER
Malignant neoplasm arising from cells of cervix
Cause: Human Papillomavirus (HPV) infection
Risks Factors
Early onset of sexual activity
Multiple sexual partners
Hx of STIs
Persistent HPV infection
Lack of regular Pap smear screening
Assessment Findings
Early Stage (often asymptomatic)
Late S/Sx
Abnormal vaginal bleeding
Foul-smelling vaginal discharge
Pelvic pain
Dyspareunia
Hematuria & Rectal bleeding (Advanced Stage)
Weight loss, anemia, fatigue
Diagnostic Tests
Pap smear
Cervical biopsy – confirms diagnosis
CT Scan, MRI (for staging)
Therapeutic Management
Surgical Management
Laser therapy
Conization
Total hysterectomy
Radical hysterectomy (removal of uterus, cervix, surrounding tissues)
Radiation Therapy
Chemotherapy (for advanced stages)
Common drugs: cisplatin, paclitaxel
Combined Therapy (Chemoradiation for advanced cases)
Nursing Interventions
Provide pre & post operative nursing care; Radiation & Chemotherapy Care
Signs of complications to report: Heavy bleeding, Fever , Severe pain
Importance of follow-up care
Prevention & Health Education
HPV vaccination
Regular Pap smear
Safe sexual practices
BREAST DISORDERS
FIBROCYSTIC BREAST DISEASE
Benign (noncancerous) breast lump
Fibrosis (thickening of tissue) & cyst formation
Causes/ Risk Factors
Hormonal fluctuations
Cyclical changes during the menstrual cycle
Premenopausal women
High-fat diet
Stress
Family hx of benign breast conditions
Diagnostic Tests
Mammogram
Breast Ultrasound
Fine Needle Aspiration (FNA)
▪ Removes fluid from cyst
▪ Confirms benign nature
Biopsy (if needed)
▪ Done for suspicious findings
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Assessment Findings
Breast pain (mastalgia)
Feeling of heaviness or fullness
Palpable movable lumps or nodules (often bilateral)
Breast tenderness
Therapeutic Management
Analgesics (e.g., NSAIDs)
Danazol (Danocrine): Suppress estrogen formation
FIBROADENOMA
Benign (noncancerous) breast tumor
Composed of glandular , fibrous connective tissue.
Cause: Hormonal influence ( estrogen sensitivity)
Assessment Findings
Painless breast lump
Movable mass (“slips under fingers”)
Non-tender
Therapeutic Management
Regular monitoring for changes in size
Lumpectomy for large mass
BREAST CANCER
Malignant growth of cells in the breast tissue
Commonly originates in ductal epithelium (ductal carcinoma) or lobular epithelium (lobular carcinoma).
Most common cancer among women
Leading cause of cancer-related deaths in women
Risk Factors
Non-modifiable
>50 y/o
Family hx breast Ca
Early menarche
Late menopause
Screening Tests
Mammogram – primary screening tool
Breast Self-examination (BSE)
Confirmatory Tests
Breast UTZ
Breast biopsy (definitive diagnosis):
Fine needle aspiration
Additional Tests
MRI of the breast
CT scan (for metastasis)
Assessment Findings
Early Signs
Painless Lump
Late Signs
Change In Breast Size Or Shape (Asymmetry)
Skin Dimpling (Peau D’orange Skin)
Redness Or Ulceration
Nipple Retraction/Elevation , Clear/Bloody Nipple Discharge
Enlarged Axillary Lymph Nodes (Axillary Lymphadenopathy)
Breast Pain
Advanced Signs
Weight Loss , Fatigue
Bone Pain (Metastasis)
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Therapeutic Management
Surgical Management
Lumpectomy (Tumor excised & removed)
Mastectomy:
Total (simple) mastectomy –Breast tissue & nipple removed
Modified radical mastectomy - Breast tissue, nipple & lymph nodes removed; muscles left intact
Axillary lymph node dissection
Radiation Therapy
Done after lumpectomy or post-mastectomy
Chemotherapy
Used before (neoadjuvant) or after (adjuvant) surgery
Common drugs:
Cyclophosphamide
Doxorubicin
Paclitaxel
Hormonal Therapy
Tamoxifen
Aromatase inhibitors
Post-Operative Interventions
Monitor VS & surgical site (swelling, infection)
Assess for complications:
Hemorrhage , Infection
Maintain drainage devices (e.g., Jackson-Pratt drain)
Encourage Coughing & deep breathing
Elevate affected arm →reduce edema ; prevent lymphedema
Avoid BP measurement & injections on affected arm
Encourage arm exercises
Avoid trauma or injury
General Health Promotion & Health Teachings (Breast Disorders)
1. Breast Self-Examination (BSE)- 7-10 days after menstruation
2. Report:
Lump or mass
Change in size or shape
Skin changes (dimpling, redness)
Nipple discharge (especially bloody)
Nipple retraction
3. Regular Screening : Mammogram, Breast UTZ
4. Promote Healthy Lifestyle
5. Balanced diet: Low fat, limit processed foods, increase Fruits & vegetables
6. Regular Exercise
7. Maintain healthy weight
8. Avoid Smoking, Reduce alcohol intake
9. Proper Breast Care: well-fitting, supportive bra , good hygiene
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