MEDSURGE EXAM 4 BP-FEMALE REPRODUCTIVE SYSTEM STUDT GUIDE LATEST
UPDATE 2022/2023
MEDSURGE an function
o 1 year of amenorrhea (absence of menstruation)
o 42 to 58 years (avg. 51), may occur earlier due to illness, surgical removal of the
uterus or both ovaries, side effects of Radiation/chemotherapy, or drugs
Menopause
o genetic factors, autoimmune conditions, cigarette smoking, racial or ethnic factors are
• Description
related to an earlier age at menopause
o Ph
ysi • Clinical manifestations *African Americans physical symptom, Whites psychological symptoms*
olo o Perimenopause
gic ▪ Irregular menses, Occasional vasomotor symptoms, Atrophy of genitourinary
ces tissue with decreased support, Stress and urge incontinence, Osteoporosis, Mood
sat changes, Atrophy of genitourinary tissue with decreased support
ion o Postmenopause
of ▪ Cessation/irregular menses, Vasomotor instability (hot flashes and night
me sweats), Atrophy of genitourinary (tissue thinning of the vaginal mucosa and
nse disappearance of reggae, dryness), Stress and urge incontinence, Breast
s tenderness
ass ▪ MOST CRITICAL***CAD (↓ HDL, ↑ LDL), osteoporosis (secondary to bone densi
oci loss)***
ate • Depression irritability and cognitive problems
d • Collaborative care
wit o Drug therapy: hormone therapy
h
▪ Estrogen
de
• (w/out uterus) *Premarin 0.625 mg common dose*, topical hormones
cli
o Side effects: nausea, fluid retention, headache, and breast enlargement
nin
• ↑ risk of stroke and emboli but ↓ risk of fractures with no increased risk
g
for heart disease, breast, or colorectal cancer
ov
▪ Progesterone
ari
• (W/ uterus) *medroxyprogesterone common dose 5-10 mg 12 days in
MEDSURGE EXAM 4 BP-FEMALE REPRODUCTIVE SYSTEM STUDT GUIDE LATEST
UPDATE 2022/2023 1
,MEDSURGE EXAM 4 BP-FEMALE REPRODUCTIVE SYSTEM STUDT GUIDE LATEST
UPDATE 2022/2023
+ progesterone = ↑ risk of breast cancer, stroke, heart disease, and emboli & ↓
hip fractures and colorectal cancer
• *If the estrogen is increased for symptom relief, then
progesterone should also be increased*
▪ Short term hormone therapy (4-5 yrs.) = ↓ bone loss, hot flashes, vaginal atrophic change
o Non-hormone therapy
▪ Exercise 3-4 times week, Loose-fitting clothes, increasing air circulation, Cool
environment, provide water-soluble lubricants, cessation of menstruation and
ability to bear children should not be equated w/ cessation of sexual capability
▪ Nutritional therapy
• Intake of 30 cal/kg, ↑ calcium (1500 mg no hormones, at least
1000 mg taking hormones, BEST ABSSORBED W/ MEALS), ↑
vitamin D, 5 fruits/ veggies a day, ↑ complex
o carbohydrates, vit B6 complex, phytoestrogens (soy, chickpeas, sunflower
seeds, tofu), herbal remedies (black cohosh), AVOID caffeine and
alcohol
• Key terms
o Amenorrhea: absence of menstruation
▪ Primary:
• Failure of menstrual cycles to begin by age 16 years or by age
14 years if secondary sex characteristics are present
▪ Secondary:
▪ E
• The cessation of menstrual cycles once they had been established
st
▪ Can be caused by running
r
o Menorrhagia: Excessive/prolonged bleeding (more than 7 days increased amount/ > 80 mL), or bo
o
▪ Anovulatory uterine bleeding is the most common cause (unopposed estrogen
g
state continues to build up the endometrium until it becomes unstable)
e
▪ Young women with excessive bleeding (clotting disorders must be considered)
n
MEDSURGE EXAM 4 BP-FEMALE REPRODUCTIVE SYSTEM STUDT GUIDE LATEST
UPDATE 2022/2023 2
,MEDSURGE EXAM 4 BP-FEMALE REPRODUCTIVE SYSTEM STUDT GUIDE LATEST
UPDATE 2022/2023
▪ C erine fibroids (leiomyomas), endometrial polyps
h o Metrorrhagia (irregular bleeding or bleeding between menses)
il ▪ Reproductive-age women pregnancy complications (spontaneous abortion or ectopic
d pregnancy)
b • Ectopic pregnancy
e •
a ▪ Other causes
ri • Cervical/endometrial polyps, infection, and cancer
n • Spotting is common during the first three cycles of oral
g contraceptives (If spotting continues beyond that, different pill
y formulation can be prescribed)
e ▪ Postmenopausal women
a • Endometrial cancer must be considered
r • Hormone therapy (exogenous estrogen therapy)
s o Menstrual Cycle
c
▪ Average tampon absorbs 20-30 mL
o
▪ Heavy menstrual flow
m
• Saturated pad or tampon in 1 to 2 hours
m
Leiomyomas (uterine fibroids)
o
**benign, noncancerous, smooth muscle uterine tumor**
n
• Description
c
o Benign smooth-muscle tumors that occur within the uterus, associated with miscarriage and
a
infertility.
u
o Depends on ovarian hormones because they grow slowly during their productive years
s
and undergo atrophy after menopause
e
▪ Symptoms decrease after menopause
s:
• S/S
U
o Asymptomatic; Majority do not have any symptoms
t
MEDSURGE EXAM 4 BP-FEMALE REPRODUCTIVE SYSTEM STUDT GUIDE LATEST
UPDATE 2022/2023 3
, MEDSURGE EXAM 4 BP-FEMALE REPRODUCTIVE SYSTEM STUDT GUIDE LATEST
UPDATE 2022/2023
o Ab o Increased bleeding is thought to be associated with increased endometrial surface
nor area that is associated with leiomyomas
ma o Pain associated with infection
l o Devascularization and blood vessel compression are also thought to contribute to pain
ute o Pressure on surrounding organs may result in rectal, bladder, and lower abdominal discomfort
rin o Large tumors may cause a general enlargement of the lower abdomen
e
• Interventions
ble
o Women experiencing menorrhagia, the use of aspirin is discouraged because of inhibited platelet
edi
aggregation
ng,
o Heaving menstrual bleeding could lead to anemia and large or rapidly growing tumors are
pai
indications for surgery
n,
• Treatment
an
o Uterine fibroid embolization (UFE):
d
▪ Minimally invasive procedure used to treat fibroid tumors of the uterus which
sy
can cause heavy menstrual bleeding, pain and pressure on the bladder or bowel
mp
▪ Use fluoroscopy to guide the delivery of embolic agents to the uterus and fibroids
to
• Small gelatin/plastic beads (embolic agents) are implanted to cut of
ms
blood supply (arteries) of the fibroids causing them to shrink
ass
o Preserves fertility
oci
• Diagnosis (based on pelvic findings)
ate
o Enlarged uterus with nodular masses
d
• Treatment (depends on symptoms)
wit
o Drug therapy
h
▪ GnRH agonists (e.g., leuprolide [Lupron])
pel
▪ danazol (Danocrine)
vic
o Surgery
pre
ssu ▪ Hysterectomy (removal of the uterus) Not for women who want to have children
re
MEDSURGE EXAM 4 BP-FEMALE REPRODUCTIVE SYSTEM STUDT GUIDE LATEST
UPDATE 2022/2023 4
UPDATE 2022/2023
MEDSURGE an function
o 1 year of amenorrhea (absence of menstruation)
o 42 to 58 years (avg. 51), may occur earlier due to illness, surgical removal of the
uterus or both ovaries, side effects of Radiation/chemotherapy, or drugs
Menopause
o genetic factors, autoimmune conditions, cigarette smoking, racial or ethnic factors are
• Description
related to an earlier age at menopause
o Ph
ysi • Clinical manifestations *African Americans physical symptom, Whites psychological symptoms*
olo o Perimenopause
gic ▪ Irregular menses, Occasional vasomotor symptoms, Atrophy of genitourinary
ces tissue with decreased support, Stress and urge incontinence, Osteoporosis, Mood
sat changes, Atrophy of genitourinary tissue with decreased support
ion o Postmenopause
of ▪ Cessation/irregular menses, Vasomotor instability (hot flashes and night
me sweats), Atrophy of genitourinary (tissue thinning of the vaginal mucosa and
nse disappearance of reggae, dryness), Stress and urge incontinence, Breast
s tenderness
ass ▪ MOST CRITICAL***CAD (↓ HDL, ↑ LDL), osteoporosis (secondary to bone densi
oci loss)***
ate • Depression irritability and cognitive problems
d • Collaborative care
wit o Drug therapy: hormone therapy
h
▪ Estrogen
de
• (w/out uterus) *Premarin 0.625 mg common dose*, topical hormones
cli
o Side effects: nausea, fluid retention, headache, and breast enlargement
nin
• ↑ risk of stroke and emboli but ↓ risk of fractures with no increased risk
g
for heart disease, breast, or colorectal cancer
ov
▪ Progesterone
ari
• (W/ uterus) *medroxyprogesterone common dose 5-10 mg 12 days in
MEDSURGE EXAM 4 BP-FEMALE REPRODUCTIVE SYSTEM STUDT GUIDE LATEST
UPDATE 2022/2023 1
,MEDSURGE EXAM 4 BP-FEMALE REPRODUCTIVE SYSTEM STUDT GUIDE LATEST
UPDATE 2022/2023
+ progesterone = ↑ risk of breast cancer, stroke, heart disease, and emboli & ↓
hip fractures and colorectal cancer
• *If the estrogen is increased for symptom relief, then
progesterone should also be increased*
▪ Short term hormone therapy (4-5 yrs.) = ↓ bone loss, hot flashes, vaginal atrophic change
o Non-hormone therapy
▪ Exercise 3-4 times week, Loose-fitting clothes, increasing air circulation, Cool
environment, provide water-soluble lubricants, cessation of menstruation and
ability to bear children should not be equated w/ cessation of sexual capability
▪ Nutritional therapy
• Intake of 30 cal/kg, ↑ calcium (1500 mg no hormones, at least
1000 mg taking hormones, BEST ABSSORBED W/ MEALS), ↑
vitamin D, 5 fruits/ veggies a day, ↑ complex
o carbohydrates, vit B6 complex, phytoestrogens (soy, chickpeas, sunflower
seeds, tofu), herbal remedies (black cohosh), AVOID caffeine and
alcohol
• Key terms
o Amenorrhea: absence of menstruation
▪ Primary:
• Failure of menstrual cycles to begin by age 16 years or by age
14 years if secondary sex characteristics are present
▪ Secondary:
▪ E
• The cessation of menstrual cycles once they had been established
st
▪ Can be caused by running
r
o Menorrhagia: Excessive/prolonged bleeding (more than 7 days increased amount/ > 80 mL), or bo
o
▪ Anovulatory uterine bleeding is the most common cause (unopposed estrogen
g
state continues to build up the endometrium until it becomes unstable)
e
▪ Young women with excessive bleeding (clotting disorders must be considered)
n
MEDSURGE EXAM 4 BP-FEMALE REPRODUCTIVE SYSTEM STUDT GUIDE LATEST
UPDATE 2022/2023 2
,MEDSURGE EXAM 4 BP-FEMALE REPRODUCTIVE SYSTEM STUDT GUIDE LATEST
UPDATE 2022/2023
▪ C erine fibroids (leiomyomas), endometrial polyps
h o Metrorrhagia (irregular bleeding or bleeding between menses)
il ▪ Reproductive-age women pregnancy complications (spontaneous abortion or ectopic
d pregnancy)
b • Ectopic pregnancy
e •
a ▪ Other causes
ri • Cervical/endometrial polyps, infection, and cancer
n • Spotting is common during the first three cycles of oral
g contraceptives (If spotting continues beyond that, different pill
y formulation can be prescribed)
e ▪ Postmenopausal women
a • Endometrial cancer must be considered
r • Hormone therapy (exogenous estrogen therapy)
s o Menstrual Cycle
c
▪ Average tampon absorbs 20-30 mL
o
▪ Heavy menstrual flow
m
• Saturated pad or tampon in 1 to 2 hours
m
Leiomyomas (uterine fibroids)
o
**benign, noncancerous, smooth muscle uterine tumor**
n
• Description
c
o Benign smooth-muscle tumors that occur within the uterus, associated with miscarriage and
a
infertility.
u
o Depends on ovarian hormones because they grow slowly during their productive years
s
and undergo atrophy after menopause
e
▪ Symptoms decrease after menopause
s:
• S/S
U
o Asymptomatic; Majority do not have any symptoms
t
MEDSURGE EXAM 4 BP-FEMALE REPRODUCTIVE SYSTEM STUDT GUIDE LATEST
UPDATE 2022/2023 3
, MEDSURGE EXAM 4 BP-FEMALE REPRODUCTIVE SYSTEM STUDT GUIDE LATEST
UPDATE 2022/2023
o Ab o Increased bleeding is thought to be associated with increased endometrial surface
nor area that is associated with leiomyomas
ma o Pain associated with infection
l o Devascularization and blood vessel compression are also thought to contribute to pain
ute o Pressure on surrounding organs may result in rectal, bladder, and lower abdominal discomfort
rin o Large tumors may cause a general enlargement of the lower abdomen
e
• Interventions
ble
o Women experiencing menorrhagia, the use of aspirin is discouraged because of inhibited platelet
edi
aggregation
ng,
o Heaving menstrual bleeding could lead to anemia and large or rapidly growing tumors are
pai
indications for surgery
n,
• Treatment
an
o Uterine fibroid embolization (UFE):
d
▪ Minimally invasive procedure used to treat fibroid tumors of the uterus which
sy
can cause heavy menstrual bleeding, pain and pressure on the bladder or bowel
mp
▪ Use fluoroscopy to guide the delivery of embolic agents to the uterus and fibroids
to
• Small gelatin/plastic beads (embolic agents) are implanted to cut of
ms
blood supply (arteries) of the fibroids causing them to shrink
ass
o Preserves fertility
oci
• Diagnosis (based on pelvic findings)
ate
o Enlarged uterus with nodular masses
d
• Treatment (depends on symptoms)
wit
o Drug therapy
h
▪ GnRH agonists (e.g., leuprolide [Lupron])
pel
▪ danazol (Danocrine)
vic
o Surgery
pre
ssu ▪ Hysterectomy (removal of the uterus) Not for women who want to have children
re
MEDSURGE EXAM 4 BP-FEMALE REPRODUCTIVE SYSTEM STUDT GUIDE LATEST
UPDATE 2022/2023 4
