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YNOCOLOGICALPROBLEMS
A. BLEEDINGPROBLEMSa. DISMENORRHEA- painful periods, late teens
early 20s. Occurs onset menses, lasts
12-24hrs. Lower abdominal pain, spastic radiating to back and
thighsN&V, diarrhea,
synchope, breast engorgement, fatigue, bloating etc.
i. Prostaglandin inhibitors if contraception not needed ex.
NSAIDS: Naproxen, ifcontraception needed: oral contraception.
ii. Yoga, exercise, heat/cold, vit B6, Ca2+, Mg2+ & protein,
limit sodiumb. AMENORRHEA- absence menses; MENORRHEA- excessive
bleeding,
METORRHAGIA- spotting
i. Oral contraceptives for Amenorrhea & Metorrhagia,
endometrial ablation,hysterectomy or myomectomy for menorrhea
1. Leg exercises & early post-op ambulation prevent DVT
& pneumoniac. ENDOMETRIOSIS- endometrial tissue outside of
uterus which undergoes menstrual
cycle scars & adhesions as tissues reabsorb blood.
i. s/s: pain just prior menses, Dyspareunia (painful
intercourse), painful defecation,sacral backache, infertility,
hypermenorrhea
1. diagnostics: ESR, WBC to r/o PID; ultrasound, definitive
diagnosis:LAPAROSCOPY
ii. tx: NSAIDS, oral contraceptives, Danazol ( Danocrine,
cyclomen) & GnRHagonists
1. heat pad back/abdomen, relaxation techniques, yoga2. removal
endometrial tissue implants those want children, hysterectomy
those who dont (Lupron for 4-6mths to decrease lesions before
surgery
& helps decrease development adhesions during surgery)
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B. PREMENSTRUAL SYNDROME- collection symptoms occurs luteal
phase cycle. Affects 30-40yr, after pregnancy, child birth, tubal
ligation, & major life stresses.
a. s/s: irritability, bloating, cravings, depression, mood
swings, uticaria, breast tenderness,fatigue, acne
b. tx: 6meals daily if hypoglycemia, limit salt, caffeine,
chocolate, sugar, red meat. TakeCa2+, VitA, B6 & C
i. K+ sparing diuretics10dys prior menses, progesterone to
relieve physical &emotional symptoms, Bromocriptine mesylat
(Parlodel) during luteal phase, oral
contraceptives, GnRH agonists, antidepressants, NSAIDS
C. CYCTOCELE- protrusion bladder through weakened vaginal walla.
s/s urinary retention, frequency & urgency; UTI, stress
incontinenceb. bladder scan, check residualc. tx: pessary to
support bladder, estrogen therapy, kegals, anterior colporrhaphy
(surgery)
D. RECTOCELE- protrusion rectum through weakened vaginal walla.
s/s:constipation, impaction, rectal/vaginal fullnessb. tx:
posterior colporrhaphy
E. FISTULA-abnormal opening between organsa. Leakage flatus,
urine or feces, bad odour
i. Assist w/ personal hygiene: sitz baths, perineal care,
douchingb. Most heal on own, if not Fistulectomyileal conduit or
temporary colostomy.
i. Low-residual diet & stool softeners for 2 wks after
repairF. MENOPAUSE- end periods, marked increase FSH(>35IU/L)
& depletion estradiol
a. Common early change is shortened time between periodsb. Tx:
HRT- lowest dose possible, antidepressants
