bleeding absdvdfgdfbfdggfdgdfgnormalities.ppt

Lecture

2. Amenorrhea

3. Amenorrhe
a
•It is the absence of menstrual flow.
or
•No menses for at least 6 months

4. Types
Primary Amenorrhea:
- Menarche does not occur by age of 15yrs. or at age of 13yrs.
with absence of secondary sex characteristics.
Secondary Amenorrhea:
- A woman who has previously had a menstrual cycle stops
having menstrual periods for three cycles in a row, or for a time
period of six months or more and is not pregnant.

5. ETIOLOGY
Causes of primary amenorrhea:
Chromosomal disorders such as Turner’s syndrome
and agenesis of uterus.
Imperforate hymen.
Causes of secondary amenorrhea:
Pregnancy or lactation
Menopause, ovarian cysts
Excessive exercise or inadequate nutrition
Hormonal imbalance ( hyperthyroidism)
Some medications such as chemotherapy,
hormonal contraceptives
depression , severe psychological trauma, physical
trauma or radiation.

6. Diagnostic Evaluation
History collection :The diagnosis of amenorrhea requires a
careful medical history to document the presence of
amenorrhea as well as any other coexisting medical conditions
that may be the cause of amenorrhea.
A physical examination, including a pelvic examination
USG scanning
Hystrosalphinography
CT scan
MRI

7. Clinical ManifestationsClinical Manifestations
Irregular menstrual periods
unwanted hair growth,
deepening of the voice and acne.
Elevated prolactin levels as a cause of amenorrhea
can result in galactorrhea (a milky discharge from
the nipples that is not related to normal
breastfeeding).

8. Treatment
In cases in which genetic or anatomical abnormalities are the
cause of amenorrhea (typically primary amenorrhea) surgery may
be recommended to correct anatomical abnormalities.
Surgical removal of tumors
Provide hormonal therapy to regulate the cycles
Stop use of IUD’s
Routine check up

9. Cont..
Amenorrhea that is related to weight loss, excessive exercise,
physical illness, or emotional stress can typically be corrected
by the underlying cause.
Dopamine agonist medications such as bromocriptine (Parlodel)
can reduce elevated prolactin levels, which may be responsible
for amenorrhea.

10. Nursing Management
Teach the patient about the Pelvic floor exercises
Explain about the side effects of the IUD’s
Assess the signs of pituitary tumor such as
headache, vision disturbances, dizziness and
galatcorrhea
Assess emotional status and coping abilities and
provide emotional support for patient and family
Teach the patient about the physiology of
menstrual cycle and possible causes of
amenorrhea.
Teach proper use and adverse effects of the
medication used or prescribed.

11. COMPLICATIONS
•Infertility
•Osteopenia (a reduction in bone density)

12. M
ENORRHAGIA

13. DEFINITION
Menorrhagia is an abnormally heavy and prolonged
menstrual period at regular intervals.
A blood loss of greater than 80 ml or lasting longer than 7
days constitutes menorrhagia (also called hyper
menorrhea).

14. Etiology
Blood disorder or stress-related
disorders.
Excessive build up in endometrial
lining
Hormonal changes
Tumors of cervix
Adenomyosis ( endometrial layer get
attached with muscles due to any
disease condition associated with
pelvis and complete endometrial
shedding take place)

15. Risk Factors
•Obesity
•Anovulation
•Estrogen administration (without progestogens)
•Prior treatment with oral contraceptives increases the risk
of endometrial atrophy

16. Diagnosis
•History collection
•Physical examination
•Check for bleeding and clotting time
•Pelvic and rectal examination
•Pap smear
•Pelvic ultrasound scan
•Endometrial biopsy to exclude endometrial cancer
•Hysteroscopy

17. Clinical manifestations
oPain
oAnemia
oIrritation and burning sensation in perineal area
oWeakness
oExcessive blood flow

18. Management
oIf the degree of bleeding is mild, all that may be sought by the woman is the
reassurance that there is no underlying cause. If anaemia occurs then iron tablets
may be used to help restore normal hemoglobin levels.
oUsually, oral combined contraceptive or progesterone only pills may be taken
for a few months, but for longer-term treatment the alternatives of injected Depo
Provera or the more recent progesterone releasing Intra Uterine System (IUS)
may be used.
oFibroids may respond to hormonal treatment, and if they do not, then surgical
removal may be required.

19. Medical management
Medications
•Antifibrinolytic agent (haemostatic agents)
•Non-steroidal anti-inflammatory drugs (NSAIDs)
•Combined oral contraceptive pills to prevent proliferation of the endometrium or
Oral progestogen (e.g. norethisterone), to prevent proliferation of the
endometrium
•Injected progestogen (e.g. Depo provera)
•Gonadotrophin-releasing hormone (GnRH) agonists (e.g. Goserelin)

20. Surgical management
•Dilation and curettage (D&C) is no longer performed for
cases of simple menorrhagia, having a reserved role if a
spontaneous abortion is incomplete
•Endometrial ablation
•Uterine artery embolisation (UAE)
•Hysteroscopy myomectomy to remove fibroids over 3 cm in
diameter

21. Nursing management

24. Metrorrhagia
Presented by:
Shivani Bharti
Clinical Instructor
ACN

25. Definition
o Metrorrhagia is abnormal bleeding or spotting that occurs
between periods or that is not associated with menstruation.
Most women will likely refer to it simply as spotting
oMetrorrhagia is bleeding or spotting that occurs either:
- Between menstrual periods
- Abnormal bleeding that is not associated with menstruation

26. Etiology
Intermittent spotting between periods can result from any of numerous reproductive
system disorders:
•Dysfunctional uterine bleeding
•Endometriosis
•Ectopic pregnancy
•Hormone imbalance
•Endometrial hyperplasia
•Polyps
•Cervicitis

27. Cont..
•Vaginitis
•Nutrional deficiencies
•Use of progestin-only contraceptives
•Pelvic inflammatory disease
•PCOS
•Change in oral contraception
•Trauma

28. Diagnosis
•History collection
•Physical examination
•Endometrial biopsy: take a sample of tissue from
the inside of the uterus. The tissue is then examined
under a microscope in the lab.
•Ultrasound scan: Sound waves are used to get pictures of the uterus,
ovaries, and pelvis. The ultrasound probe may be placed on your lower
abdomen or into vagina.

29. Cont..
•Sonohysterogram: An ultrasound scan is done after fluid ( normal saline)
is injected through a tube into your uterus. This test allows provider to look
for problems with the lining of the uterus.
•Hysteroscopy: inserts a thin metal tube with a light and tiny
camera through the vagina and cervix and into the uterus. This
allows provider to see the inside of the uterus.

30. Cont..
o Hysterosalpingography: Dye is injected into
the uterus and fallopian tubes through the cervix.
X-rays are then taken.

31. Clinical manifestations
oThe main symptom of metrorrhagia is light to heavy
bleeding or spotting between regluar menstrual periods.
oDiscomfort
oSevere cramping pain
oDiscomfort in bladder during urination

32. Management
The treatment depends on the cause of the problem, if there is
having a hormone imbalance, prescribe hormones.
 If an IUD is causing the problem, it will be removed.
Erosion of the cervix may be treated by removing or
destroying some of the cervical tissue.

33. Cont..
D&C: in which tissue is suctioned from the uterus
Hysteroscopy: to remove a polyp
Hysterectomy: which is removal of the uterus

34. Nursing management
•Maintain personal hygiene
•Follow the medications as per the
doctor’s order
•Health education
•Advise to keep a record of menstrual periods and note any
changes in your menstrual pattern, including abnormal bleeding.
•Females over the age of 18 or who are sexually active should
receive annual Pap smear tests and pelvic examinations.

35. DUB
( dysfunctional uterine bleeding)

36. Definition
Dysfunctional uterine bleeding is
abnormal uterine bleeding that
has no organic cause, such as
tumour or infection

37. Etiology
•Immature hypothalamic
stimulation in adolescents
•Temporary estrogen
withdrawal
•psychological stress,
•weight (obesity, anorexia, or a
rapid change),
•neoplasm, drugs, or it may be
otherwise idiopathic.

38. Types
Ovulatory DUB: 10% of cases occur in women who are
ovulating.
Estrogen level decreases
Progesterone secretion is increased
causes irregular shedding of the uterine lining and break-through
bleeding

39. Cont…
Anovulatory DUB:
About 90% of DUB events occur when
ovulation is not occurring. Anovulatory menstrual cycles are
common at the extremes of reproductive age, such as early
puberty and peri menopause (period around menopause).

40. women do not properly develop and release a mature egg.

When this happens, the corpus luteum, that produces
progesterone, does not form.
As a result, estrogen is produced continuously, causing an
overgrowth of the uterus lining.
The period is delayed in such cases, and when it occurs
menstruation can be very heavy and prolonged.

41. Cont…
Anovulatory DUB:
About 90% of DUB events occur when
ovulation is not occurring. Anovulatory menstrual cycles are
common at the extremes of reproductive age, such as early
puberty and peri menopause (period around menopause).

42. Clinical manifestations
•Oligomenorrhea (Oligomenorrhea is a medical term which
generally refers to irregular or infrequent menstrual periods
with intervals of more than 35 days )
•Polymenorrhea ( frequent menstruation occurring at intervals
of less than 3 weeks)

43. Diagnostic evaluation
History collection
Physical examination
Pap smear
Hysteroscopy
Endometrial biopsy
Pelvic ultrasound

44. Management
Treat anemia with IFA
Progesterone therapy to stop
bleeding
Hormonal contraceptives
D & C
Hysteroscopy endometrial ablation/
resection ( removal of diseased or
abnormal tissue)
Hysterectomy in rare cases

45. Nursing management
oEncourage good dietary intake with increased source of
iron
oAdminister oral iron preparations
oMonitor Hb level of the patient
oTeach the patient about the causes of DUB and its
management
oProvide emotional support

46. Menopause

47. DEFINITION
•Menopause is described as the physiological
cessation of menses.
•Menopause literally means the "end of monthly
cycles.

48. Etiology
Cessation of ovarian functions
Decreased estrogen production by the ovaries
Artificial menopause may be due to the surgery
Use of some chemotherapeutic agents
Exposure of radiations to the ovaries

49. Clinical manifestations
oGenitalia:
 Atrophy of vulva
urethra results in dryness
Itching
Burning
Dysuria
thinning of pubic hairs
loss of labia minora

50. Cont…
oSexual function:
Dyspareunia
oVasomotor:
 hot flashes
Night sweat
oPsychological:
Insomnia
Irritability
Anxiety
memory loss
depression

51. Diagnostic evaluation
oHistory collection
oPhysical examination
oFSH level should be checked: if it
is more than 30 to 40 IU/l indicates
menopause
oLH level will also increase
oEstradiol level will be decreased.

52. Management
oEstrogen replacement therapy: indicated to reduce vasomotor
symptoms
oVaginal lubricants, such as replens to decrease
vaginal dryness and dyspareunia
o Vitamin E and Vitamin B Supplements : to decreases hot
flashes
oCalcium supplements to prevent bone loss
oDietary supplements
oAntidepressants: Antidepressants such as paroxetine (Paxil),
Fluoxetine hydrochloride (Prozac),
o

53. Cont..
•Individual counseling or support groups can sometimes be
helpful to handle depressed, anxious or confused feelings of
women.
•The risk of acute myocardial infarction
and other cardiovascular diseases rises sharply
after menopause, but the risk can be reduced by managing risk
factors, such as tobacco smoking, hypertension, increased
blood lipids and body weight.

54. Nursing management
Explore with patient her feelings about menopause, clear up
misconceptions about sexual functioning.
Encourage her to discuss her feelings with her partner.
Tell patient that sexual functioning may decrease during
menopause

55. Cont…
Provide patient with information related to estrogen
replacement therapy, including dose, route, adverse effects etc.
Teach the patient about the food that are high in calcium
Encourage patient to keep regular medical and gynecological
follow up visits.