Lecture 15C Reproductive system concerns Flashcards Preview

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Flashcards in Lecture 15C Reproductive system concerns Deck (24):


Absence of menstrual flow
Not a disease, often the sign of one
Most common and benign → result of pregnancy
May be clinical symptom of a variety of disorders
First action w/ a pt. reporting amenorrhea is a pregnancy test (hCG); if negative, usually a sign of clinical disorder. Dylantin and COCs associated with amenorrhea.


Exercise-associated amenorrhea

*Female athlete triad*: 1. Eating disorder; 2. amenorrhea; 3. premature osteoporosis.


Nutritional considerations for amenorrhea

Daily calcium intake 1000-1500 mg
Vitamin D 400-600 IU


Primary dysmenorrhea

Abnormally increased uterine activity/myometrial contractions
Result of *prostaglandins in 2nd half of cycle* - these women will have more intense labors.
Most common in late teens and early twenties, incidence declines w/age


Primary dysmenorrhea management

Decrease salt and refined sugar intake 7-10 d before menses, natural diuretics.
NSAIDs - ibuprofen taken at regular intervals


Secondary dysmenorrhea

Acquired menstrual pain
Menstrual pain that develops later in life than primary (after age 25)
May have other symptoms suggestive of underlying cause
Dull, lower abdominal aching, radiating to back or thighs
Bloating or pelvic fullness


Hypogonadotropic amenorrhea

Suppression of the hypothalamus, from stress, etc.


PMS/PMDD with partial hysterectomy

PMS and PMDD can *still occur* because ovarian function is necessary for the disorder, not the presence of a uterus.


Nutritional supplementation with PMS/PMDD

Vitamin B6, up to 100-150 mg/day
Vitamin E, up to 600 IU/day
Calcium, 1000 -1200 mg/day
Magnesium, up to 300-400 mg /day
Evening Primrose Oil (*not* during pregnancy)


PMDD pharmacological therapy

SSRIs: Fluoxetine (Sarafem); Paroxetine (Paxil); Sertaline (Zoloft)
YAZ (an oral contraceptive)



Presence and growth of endometrial tissue outside of the uterus. Believed to be the result of reverse flow of blood and endometrial tissue.
Tissue found most commonly in and near ovaries; can be in stomach, lungs, spleen, and intestines. Often grows *on surgical scars* (i.e., previous cervical surgery.
*Disappears with menopause*
*A leading cause of infertility*


Endometriosis and menstruation

Each month, estrogen causes *all* endometrial tissue, regardless of location, to become inflamed and painful - pelvic pain, sacral backache, dyspareunia, secondary dysmenorrhea, constipation and pain during exercise.


Average age of menopause



Average of perimenopause or climacteric phase



Declaration of menopause requires

No menstrual periods (no ovulation) for *12 months*, including spotting - continue to use contraception.


Hormonal changes in menopause

1. FSH is *elevated* because the ovarian follicle becomes less sensitive to it.
2. Progesterone and estrogen is *decreased*.


SCOVU mnemonic for menopause symptoms

S - Sleep disorders
C - Cardiovascular
O - Osteoporosis
V - Vasomotor
U - Urogenital
(Also: Cognitive disorders)


Due to falling estrogen levels, there is an increased risk of developing _ after menopause

Cardiovascular disease: Causes an increase in LDL (bad cholesterol) and a decrease in HDL (good cholesterol); causes decreased elasticity of the blood vessels.


Osteoporosis and menopause

Estrogen plays a role in stimulating osteoblasts, as well as the conversion of vitamin D to calcitonin; falling estrogen levels inhibit new bone from being formed - results in thinning of the bones.



Causes reversible osteoporosis, women should not take this medication for more than 2 years.


Increased intake of calcium and vitamin D

*At age 40* - at least 1200 mg/day of calcium and at least 400 IU/day of vitamin D.


Medications for osteoporosis

Miacalcin, Fosamax, Actonel, Boniva, Reclast, Evista - follow instructions precisely - some require woman to remain in an upright position afterward.


Menopause hormonal therapy (MHT)

Controversial - long term use is associated with increased risk for blood clots, heart attack, stroke, invasive breast cancer; should only be used on a *short term* basis (1-3 years) and for very disruptive menopausal symptoms.


Contraindications to hormone therapy

Women w/increased risk of cardiovascular disease
High risk or hx of breast CA
May worsen myomas of the uterus
Women with a known hx of gallbladder disease (conjugated estrogens are associated with an increased incidence)