DISORDERS OF MENSTRUATION &

DISORDERS OF THE UTERUS

By C Settley
Dysmenorrhoea
■ Primary dysmenorrhea is common menstrual cramps
that are recurrent (come back) and are not due to other
diseases.
■ Secondary dysmenorrhea is pain that is caused by a
disorder in the woman's reproductive organs, such as
endometriosis, adenomyosis (A condition in which endometrial tissue exists within
and grows into the uterine wall), uterine fibroids, or infection.

■ Pain from secondary dysmenorrhea usually begins

earlier in the menstrual cycle and lasts longer than
common menstrual cramps.
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Management

■ Analgesics
■ Place a heating pad or hot water bottle
■ Rest
■ Avoid foods that contain caffeine
■ Avoid smoking and drinking alcohol
■ Massage of lower back and abdomen

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Premenstrual tension

■ A group of symptoms that occur in women, typically between ovulation and a period.

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Premenstrual tension

■ The cause isn't fully understood but likely involves

changes in hormones during the menstrual cycle.
■ Symptoms include mood swings, tender breasts, food
cravings, fatigue, irritability and depression.
■ Lifestyle changes and medication may reduce
symptoms.

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Remember that….

■ The menstrual cycle is the monthly series of changes a woman's

body goes through in preparation for the possibility of pregnancy.
■ Each month, one of the ovaries releases an egg — a process
called ovulation.
■ At the same time, hormonal changes prepare the uterus for
pregnancy.
■ If ovulation takes place and the egg isn't fertilized, the lining of
the uterus sheds through the vagina.
■ This is a menstrual period.

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Amenorrheoa
■ Primary Amenorrhea is the absence of a menstrual
period in a woman of reproductive age.
■ Secondary amenorrhea is the absence of menstrual
bleeding in a woman who had been menstruating but
later stops menstruating for three or more months in
the absence of pregnancy, lactation (production of
breast milk), cycle suppression with systemic hormonal
contraceptive (birth control) pills, or menopause.
■ In primary amenorrhea, menstrual periods have never begun (by age 16), whereas
secondary amenorrhea is defined as the absence of menstrual periods for three
consecutive cycles or a time period of more than six months in a woman who was
previously menstruating.
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Amenorrheoa: Causes

■ Absent menstruation, or amenorrhea, is the absence of

menstrual bleeding.
■ Lifestyle factors, including body weight and exercise
levels, stress.
■ In some cases, hormonal imbalances or problems with
the reproductive organs might be the cause.
■ Emergency contraceptives.

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Amenorrheoa: Management

■ Birth control pills or other types of hormonal medication.

■ Certain oral contraceptives may help restart the menstrual
cycle.
■ Medications to help relieve the symptoms of PCOS.
– A hormonal disorder causing enlarged ovaries with small
cysts on the outer edges.
■ Oestrogen replacement therapy (ERT).

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Menorrhagia
■ Abnormally heavy bleeding at menstruation.
■ Prolonged
■ Excessive
■ Hormonal imbalances’
■ Causes:
– Fibroids (Non-cancerous growths in the uterus that can develop during a woman's
childbearing years)
– Intra uterine contraceptive device
– Pelvic inflammatory disease (An infection of the female reproductive organs)
– Blood-clotting factors (Some of the contributing factors of blood clotting include
cigarette smoking, advanced age, obesity, major surgery, sickle cell anaemia, use of
estrogen supplements, lack of physical activity, and injury)

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Menorrhagia: Management

■ Monitor blood loss

■ Pad usage
■ Anaemia
■ Underlying cause
■ Combined oral contraceptives

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Metrorrhagia

■ Irregular vaginal bleeding between menstrual periods

■ Needs urgent attention
■ Metrorrhagia may be a sign of an underlying disorder, such as hormone imbalance,
endometriosis, uterine fibroids or, less commonly, cancer of the uterus.
■ Metrorrhagia may cause significant anaemia.

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Polymenorrhoea
■ The average menstrual cycle is 28 days long. Cycles can range anywhere from 21 to 35
days in adults and from 21 to 45 days in young teens.
■ Polymenorrhoea is the medical term for cycles with intervals of 21 days or fewer.
■ Causes:
– Stress
– STD’s
– Menopause
– Endometriosis
– Other causes include hyperactivity of the anterior pituitary gland causing frequent
ovulation, malnutrition, chronic pelvic inflammation, and very rarely, cancer of the
female reproductive organs.
– shortening of the follicular phase (first phase of the cycle), and the corpus luteum
phase flows regularly
– shortening of the luteal phase (the second phase of the cycle)

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Phases of the normal menstrual cycle

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Postmenopausal bleeding
■ Occurs at least 6 months after menopause
■ Associated with malignancy
■ Must be investigated urgently
■ Health info:
– Report vaginal bleeding not in line with menstruation cycle
– Imbalance in hormones- must be attended to urgently
– Menstrual calendar
– Diet must be rich in protein and iron to prevent anaemia

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Menopause

■ A natural decline in reproductive hormones when a woman reaches her 40s

or 50s.
■ Common symptoms include hot flashes and vaginal dryness. There may also
be sleep disturbances. The combination of these symptoms can cause
anxiety or depression.
■ Menopause is a natural process with treatments that focus on symptomatic
relief. Vaginal dryness is treated with topical lubricants or oestrogen.
Medications can reduce the severity and frequency of hot flushes. In special
circumstances, oral hormone therapy may be used.

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Menopause:
Nursing management
■ Psychological issues
■ Feelings of loss
■ At risk for developing cancers
■ Sensitive to feelings
■ Support
■ Nutrition
■ Exercise

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Menopause:
Pharmacological management
■ Hormone replacement therapy
– Estrogen supplementation benefits: lowers risk of developing heart
disease
– Protect against osteoporosis—bone loss that increases with age—
especially after menopause.
■ Hot flushes
– Women of all ages may have low estrogen, and they don't always
have hot flashes. Rather, it's the decrease in estrogen during
menopause that experts believe to be the cause of hot flashes
■ Promote comfort
■ Bone loss as explained above

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Menopause:
Essential health information
■ Diet
■ Water intake
■ Breast self examinations
■ Report findings
■ Prescribed medication
■ Osteoporosis
– A condition in which bones become weak and brittle.

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 Endometriosis
■ A disorder in which tissue that normally lines the uterus grows outside the uterus.
■ Rare condition because the endometrium is shielded from bacteria by:
– The acid barrier of the vagina
– The cervical mucus plug
■ The mucus plug serves to protect the uterus and the fetus by preventing bacteria from entering the
uterus. The mucus plus can be clear or slightly pink in color and can be tinged with brown or red
blood. As the cervix slowly begins to dilate prior to the onset of labor, the mucus plug is expelled.
– The constant shedding of the endometrium with each menstrual period

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Endometriosis: Symptoms
■ Painful periods (dysmenorrhea).
– Pelvic pain and cramping may begin before the period and extend several days into
the period
– Lower back and abdominal pain are common.
■ Pain with intercourse.
– Pain during or after sex is common with endometriosis.
■ Pain with bowel movements or urination.
■ Excessive bleeding.
■ Infertility.
– Endometriosis is first diagnosed in some women who are seeking treatment for
infertility.
■ Other symptoms
– fatigue, diarrhoea, constipation, bloating or nausea, especially during menstrual
periods.
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Endometriosis: Causes
■ Retrograde menstruation.
– Flowback of cells in the fallopian tubes.
■ Transformation of peritoneal cells.
– When peritoneal cells — cells that line the inner side of your abdomen are transformed into
endometrial cells.
■ Embryonic cell transformation.
– Hormones such as estrogen may transform embryonic cells — cells in the earliest stages of
development — into endometrial cell implants during puberty.
■ Surgical scar implantation.
– After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a
surgical incision.
■ Endometrial cells transport.
– The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other
parts of the body.
■ Immune system disorder.
– It's possible that a problem with the immune system may make the body unable to recognize
and destroy endometrial tissue that's growing outside the uterus.

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Endometriosis: Risk factors
■ Never giving birth
■ Starting of period at an early age
■ Going through menopause at an older age
■ Short menstrual cycles — for instance, less than 27 days
■ Having higher levels of oestrogen in the body or a greater lifetime exposure to oestrogen the body
produces
■ Low body mass index
■ Alcohol consumption
■ Hereditary
■ Any medical condition that prevents the normal passage of menstrual flow out of the body
■ Uterine abnormalities
■ Complications: infertility and ovarian cancer

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Endometriosis: Management
■ Analgesics
■ Contraceptives
■ Pregnancy
■ Hormone therapy
■ Hysterectomy

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Ovarian cysts

■ A solid or fluid-filled sac or pocket (cyst) within or on the surface of an ovary.

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Ovarian cysts
Symptoms
■ Most cysts don't cause symptoms and go away on their own. However, a large
ovarian cyst can cause:

■ Pelvic pain — a dull or sharp ache in the lower abdomen on the side of the cyst
■ Fullness or heaviness in your abdomen
■ Bloating

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Ovarian cysts
Risk factors
■ Hormonal problems.
– Fertility drugs.
■ Pregnancy.
– Sometimes, the cyst that forms when ovulating stays on the ovary throughout a
pregnancy.
■ Endometriosis.
– This condition causes uterine endometrial cells to grow outside the uterus. Some of
the tissue can attach to the ovary and form a growth.
■ A severe pelvic infection.
– If the infection spreads to the ovaries, it can cause cysts.
■ A previous ovarian cyst.
– likely to develop more if had before.

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Ovarian cysts
Complications
■ Ovarian torsion.
– Cysts that enlarge can cause the ovary to move, increasing the chance of
painful twisting of your ovary (ovarian torsion). Symptoms can include an
abrupt onset of severe pelvic pain, nausea and vomiting. Ovarian torsion can
also decrease or stop blood flow to the ovaries.
■ Rupture.
– A cyst that ruptures can cause severe pain and internal bleeding. The larger
the cyst, the greater the risk of rupture. Vigorous activity that affects the pelvis,
such as vaginal intercourse, also increases the risk.

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Ovarian cysts
Diagnosis & Treatment
■ Pregnancy test.
– A positive test might suggest a cyst.
■ Pelvic ultrasound.
– A wand like device (transducer) sends and receives high-frequency sound waves
(ultrasound) to create an image of the uterus and ovaries on a video screen.
■ Laparoscopy.
– Using a laparoscope — a slim, lighted instrument inserted into the abdomen
through a small incision.
■ CA 125 blood test.
– Blood levels of a protein called cancer antigen 125 (CA 125) often are elevated in
women with ovarian cancer. If the cyst is partially solid and the patient is at high
risk of ovarian cancer, your doctor might order this test.
– Elevated CA 125 levels can also occur in noncancerous conditions, such as
endometriosis, uterine fibroids and pelvic inflammatory disease.

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Ovarian cysts
Diagnosis & Treatment
■ The doctor will likely recommend that the patient gets a follow-up pelvic ultrasound
at intervals to see if the cyst changes in size.

■ Medication.
■ Surgery.

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 Diagnostic tests: Mammogram
■ Mammography is the process of using low-energy X-rays to examine the human
breast for diagnosis and screening. The goal of mammography is the early detection
of breast cancer, typically through detection of characteristic masses or micro
calcifications.

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 Diagnostic tests: Ultrasound
■ Ultrasound is sound waves with frequencies higher than the upper audible limit of
human hearing. Ultrasound is not different from "normal" sound in its physical
properties, except in that humans cannot hear it.

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 Diagnostic tests: Biopsy
■ A biopsy is a medical test commonly performed by a surgeon, interventional
radiologist, or an interventional cardiologist involving extraction of sample cells or
tissues for examination to determine the presence or extent of a disease.

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Fibrocystic breast
■ Changes that give a breast a lumpy or ropelike texture.
■ Fibrocystic: characterized by the development of fibrous tissue and cystic spaces,
typically in the pancreas or the breast.

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Fibrocystic breast: Causes

■ Fluctuating hormone levels during the menstrual cycle

can cause breast discomfort and areas of lumpy breast
tissue that feel tender, sore and swollen.
■ Fibrocystic breast changes tend to be more bothersome
before your menstrual period, and the pain and
lumpiness tends to clear up or lessen once your
menstrual period begins.

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Fibrocystic breast: Symptoms
■ Breast lumps or areas of thickening that tend to blend into the surrounding breast
tissue
■ Generalized breast pain or tenderness
■ Breast lumps that fluctuate in size with the menstrual cycle
■ Green or dark brown nonblood nipple discharge that tends to leak without pressure
or squeezing
■ Breast changes that are similar in both breasts
■ Monthly increase in breast pain or lumpiness from midcycle (ovulation) to just before
your period

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Fibrocystic breast:
Diagnosis & treatment
■ Breast exam
■ Ultrasound
■ Mammogram
■ Fine needle aspiration
■ Breast biopsy
■ Biopsy is the procedure to remove a small amount of suspicious tissue from the breast
with a larger “core” (meaning “hollow”) needle. It is usually performed while the patient
is under local anesthesia, meaning the breast is numbed. As with fine-needle aspiration,
this may involve ultrasound.

– Home remedies, evening primrose oil & Vit E

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Fibro adenoma

■ A non-cancerous breast tumour that most often occurs in young women.

■ Reproductive hormones may cause fibroadenomas.
■ A fibroadenoma feels like a firm, smooth or rubbery lump in the breast with a well-
defined shape. It's painless and moves easily when touched. Although healthy
breast tissue often feels lumpy, a new lump or change in the breasts should be
looked at by a doctor.
■ Treatment may include monitoring for changes in the size or feel, a biopsy to
evaluate it or surgery to remove it.

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Breast cancer

■ Leading cause of death in women over the age of 50

■ Breast self examination important
■ Early detection
■ Improve detection
■ Genetic
■ Hormonal
■ Oral contraceptives

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Breast cancer: Risk factors

■ Age
■ Family history
■ Alcohol consumption
■ High fat diet
■ History of other cancers

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Breast cancer:
Assessment and common findings
■ WARING SIGNS:
– Next page

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Breast cancer:
Assessment and common findings
■ WARING SIGNS:

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Breast cancer:
Management
■ Depending on stage
■ Even though chemotherapy is recommended for systemic treatment, surgical
management is the most widely used management.
■ Chemotherapy is administered to eradicate the spread of disease
■ Radiation can also affect healthy cells, however, normal cells can repair themselves,
while cancer cells cannot. Radiation therapy differs from chemotherapy — it is used
to treat just the tumor, so it affects only the part of the body that has cancer.

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Breast cancer:
Surgical Management
■ Lumpectomy
– Lumpectomy is surgery to
remove cancer or other
abnormal tissue from your
breast. Lumpectomy is also
called breast-conserving
surgery.
■ Mastectomy
– A mastectomy is surgery to
remove a breast. In the past, a
radical mastectomy with
complete removal of the breast
was the standard treatment for
breast cancer.

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Premastectomy nursing management
■ Provide patient information about:
– The tumour, its location and size
– The spread
– Surgery, chemotherapy & radiotherapy
– Methods to compensate for physical changes
– Duration & frequency of treatment, side effects and their management
■ Introduce to the oncology team
■ Postoperative bodily exercises can be introduced

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 Post mastectomy nursing management
■ Evaluate intensity of pain, relief pain & assess
■ Ensure that inserted drain is working
– Surgeries which require drains are those in which fluid is expected to collect
during healing.
■ Elevate affected arm to prevent oedema
■ Comfortable position
■ Apply heat to promote comfort
■ Commence arm exercises early to facilitate circulation, prevent congestion and
oedema and promote comfort and healing

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Post mastectomy exercises

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Reconstructive breast surgery
■ Breast reconstruction surgery is the creation of a new breast shape, or mound,
using surgery.
■ It may be done after removal of a whole breast (mastectomy) or part of the breast
(breast-conserving surgery).
■ Reconstruction can be done at the same time as breast cancer surgery (immediate
reconstruction), or months or years later (delayed reconstruction).
■ There are three general options for breast reconstruction. One method is to use a
breast implant, the second is to use the patient’s own tissue and the third combines
both an implant and tissue.

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Reference list

■ https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-
causes/syc-20354656
■ https://www.menstrupedia.com/articles/physiology/cycle-phases
■ https://za.pinterest.com/pin/297659856614599891/
■ https://bestdoctors.com/blog/2017/10/06/staying-step-ahead-osteoporosis/
■ http://www.inboundwriter.com/health/what-is-breast-cancer-lumpectomy-2/

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