GYNOCOLOGICAL PROBLEMS A. BLEEDING PROBLEMS a. 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, if contraception needed: oral contraception. ii. Yoga, exercise, heat/cold, vit B6, Ca2+, Mg2+ & protein, limit sodium b. 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 & pneumonia c. 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) & GnRH agonists 1. heat pad back/abdomen, relaxation techniques, yoga 2. 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)

B. PREMENSTRUAL SYNDROME- collection symptoms occurs luteal phase cycle. Affects 3040yr, 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. Take Ca2+, 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 wall a. s/s urinary retention, frequency & urgency; UTI, stress incontinence b. bladder scan, check residual c. tx: pessary to support bladder, estrogen therapy, kegals, anterior colporrhaphy (surgery) D. RECTOCELE- protrusion rectum through weakened vaginal wall a. s/s:constipation, impaction, rectal/vaginal fullness b. tx: posterior colporrhaphy E. FISTULA-abnormal opening between organs a. Leakage flatus, urine or feces, bad odour i. Assist w/ personal hygiene: sitz baths, perineal care, douching b. Most heal on own, if not Fistulectomyileal conduit or temporary colostomy. i. Low-residual diet & stool softeners for 2 wks after repair F. MENOPAUSE- end periods, marked increase FSH(>35IU/L) & depletion estradiol a. Common early change is shortened time between periods b. Tx: HRT- lowest dose possible, antidepressants