Menstrual Disorders

Abdulkadir U. Yusuf Tsangaya

Kano State Collage of
Nursing Science
(School of Nursing Kano)
 Menstrual Disorders
 Disorders of menstruation may present as abnormal uterine bleeding (AUB). WHICH
includes the following;
 Premenstrual syndrome (PMS); dysmenorrhea; amenorrhea; and excessive bleeding,
irregular bleeding, or bleeding between cycles or unrelated to cycle.
 These problems need to be discussed with a health care provider and managed
individually.
 Menstrual-related disorders have been reported in as many as 19% of women who report
feeling more anxious, sad, nervous, restless, hopeless, and worthless than those without
complaints.
 Menarche
 Menarche; Is first onset of menstruation in a girls who reach puberty around the age of 10-
13yrs. But it varies due to so many factors such as environment, nutrition, parental,
culture, diseases condition etc..
 The median age of menarche is 12.43 years, with only 10% of females menstruating at 11
years and 90% by 13.75 years.
Psychosocial Considerations in girls who are reached menarche
 Girls who are approaching menarche (the onset of menstruation) should be instructed
about the normal process of the menstrual cycle before it occurs. Psychologically, it is
much healthier and appropriate to refer to this event as a “period” rather than as “being
sick.”
 With adequate nutrition, rest, and exercise, most women feel little discomfort, although
some report breast tenderness and a feeling of fullness 1 or 2 days before menstruation
begins.
 Psychosocial consideration cont.
 Others report fatigue and some discomfort in the lower back, legs, and pelvis on the first
day and temperament or mood changes.
 Slight deviations from a usual pattern of daily living are considered normal, but excessive
deviation may require evaluation.
 To manage these the following should be considered
 Regular exercise and a healthy diet have been found to decrease discomfort for some
women.
 Heating pads or nonsteroidal anti-inflammatory drugs
 Cultural Considerations
Cultural views and beliefs about menstruation differ according to community, cultural
group
 Some women believe that it is detrimental to change a pad Or tampon too frequently; they
think that allowing the discharge to accumulate increases the flow, which is considered
desirable.
 Some women believe they are vulnerable to illness during menstruation.
 Others believe it is harmful to swim, shower, have their hair permed,, or eat certain foods
during menstruation.
 In such situations, nurses are in a position to provide women with facts in an accepting and
culturally sensitive manner.
 The objective is to be mindful of these unexpressed, deep-rooted beliefs and to provide the
facts with care
 Perimenopause
 Perimenopause is the period extending from the first signs of menopause—usually hot
flashes, vaginal dryness, or irregular menses to beyond the complete cessation of menses.
 It has also been defined as the period around menopause, lasting to 1 year after the last
menstrual period.
Nursing Management
 Perimenopausal women often benefit from information about the subtle physiologic
changes they are experiencing
 Perimenopause has been described as an opportune time for teaching women about health
promotion and disease prevention strategies
 Mgt. cont.
 When discussing health-related concerns with these women, nurses should consider the
following issues:
• Sexuality, fertility, contraception, and STDs
• Unintended pregnancy (if contraception is not used correctly and consistently)
• Oral contraceptive use. Oral contraceptives provide
 perimenopausal women with protection against uterine cancer, ovarian cancer, anemia,
pregnancy, and fibrocystic breast changes as well as relief from perimenopausal symptoms.
 This option should be discussed with perimenopausal women. (Women who smoke and are
35 years of age or older should not take oral contraceptives because of an increased risk of
cardiovascular disease.)
 Menopause
Menopause is the permanent physiologic cessation of menses associated with declining ovarian
function; during this time, reproductive function diminishes and ends.
Post menopause is the period beginning from about 1 year after menses cease.
Menopause may be associated with some atrophy of breast tissue and genital organs, loss in
bone density, and vascular changes.
 Menopause starts gradually and is usually signaled by changes in menstruation.
 The monthly flow may increase or decrease, become irregular, and finally cease.
 Clinical presentation
 Because of these hormonal changes, some women notice irregular menses, breast
tenderness, and mood changes long before menopause occurs.
Some of the manifestations are;
 Hot or warm flashes and night sweats reported by some women
 profuse night sweating, causing discomfort, sleep disturbances, and subsequent fatigue.
 increased bone loss (osteoporosis)
 Changes in the vulvovaginal area may include a gradual thinning of pubic hair and a
gradual shrinkage of the labia.
 Vaginal secretions decrease, and women may report dyspareunia (discomfort during
intercourse).
 The vaginal pH increases during menopause, predisposing women to bacterial infections
Clinical presentation cont.
 And atrophic vaginitis. Discharge, itching, and vulvar burning may result.
 Fatigue, forgetfulness, weight gain, irritability, trouble sleeping, feeling “blue,” and
feelings of panic.
 Hot flashes or flushes (most common)
 Insomnia
 Weight gain and bloating

N.B.
 Menopausal complaints need to be evaluated carefully because they may indicate
other disorders.
 Most women have few problems and are relieved to be free from menstrual periods
Management
Treatment options for preventing fractures
Calcium
Vitamin D
Calcitonin
Monoclonal antibodies
 Hormonal medications Estrogen therapy (considered a second-line therapy for
osteoporosis)
 Nursing Management
Nurses can encourage women to view menopause as a
 Natural change resulting in freedom from symptoms related to menses.
 No relationship exists between menopause and mental health problems;
 Measures should be taken to promote general health.
 The nurse explains to the client that cessation of menses is a normal occurrence that is
rarely accompanied by nervous symptoms or illness.
 The nurse also the client that the current expected lifespan after menopause for the
average woman is 30 to 35 years, which may encompass as many years as the
childbearing phase of her life.
 Normal sexual urges continue, and women retain In their usual response to sex long after
menopause
Premenstrual symptoms (PMS)

 Premenstrual symptoms are common in ovulating women and can influence quality of
life.
 Symptoms occur in the luteal phase and disappear with the onset of menses.
 PMS is a combination of bothersome symptoms, and premenstrual dysphoric disorder
is a severe type of premenstrual disorder that significantly impairs normal
 The cause of these conditions is unknown; they are diagnosed if symptoms occur
during the 5 days prior to the onset of menses, disappear within 4 days of the onset of
menses, and occur through several cycles.
 PMS tends to become less symptomatic with menopause.
 Clinical Manifestations
Major symptoms of PMS include
Behavioral and emotional symptoms
physical symptoms such as
may include
 Headache,  General irritability,
 Fatigue,  Mood swings,
 Low back pain,  Fear of losing control,
 Painful breasts, and a  Binge eating, and
 feeling of abdominal fullness.  Crying spells.
N.B N.B
 Generally stressful life and problematic  Symptoms vary widely from one woman
relationships may be related to the to another and from one cycle to the
intensity of physical symptoms. next in the same woman.
 PMS may also be a factor in reducing
productivity, work-related injuries, and
absenteeism
AMENORRHEA
Amenorrhea (absence of menstrual flow) is a symptom of variety of disorders and
dysfunctions.
It Can be either primary or secondary.
 Primary amenorrhea: is defined as either
(a) the lack of menstruation by the age of 15 years (or within 3 years after thelarche)
with otherwise normal pubertal development or
(b) the lack of secondary sexual characteristics by the age of 13 years
Amenorrhea may be of considerable concern but often occurs as a result of minor
variations in body build, heredity, environment, and physical, mental, and emotional
development.
Causes
I. Anatomic defects – Müllerian agenesis, complete androgen insensitivity syndrome;
imperforate hymen; transverse vaginal septum
II. Primary hypogonadism - Gonadal dysgenesis: Turner syndrome (45,X), Swyer
syndrome (46,XY); gonadal agenesis
III. Hypothalamic causes - Dysfunctional (stress, exercise, diet, eating disorders);
IV. Pituitary causes - Tumors (prolactinoma, other hormone-secreting tumors)
V. Other endocrine gland disorders - Adrenal (adult-onset adrenal hyperplasia, Cushing
syndrome); thyroid disease; ovarian tumors
VI. Multifactorial/other causes - PCOS; constitutional delay, systemic illness
 Secondary Amenorrhea

 Secondary amenorrhea (an absence of menses for three cycles or 6

months after a normal menarche ) , though it is uncommon even in
adolescents to lack menses for more than 3 months.
May be caused by
 pregnancy
 emotional upset
 eating disorder, (such as anorexia and bulimia) or excessive exercise.
 Obesity
In adolescents, secondary amenorrhea can be caused by
 minor emotional upset related to being away from home, attending
college, tension due to schoolwork, or interpersonal problems.
 However, the second most common cause is pregnancy, so a pregnancy
test is almost always indicated.
Diagnosis
 Pregnancy test; measurement of serum urinary Hcg is recommended as a first step in
evaluation of a secondary amenorrhea
 A CBC count, urinalysis and serum chemistries should evaluated to rule out systemic
illness
 Hormonal studies may include (assay of prolactin, FSH, LH, estradiol, thyroid
hormones or androgen)
Imaging studies
Pelvic USS, MRI
Managements
 Hormones therapy (estrogen and progestin) needed in women with estrogen
deficiency or in young women who secondary sex characteristics failed to develop
 For secondary amenorrhea dopamine agonist is the only medical therapy
Nursing managements

 The nurse encourages the patient to express her concerns and anxiety about this
problem because the patient may feel that she is different from her peers.
 A complete physical examination, careful health history, and simple laboratory tests
help rule out possible causes, such as metabolic or endocrine disorders and systemic
diseases.
 Treatment is directed toward correcting any abnormalities
 Nutritional such as vitamin D to prevent osteoporosis
 Help the adolescent girls to formulate self-esteem and body images despite impaired
fertility.
 Adolescence encompasses a broad spectrum of emotional maturity which need to be
considered in assessment and treatment
Menorrhagia

Menorrhagia is prolonged or excessive bleeding at the time

of the regular menstrual flow.
 Is defined as blood loss exceeding 80 mL or bleeding that lasts longer
than 7 days each menstrual cycle.
 And when menorrhagia occurred from the onset of menarche, 65% of
women had a bleeding disorder.
Menorrhagia cont.

 In young women the cause is usually related to endocrine disturbance, whereas in

later life it usually results from inflammatory disturbances, tumors of the uterus, or
hormonal imbalance.
N.B
 Women with menorrhagia are urged to see a primary health care provider and to
describe the amount of bleeding by pad count and saturation (ie, absorbency of
perineal pad or tampon and number saturated hourly). Persistent heavy bleeding can
result in anemia.
 It can also be a sign of a bleeding disorder or a result of anticoagulant therapy.
 Hysterectomy can be challenging in these women; endometrial ablation has been
found to be less risky
Metrorrhagia
 Metrorrhagia (vaginal bleeding between regular menstrual periods) is probably the
most significant form of menstrual dysfunction because it may signal cancer, benign
tumors of the uterus, or other gynecologic problems.
 This condition warrants prompt evaluation and treatment.
 Although bleeding between menstrual periods by women taking oral contraceptives is
usually not serious, irregular bleeding by women taking HT should be evaluated.
 Menometrorrhagia is heavy vaginal bleeding between and during periods. It, too,
requires evaluation.
Dysmenorrhea

 Dysmenorrhea refer to the symptoms of painful menstruation.

 may be either primary or secondary.
 Primary dysmenorrhea occurs in the absence of any identifiable pathology and is
attributed to the production of prostaglandins during the menstrual cycle.
 Secondary dysmenorrhea occurs when there is an identifiable pelvic or hormonal
pathology causing pain.
 The most common gynecologic causes of secondary dysmenorrhea are endometriosis
and pelvic inflammatory disease (PID).
Postmenopausal Bleeding

 Postmenopausal Bleeding; Bleeding 1 year after menses cease at menopause must

be investigated, and a malignant condition must be considered until proven otherwise.
 A vaginal ultrasound can be used to measure the thickness of the endometrial lining.
 The uterine lining in postmenopausal women should be thin because of low estrogen
levels.
 A lining thicker than 5 mm usually warrants evaluation by endometrial biopsy or a D
& C.
Dyspareunia

Dyspareunia (difficult or painful intercourse) can be superficial, deep, primary, or

secondary
 and may occur at the beginning of, during, or after intercourse.
 Dyspareunia may be related to many factors, including injury during childbirth; lack of
vaginal lubrication; a history of incest, sexual abuse, or assault; endometriosis; pelvic
infection; vaginal atrophy with menopause;
 gastrointestinal disorders; fibroids; urinary tract infection; STDs; or vulvodynia (vulvar
pain that affects women of all ages without any discernible physical cause).
 Depending on age/cause of dyspareunia, counseling, extra lubrication, or
antidepressants may be prescribed.
 Women’s health issues related to sexuality may be affected by many factors.
 Thus, these issues need to be taken seriously, carefully assessed, and treated.
Questions if any?
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