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Women-s Health Final Review NSG 6430 Check-Question and Answers
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10/7/24, 4:57 AMWomen's Health Final Review NSG 6430
Jeremiah
Terms in this set (75)
Absence of menses: by age 15 years
Primary Amenorrhea Often secondary to: dysfunction in the hypothalamus, pituitary, ovaries (HPO
axis), uterus, or vagina
Painful cramping: associated with menstruation caused by spasmodic uterine
contractions
DYSMENORRHEA Most common GYN problem: in adolescents & adult females
HISTORY: is KEY!!!
Primary versus Secondary
CAUSE: Excessive Prostaglandins
ONSET: in adolescence
Primary Dysmenorrhea: Absence of pelvic PAIN: starts 1-2 days prior to onset of menses or with menses, resolving over
pathology 12-72 hours
ASSOCIATED: with nausea, diarrhea, dizziness, fatigue, HA, back pain
IMPROVES: with NSAIDs, hormonal contraceptives, AGE & PARITY
ONSET: Usually after age 25 years
Abnormal uterine bleeding (AUB)
Secondary Dysmenorrhea: Presence of Variable SX: N, V, D, back pain
Pelvic Pathology Dyspareunia: (esp. w/Endometriosis)
Symptoms: OFTEN worsen over time
Causes: Endometriosis, fibroids, infection/PID, adenomyosis, etc.
Get a good history: (medical & menstrual)
Physical exam: to identify a cause
Pelvic exam: may defer if young, non-sexually active adolescents with mild
Dysmenorrhea Management symptoms
Consider pelvic US: to look for adnexal masses, fibroids, other pelvic
pathology
If secondary, address underlying cause.
HEAT: to lower abdomen = Oral Analgesics
Dysmenorrhea Non-Pharm Management
EXERCISE: improves symptoms
1/9
, 10/7/24, 4:57 AM
NSAIDs: 80-86% efficacy
o Start at onset of menses for x 1-2+ days
o If no relief, consider starting 1-2+ days before
Combination Hormonal Contraceptives (CHC)
Dysmenorrhea Pharm Management
Consider BOTH, if no relief with NSAIDs
Intrauterine Contraceptive (IUC): Hormonal
o Mirena or Skyla (smaller) with Levonorgestrel
If NO relief, consider SECONDARY CAUSE
Comprehensive, focused history
Many causes: PALM-COEIN classification
Consider DIFFERENTIAL by AGE & HISTORY
ABNORMAL UTERINE BLEEDING (AUB)
Post-menopausal:
o Any bleeding beyond 12 months since LMP o Even "1 drop of blood" is concerning
o Must REFER to OBGYN to R/o cancer
Structural
P
Polyps:
> 30 years
A
Adenomyosis:
> 30
L
Leiomyoma/Fibroids:
> 30
M
Malignancy/Hyperplasia:
> 40 (Obesity, DM, PCOS, > 50 yr)
Non Structural
Classification/Differential: PALM-COEIN
C
Coagulopathy:
Any age
O
Ovulatory Dysfunction:
Any age
E
Endometrial Disorders:
Any age
I
Iatrogenic, Medications:
Any age
N
Not Classified
2/9
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