Women With Reproductive System Disorders

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Fibrocystic breast changes

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Breast tissue changing in response to hormonal, nutritional, physical, and/or environmental stimult

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When do fibrocystic breast changes usually occur

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30-50 yrs of age

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Pharm- FBC

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OC, progesterone, synthetic androgen, tamoxifen, vit-E, special diets

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Most common cancer in woman

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Breast Cancer

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Most significant risk factors

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Female, over 50, + fam history,

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Breast Cancer gene

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BRCA1 BRCA2

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Most common type of breast cancer

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Invasive ductal carcinoma 75-85%

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Metastasis of breast cancer

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bloodstream of lymphatic system

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sites of metastasis of breast cancer

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bone, brain, lung, liver, skin, and lymph nodes

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Screening age 20-39

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clinical breast exam q 3 yrs

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Screening age 40+

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clinical breast exam q year

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Screening age 40+

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Mammogram q year for as long as the woman is in good health

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Diagnostic test for breast cancer

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Mammogram, ultrasound, MRI, PET, Biopsy

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Types of biopsies

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Aspiration
Incisional
Excisional
Core
Sentinel node biopsy

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When is radiation used in breast cancer

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if lymph node involved, chest wall involved, chest wall involved, or tumor larger than 5cm

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Types if breast surgeries

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Radical mastectomy
Modified radical mastectomy
simple mastectomy
segmental or lumpectomy
reconstruction surgery

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Txn: for breast cancer

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Tamoxifen- anti-estrogen
Chemotherapy
Surgery

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Cyst

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fluid filled sac.

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Polyp

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Vascular solid tumor attached by a stem.

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Cyst/Polyps can occur:

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in the vulva, cervix, endometrium,or ovary

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Bartholin Cyst

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most common in the vulva. Caused by infection or obstruction

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Cervical Polyp

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Most common benign cervical. Usually in ppl over age. Possibly develops from endocervical hyperplasia. At vaginal end of cervix

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Endometrial cyst/polyps

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Caused by endometrial overgrowth and often filled w/ old blood (chocolate cyst) polyps are untrauterine growths.

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Ovarian cyst (PCOS)

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numerous follicular cyst

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Diagnostic test of benign cyst and polyps

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WBC & LH level, pregnancy test, laparoscopy, C&S, u/s, x-ray

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Pharm:

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ATB, OC

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Surgery

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Cervical polyp removal
Endometrial polyp removal by transcervical approach
Bartholins Cyst- I&D
Ovarian cys- cystectomy, oopherectomy

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PMS

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Recurrent symptoms days before menstruation
Common age - 30-40
25-30% report symptoms

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Affective symptoms

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Psychological
irritability depression

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Somatic symptoms

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cramping
fatigue

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Pharmacology

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Multi-V
vit-E
Calcium
Magnesium
NSAID'S
OC's
Antidepressants
Anxiolytics
Diuretics

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DUB

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Vaginal Bleeding- usually painless but abnormal in amount, duration, or timing.

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Most frequently reported healthcare problem

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DUB

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Leading cause of hysterectomy

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DUB

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Possible causes of DUB

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stress, wt. change, OC and IUD use, hormonal imbalance, PCOS, steroid therapy, hypothyroidism, etc.

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Diagnostic and lab testing for DUB

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CBC, PT, thyroid function test, endocrine work up, progesterone levels, pap, hCG, pelvis u/s, hysteroscopy, endometrial bx, menstrua history, basal body temp for several months.

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Pharmacology DUB

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estrogen, progestin, OC's, NSAID's, levonorgestrel-20 intrauterine device, iron salts

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Surgery DUB

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D&C
Endometrial ablation
Hysterectomy

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Dysmenorrhea

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Painful menstruation
>50% of woman, increase prostaglandin production by endometrium causing muscle fibers to contract.

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Diagnostic and lab testing for dysmenorrhea

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pap, cultures, CBC, UA, FSH, LH, progesterone, estradiol, thyroid, vaginal/pelvic u/s, CT, MRI, sed rate, guaiac stool, laparoscopy, D&C

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Pharm:
Lifestyle changes:

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NSAID'S, COX- inhibitors, OC's
diet, exercise, wt. loss, relaxation, smoking cessation

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Amenorrhea

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Absence of menses during reproductive year.

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Primary amenorrhea

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abscence by 14 w/ absence of development of secondary sex chararistics or absence by 16 w/ normal development.

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Etiology of amenorrhea

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Primary: extreme wt. gain/loss, congenital, stress, increase exercise, eating disorders, PCOS, cushings disease, hypothyroidism, chronic illness
Secondary: pregnancy, lactation, stress, certain tumors, depression, rapid wt. change, early menopause.

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Secondary amenorrhea

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absence for 3 cycles or 6 months when woman was regular.

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Diagnostic and lab testing for pt w/ amenorrhea includes

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H&P, physical assesment, karyotype, u/s, hCG, throid function test, prolactin, FSH, LH, 17-ketosteroids, laparoscopy, CT of head to see pituitary.

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Txn for secondary amenorrhea

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progesterone, bromocriptine, GnRH, thyroid replace

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Menopause (climacteric)

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Permanant cessation of menses
between 35-58
average 50

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Causes of menopause can be

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Natural biologic, surgical, or chemical

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Manifestations of menopause

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affects brain, breasts, cardiovascular, skeletal, GU, GI, integumentary and body shape

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Benefits of HRT

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Lowers the risk of CAD by 50%
Reduce the risk of bone loss & osteoporosis

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Risk and side effects of HRT

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Change in vaginal bleeding pattern, breast tenderness/engorgement, HA, depression, chest pain, GB disease, GI distress, endometrial/ovarian CA, and breast CA

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Increase risk of chest pain and heart attack

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increased by 29%

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Pelvic Organ Prolase degrees

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1st degree- prolapse into vaginal canal
2nd degree- cervix descends into vaginal introitus (procidentia)
3rd degree- Cervix below vaginal introitus

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Cause of Pelvic Organ Prolapse

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erect posture, aging, decrease in estrogen, childbirth, surgery, pelvic radiation, and increased abdominal pressure.

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Collaborative care

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H&P
Txn: Kegals, ERT, lifestyle changes, and pessasaries

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Cystocele

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Txn: anterior colporrhaphy, MMK
shortens the pelvic muscles, suport for the bladder

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Rectocele

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Txn: posterior colporrhaphy
shortens the pelvic muscles, to aid in support of the rectum

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Prolapsed Uterus

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repositioned and muscles shortened to provide support; hysterectomy

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Uterine Fibroid Tumors (leiomyomas)

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solid pedunculated benign tumors 50% in women older than 30. Most common indication for hystercomy in U.S.

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Positions of leiomymomas

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Intramural, sub-serous, or submucous.

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Symptoms of leiomymomas

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pelvic pain, low back pain, bloating, infertility, dysmenorrhea, dyspareunia, anemia, and feeling "heavy"

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Txn:

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GnRH agonist, uterine artery embolization, myomectomy,laser surgery, and hysterectomy.

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Postmenopausal calcium intake

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1200-1500mg daily

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Vitamin D intake

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400-600 iu daily

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Vitamin E intake

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100mg daily

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Vaginal Fistulas

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Abnormal opening/passage between two organs or spaces normally seperated or abnormal passafe outside of the body

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Diagnosed:

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by pelvic examination; dye into the bladder to help identify vesicovagina fistula.

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Cancer is the __ leading cause of death for women in the united states.

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2nd

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Assessment of pt w/ cancer includes

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health history (personal and family)
Physical exam
Laboratory and diagnostic testing

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Most common gynecological cancer in the u.s

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Endometrial/Uterine Cancer

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Average age of pts w/ endometrial cancer

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50-70

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95% of endometrial cancers are ___

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carcinomas

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Risk factors for endometrial cancer

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Early menarche, late menopause, h/o infertility, anovulation, nulliparity, extened use of tamoxifen(anti-estrogen hormone), obesity, diabetes, and hight fat diet.

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Endometrial cancer can metastisize to:

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Lungs, inguinal/supraclavicular nodes, brain, vagina, liver, and bone

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Laboratory and diagnostic testing

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Vaginal u/s, CBC, endometrial biopsy

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Pharm

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Progesterone therapy for recurrent disease.

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surgery:

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TAH&BSO, radical hysterectomy w/ node disesction

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Cervical cancer 5 yr survival rate

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73%

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Median age when diagnosed

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47 (ages 35-50)

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More than 90% is caused by

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HPV

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Risk factors for cervical cancer

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early 1st intercourse, low socioeconomic status, promiscuous male partners, unprotected sex, family history, sec w/ uncircumcised male, smoking HIV, OC, etc.

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Gardasil Vaccine prevents wich strains of HPV

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6,11,16,18 9-26 yrs old for vaccine

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Testing for cervical cancer

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pap, colposcopy & biopsy, MRI, CT

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PHARM:

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Chemotherapy used for tumors not respomsive to other therapy, tumors than cannot be removed, or as adjunct therapy.

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Surgery:

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laser surgery with colposcopy, cryosurgery, conization, hysterectomy, pelvic, or anterior exenteration.

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Vaginal Cancer

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Rare malignant tissue growth arising in vagina <3% of genital cancers
2000 new cases 800 deaths peak age 60-65

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About 85% are

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squamous cell carcinomas

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Txn of Vaginal cancers

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radiation, laser surgery

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Ovarian cancer is the 2nd most common gynecological cancer

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True

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Common age for ovarian cancer

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55-75

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Ovarian cancer risk factors

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+ family history, advancing age, late 1st pregnancy, nulliparity, history of breast CA, long term HRT use, BRCA1 and BRCA2

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90% of Ovarian tumors are

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epithelial tumors

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Laboratory and diagnostic testing of ovarian CA

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laparoscopy, pap, CA125, BE, proctoscopy, IVP, u/s, CT, X-ray,

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pharmacology for ovarian cancer

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Chemotherapy may be used to achieve remission. Taxol may be effective.

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Surgery for ovarian cancer

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Removal of one ovary, total hysterectomy w/ BSO and removal of omentum, second look in 6 mths.

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Endometriosis
(diagnostic and laboratory testing)

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pelvic u/s, CBCw/ diff, laparoscopy w/ biopsy

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Cancer of the Vulva

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4th most common gynecologucal cancer. usually after age 60

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5 yr survival if vulva

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85-90% if early

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Surgery for vulvar cancer

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laser surgery, cryosurgery, electrocautery, vulvectomy (skinning, simple, or radical.

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PID

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Inflammation of the uterine tubes, ovaries, cervix, uterus, & peritoneum.

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Number of hospital stays/ yr

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200,000

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Manifestations of PID

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high fever, vaginal discharge, severe lower abd pain, nausea, malaise, dysuria, infertility, & increased risk of ectopic pregnancy, abscess, dyspareunia, dysmenorrhea.

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Laboratory and Diagnostic test for PID

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clinical exam, CBC, endocervical or cervical culture, laparoscopy, or laparotomy.

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Pharmacology for PID

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combination ATB therapy,
Tetracycline, PCN, quinolones, cephalosporins.

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Surgery of PID

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drain abscess, remove adhesions, hysterectomy

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Toxic shock syndrome

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Rare acute caused by staphylococcus aures r/t tampon use

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Testing for Toxic shock syndrome

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WBC, Bun, Creat, SGOT, SGPT, platelet count, vaginal and blood culture

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Pharmacology for toxic shock syndrome

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IV beta-lactamase-resistent ATB

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Primary cause of dysmenorrhea

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Endometriosis

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Destroys uterine lining

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Endometrial ablation

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Biggest risk factor for cervical cancer

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+family history

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#1 txn for vulva CA

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vulvectomy

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Post menopausal bleeding is usually caused by

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HRT

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Pts not on HRT need to take in atleast _____ of vit-D

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400-600 iu

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Menstrual cycle lasting longer than 35 days

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Oligomenorrhea

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Endometriosis is the most common gynecological diagnosis responsible for hospitalization of females in which age group?

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15-44 yr olds

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Which procedure is done to visualize the pelvic cavity to assist in making a diagnosis of endometriosis

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laparoscopy

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Of the wimen referred to endometriosis centers what percentage had dysmenorrhea?

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75%

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One of the most common sites for endometrial lesions are the

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ovaries

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Anti-estrogen drug used to treat estrogen receptor + breast CA

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Tamoxifen (Nolvadex)

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Prevents estrogen from being made in the body

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aromatase inhibitors

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Aromatase Inhibitors

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anastrozole (Arimidex)
letrozole (Femara)
exemestane (Aromasin)

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Drug that works by bnding to estrogen receptors and changing their shape

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fulvestrant (Faslodex)

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Drugs that interferen with estogen's ability to fuel metastatic breast cancer growth include fluoxymestrone

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fluoxymestrone (Halotestin) and megestrol (Megace)