Common Gyn Problems

Peyton Brown

What are Uterine Fibroids

What are fibroids?

Leiomyomas or myomas

Round growths that develop in the uterus

Almost always benign *The average age at diagnosis is 60 years

for a sarcoma-hard to distinguish

Can be as small as a pea or as big a melon

Unknown etiology but seems to occur more frequently in
African-Americans and also women whose family members also have them.
Up to 80% of women by age 50. 20-30% of those show symptoms

What are signs and symptoms?

Heavy Vaginal Bleeding

Pelvic Discomfort

Pelvic Pain

Bladder Problems

Low Back Pain

Rectal Pressure

Dyspareunia

Fibroids Cont

How are fibroids diagnosed?

Ultrasound

Saline Hysterosonography

Magnetic Resonance Imaging (MRI)

Hysteroscopy

How are fibroids treated?

Unless fibroids are causing excessive bleeding,

discomfort or bladder problems, treatment usually isnt necessary.

Medications treat symptoms but do not make them go away.

Women with pressure symptoms wont benefit from any medications

Contraceptive pills and progestational agents (

GnRH agonists (before a myomectomy)

IUD-bleeding

Myomectomy

Abdominal, laparoscopic, hysteroscopic

Hysterectomy

Uterine Artery Embolization (UAE)

Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS)

AKA Stein-Leventhal Syndrome
A condition of imbalanced hormones that affects women
of childbearing age
Common reproductive health issue for women
Unknown cause
Possibly influenced by genetics
Women may have cysts in the ovaries, although there
should be many to be pathologic with PCOS
GnRH pulse frequency LH androgen
Blood tests are done to evaluate hormone levels in order
to diagnosis PCOS
Looking for abnormal levels of testosterone,
prolactin, FSH/LH, and others
Physical exam should also be done

Clinical Signs/Symptoms
Begins after menarche
Infertility
Irregular menstrual periods
Oligomenorrhea
Obesity
Hirsutism
Acne
Acanthosis nigricans
Skin tags
Alopecia

How is it treated?
No cure for PCOS
PCOS tends to be treated based on the symptoms that the patient presents
Infertility
First line treatment for ovulation induction: anti-estrogen clomiphene citrate (CC)
Improves secretion of gonadotropins
Exogenous gonadotropins: for whom CC treatment has failed
Oligomenorrhea
Combination of oral contraceptives: suppress the secretion of pituitary luteinizing
hormone and ovarian androgen; increases sex hormone-binding globulin
Hirsuitism
Spironolactone: diuretic, aldosterone antagonist, ovarian and adrenal
steroidogenesis inhibitor

Primary
No Menses by age 14 and
no secondary sex
characteristics OR
No menses by age 16 with
secondary sex
characteristics

Secondary Sex Characteristics

Primary
Possible Causes?
Body build, minimal fat
Hereditary, family history of delay
Pituitary function, lack of LH or FSH
Congenital absence of Vagina
Management
Treat the underlying condition
Provide emotional support

Secondary
No menses for 6
months in a woman
who normally has a
menstrual cycle

Secondary
Possible causes?
Pregnancy
Lack of ovarian production
Polycystic ovarian syndrome
Nutritional or endocrine disturbances
Uncontrolled diabetes
Heavy athletic activity
Emotional distress
Management
Treat underlying condition
Explain Cause

Toxic Shock Syndrome (TSS)

What is it?
Toxic shock syndrome is a serious infection caused by
Staphylococcus aureus or Streptococcus pyrogenes bacteria.
How do you get infected?
TSS was originally linked to the use of tampons, however
research on healthy tampon habits dropped the number of TSS
cases dramatically. Today, about half of TSS cases are due to
menstruation.
Tampons arent the only way to develop TSS. The contraceptive
sponge and diaphragm are both linked to TSS.
Anyone with a type of staph infection (pneumonia, skin or
wound infection, septicemia or osteomyelitis)
Strep bacteria related cases are due to bacteria entering
injured skin, surgical wounds or chickenpox blisters.

 Signs and Symptoms

Sudden high fever (at least 102F)
Sudden drop in blood pressure (feeling faint and
confused)
Diarrhea and vomiting
Headache
Rash (sunburn looking)
Muscle aches
Bloodshot eyes and redness inside the mouth (vaginal
area for women)
Wound may not appear infected

If TSS goes untreated, the liver and kidneys may begin to

fail and seizures, bleeding and heart failure may develop.

 Diagnosis
Take a sample from site of infection (nose, vagina or skin)
Blood sample
Blood tests to monitor kidney or liver function and to rule
out other causes.

Treatment
Start IV fluids and antibiotics
Remove tampon, contraceptive or wound packing and
clean the wound
Can be fatal, curable if recognized and treated early

Nursing Actions
The patient will usually be in the hospital for a few days
Monitor blood pressure and breathing
Signs of organ damage
Monitor wound for infection

Cystitis & Pyelonephritis

Signs and Symptoms

Cystitis

Dysuria
Frequency
Urgency
Dehydration (secondary to increased
urinary output)
Bacteriuria
Suprapubic discomfort
Can lead to pyelonephritis

Pyelonephritis

Chills
Flank pain
CVA tenderness
Pyuria
Hematuria
Fever
Nausea
Vomiting
Proteinuria
Urosepsis

Diagnosis
Physical Examination

CVA tenderness
Examine urine
Temperature
Pelvic examination

Testing

Urinalysis
Urine dipstick
Urine culture
Pyelonephritis >10000 CFUs
Cystitis > 1000 CFUs
CT scan
Ultrasonography

Treatment
Pyelonephritis

Cystitis

Fibrocystic Breast Changes

What Are They?

Lumpy Bumpy Breasts
Nodular or Glandular breast tissue with
hormone fluctuation (estrogen)
Usually before a womans menstrual
period begins.
No longer considered a disease!
Important to be seen by doctor!
under a microscope:
fluid filled sacs
fibrous scar tissue
Hyperplasia around milk ducts

Signs and Symptoms

Lumps that blend into surrounding breast
tissue
Breast Pain
Green/brown discharge from nipple
(nonbloody)
Changes in both breasts
Increase in lumps and pain before period
Rarely in postmenopausal women

Diagnosis
Clinical Breast Exam
manual examination of breast tissue and
lymph nodes in neck and underarm area
if changes found- will have another exam after
menstrual period.
If not related to menstrual period:
Mammogram-x-ray for abnormal thickening or
bump
Ultrasound- distinguish between solid masses
and cysts
Breast Biopsy- test of breast tissue

Treatment
If no symptoms- no treatment!
If severe pain:
over the counter of prescription pain
medication
large cysts:
fine needle aspiration: draining cyst to remove
discomfort
Surgical excision: if cyst does not resolve
following aspiration
Oral contraceptive may decrease fibrocystic
breast changes

References:
The American College of Obstetricians and Gynecologists. (2015). Dysmenorrhea: Painful periods frequently asked questions. Retrieved April 26, 2015,
from http://www.acog.org/-/media/For-Patients/faq046.pdf?dmc=1&ts=20150426T1943557270
Barclift, S. (2014). Premenstrual syndrome (PMS) factsheet. Retrieved April 24, 2015, from Womenshealth.gov website:
http://womenshealth.gov/publications/our-publications/fact-sheet/premenstrual-syndrome.html
Dewailly, D., Lujan, M. E., Carmina, E., Cedars, M. I., Laven, J., Norman, R. J., & Escobar-Morreale, H. F. (2014). Definition and significance of polycystic ovarian morphology: a task force

report from the Androgen Excess and Polycystic Ovary Syndrome Society. Human Reproduction Update, 20(3), 334-352. doi:10.1093/humupd/dmt061
Disease and conditions: Fibrocystic breasts. (2013). Retrieved from: http://www.mayoclinic.org/diseases-conditions/fibrocystic-breasts/basics/treatment/con-20034681
Hirsch, L. (2014, June 1). Toxic Shock Syndrome. Retrieved April 25, 2015, from http://kidshealth.org/parent/infections/bacterial_viral/toxic_shock.html#

Madnani, N., Khan, K., Chauhan, P., & Parmar, G. (2013). Polycystic ovarian syndrome. Indian Journal Of Dermatology, Venereology & Leprology, 79(3), 310-321.
doi:10.4103/0378-6323.110759
Moroni, R., Vieira, C., Ferriani, R., Candido-Dos-Reis, F., & Brito, L. (2014). Pharmacological treatment of uterine fibroids. Annals of Medical and Health Sciences Research, 4(Suppl 3), S18592. doi:10.4103/2141-9248.141955
Patel, A., Malik, M., Britten, J., Cox, J., & Catherino, W. H. (2014). Alternative therapies in management of leiomyomas. Fertility and Sterility, 102(3), 649-655.
doi:10.1016/j.fertnstert.2014.07.008