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Lecture 6

NURS 364 Lecture Notes - Lecture 6: Pelvic Inflammatory Disease, Premenstrual Dysphoric Disorder, Dysfunctional Uterine Bleeding

Course Code
NURS 364
Deborah Van Kuiken

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Alterations of the Reproductive Systems, Including Sexually Transmitted Infections
Alterations of Sexual Maturation
Secondary sex characteristics have not appeared
in girls by age 13
in boys by age 14
95% genetic/familial links
5% caused by hypothalamic-pituitary-gonadal axis disruption
Alterations of Sexual Maturation
Precocious puberty
Sexual maturation before
age 6 - 7 in girls
age 9 in boys
Some link to environment
and epigenetics
Hormonal and menstrual alterations
Primary --- dysmenorrhea--- literally just painful periods
Painful menstruation associated with prostaglandin release in ovulatory cycles
Related to the duration and amount of menstrual flow
Secondary dysmenorrhea--- linked to something else not just painful periods
Painful menstruation related to pelvic pathology
Can occur any time in the menstrual cycle
Hormonal and menstrual alterations
Primary: Absence of menstruation by age 14 (gymnasts or turner’s syndrome)
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Often congenital
Secondary amenorrhea
Absence of menstruation for a time equivalent to three or more cycles or 6 months in
women who have previously menstruated
Dramatic weight
loss--- anorexia or
even a lot of exercise
Change in hormone levels
Hormonal and menstrual alterations
Abnormal uterine bleeding—frequency or duration. Or amount of blood scant or heavy
Menstrual irregularity
Dysfunctional uterine bleeding
Polycystic ovarian syndrome--- leading androgen problem in women
Hyperinsulinism  Type II Diabetes Mellitus
Elevated levels of androgens (unbound testosterone
levels) --- females have male like characteristics
Oligo-ovulation or anovulation
Polycystic ovaries
Dysfunction of follicle development
Leading cause of infertility in the
United States--- egg never ovulates and leads to a series of cysts in the ovaries
Hormonal and menstrual alterations
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Premenstrual syndrome (PMS)
Cyclic physical, psychological, or behavioral changes that impair interpersonal
relationships or interfere with usual activities
Premenstrual dysphoric disorder (PMDD) in 3% to 8% of women—PMS on
steroids… severe depression or irritability and anger
Greater than 200 physical, emotional, and behavioral signs and symptoms
Female Reproductive System
Infection and Inflammation
Pelvic Inflammatory Disease (PID)--- ovaries, fallopian tube, uterus. Infection that came from
outside and made its way in usually multiple microorganisms and is usually linked to STI’s
Infection and Inflammation
Pelvic inflammatory disease (PID)
Acute inflammatory disease caused by infection
Sexually transmitted diseases migrate from the vagina to the upper
genital tract
Polymicrobial infection
May involve any organ of the reproductive tract
Salpingitis—inflammation of fallopian tube
Oophoritis--- inflammation of ovaries
Pelvic Inflammatory Disease (PID) (cont’d)—inflammation causes redness, swelling
and fibrosis sometimes causing infertility. Mostly causes pain and bleeding
Infection and Inflammation
Vaginitis—infection of vagina… STI’s or yeast infections
Infection of the vagina
Acidic nature of the vagina provides some protection
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