Special Issues of Women’s Health Care and Reproduction Chapter 4: Special Issues of Women’s Health Care and Reproduction

Health Screening Recommendations Breast cancer screening Self-awareness of breast characteristics and yearly clinical breast examinations are appropriate for women of all ages. Women older than 40 years should have yearly mammograms Pelvic exam and Pap smear The woman's first Pap smear should be at age 21, regardless of when she first had sexual intercourse, and then every 3 years from age 21 to 29 and every 5 years after age 30. Vulvar self examination

Mammmography

Common Disorders of the Female Reproductive Tract Menstrual disturbances Dysmenorrhea is painful or difficult menses. Premenstrual syndrome (PMS) encompasses a group of symptoms that are cyclical in nature and progress with time.

Common Disorders of the Female Reproductive Tract (cont.) Menstrual disturbances (cont.) Endometriosis A classic symptom of endometriosis is cyclic pelvic pain that occurs in conjunction with menses. Therapy aims to suppress ovulation and induce an artificial menopause to curb growth of abnormal tissue and relieve symptoms. The nurse's role is to help the woman find pain relief and provide support.

Infectious Disorders of the Reproductive Tract (cont.) Pelvic inflammatory disease (PID) The major risk factor for development of pelvic inflammatory disease (PID) is untreated sexually transmitted infections (STIs). The woman and her partner should be treated with antibiotics.

Weakening of the structures that support the pelvic organs causes pelvic support disorders including cystoceles, rectoceles, and prolapse of the uterus. Major risk factors for pelvic support disorders include pregnancy, vaginal delivery, and poor muscle tone.

Pelvic Support Disorders

Reproductive Life Cycle Issues Family planning involves the two components of planning pregnancy and preventing pregnancy. Family planning should include preconception care, which involves focusing on nutrition and exercise, lifestyle changes, counseling and treatment for chronic illness and genetic disorders, and evaluation of medications.

Reproductive Life Cycle Issues (cont.) Preventing pregnancy Natural methods of contraception do not use hormones or other physical barriers to prevent conception. These methods include abstinence, coitus interruptus, and fertility awareness methods (FAMs). Natural methods do not require the use of artificial devices or hormones but require a great deal of education and discipline to be effective.

Reproductive Life Cycle Issues (cont.) Preventing pregnancy (cont.) Barrier methods of contraception provide a physical and/or chemical barrier to prevent pregnancy. These include spermicides, male and female condoms, the diaphragm, and cervical cap. Many barrier methods have the advantage of decreasing the risk for STIs.

Reproductive Life Cycle Issues (cont.) Preventing pregnancy (cont.) Hormonal methods of contraception include combination oral contraceptives (COCs), progestin-only pills (POPs), hormonal injections, hormonal implants, the transdermal patch, and the vaginal ring. Hormonal contraceptives are highly effective but do not provide reliable protection against STIs.

Reproductive Life Cycle Issues (cont.) Preventing pregnancy (cont.) Intrauterine devices (IUDs) provide long-term pregnancy protection. They must be inserted by a healthcare provider and require removal every 5 to 10 years. They do not provide protection against STIs. Female and male sterilization techniques are highly effective, permanent methods of contraception. Emergency contraception (EC) refers to methods used to prevent pregnancy after unprotected intercourse. EC can be the insertion of a copper IUD or medication.

Infertility Infertility is the inability to conceive after a year of unprotected intercourse. Multiple factors contribute to infertility. Evaluation of infertility begins with the least invasive and complex and progresses to the more invasive and complex techniques. All infertility evaluations begin with a thorough history and physical examination of both partners. Usually the first test is a sperm analysis, and the second test is a postcoital examination.

Infertility (cont.) Treatment of infertility depends on the identified cause. Surgical techniques to correct structural problems, medication to stimulate ovulation, and advanced reproductive therapies (ART) may all be used in the treatment of infertility. A couple undergoing evaluation and treatment for infertility may feel guilt, shock, isolation, depression, and stress. It is stressful on a relationship to sexually perform on demand, and intercourse often takes on a clinical and mechanical tone, rather than the desired traits of intimacy, love, and support.

Menopause Menopause is a natural part of the life cycle. It is not a disease; however, the associated symptoms may need medication or other interventions. Hormone replacement therapy (HRT) used to be the gold standard of treatment for major menopausal symptoms; however, recent research has highlighted serious adverse effects that may be associated with HRT. Hot flashes, osteoporosis, and vaginal atrophy and dryness are the major symptoms for which women need and desire treatment and nursing care during menopause.