Common Menstrual Problems Many girls and women have had to deal with one or more of them at one time or another. PMS includes both physical and emotional symptoms that many females get right before their periods, such as: acne bloating fatigue backaches breasts tenderness headaches constipation diarrhea food cravings depression or feeling blue irritability difficulty concentrating difficulty handling stress

Different girls may have some or all of these symptoms in varying combinations. PMS is at its worst in the first 7 days before the period starts and disappears soon after it begins. symptoms associated with PMS mostly will not develop until several years after menstruation starts if ever. -Although the exact cause of PMS is unknown, it seems to occur because of changing hormone levels, and their effect on chemicals in the brain. During the second half of the menstrual cycle, the amount of progesterone in the body increases. Then, about 7 days before the period starts, levels of both progesterone and estrogen drop. Some girls' bodies seem to be more sensitive to these hormone changes than others. Talk to your daughter's doctor if her symptoms are severe or interfere with her normal activities.

COMMON UTERINE BLEEDING PROBLEMS Cramps cramps during the first few days caused by prostaglandin, chemical in the body that makes the smooth uterus muscle contract. These involuntary contractions can be either dull or sharp and intense. -that cramps usually only last a few days. But call your doctor it is severe cramps that keep from school. Irregular Periods -It can take 2 to 3 years from a girl's first period for her body to develop a regular cycle. what's "regular" varies from person to person. The typical cycle of an adult female is 28 days, although some are as short as 21 days and others are as long as 45. -Changing hormone levels might make a girl's period last a short time during one month (just a few days) and a long time the next (up to a week). She may skip months, get two periods almost right after each other, or alternate between heavy and light bleeding from one month to another. -period still hasn't settled into a relatively predictable pattern after 3 years, or four or five regular periods and then skips the period or becomes irregular, make an check for possible problems. if the cycle is less than 21 days or more than 45 days, or if doesn't get a period for 3 months at any time after first beginning to menstruate.

Amenorrhea Girls who haven't started their periods by the time they're 16 years old or 3 years after they've shown the first signs of puberty have primary amenorrhea, which is usually caused by a genetic abnormality, a hormone imbalance, or a structural problem. Hormones are also often responsible for secondary amenorrhea, which is when a girl who had normal periods suddenly stops menstruating for more than 6 months or three of her usual cycles. -Since pregnancy is the most common cause of secondary amenorrhea, it should always be ruled out when a girl skips periods. In addition hormonal imbalances, other things that can cause both primary and secondary amenorrhea include:

stress significant weight loss or gain anorexia (amenorrhea can be a sign that a girl is losing too much weight and may have anorexia) stopping birth control pills thyroid conditions ovarian cysts other conditions that can affect hormone levels is excessive exercising (often distance running ) combined with a poor diet, which usually results in inappropriate weight loss or failure to gain weight during growth. But this doesn't include the usual gym class or school sports team, even those that practice often.

Menorrhagia: (Extremely Heavy, Prolonged Periods) -It's normal for a girl's period to be heavier on some days than others. But signs of menorrhagia (excessively heavy or long periods) can include soaking through at least one sanitary (pad) an hour for several hours in a row or periods that last longer than 7 days. Girls with menorrhagia sometimes stay home from school or social functions because they're worried they won't be able to control the bleeding in public.

The most frequent cause of menorrhagia is an imbalance between the levels of estrogen and progesterone in the body, which allows the endometrium (the lining of the uterus) to keep building up. When the endometrium is finally shed during menstruation, the resulting bleeding is particularly heavy. -Because many adolescents have slight hormone imbalances during puberty, menorrhagia isn't uncommon in teens. But in some cases, heavy menstrual bleeding can be caused by problems such as: fibroids (benign growths) or polyps in the uterus thyroid conditions clotting disorders inflammation or infection in the vagina or cervix

Dysmenorrhea (Painful Periods) -There are two types of dysmenorrhea, which is severely painful menstruation that can interfere with a girl's ability to attend school, study, or sleep: Primary dysmenorrheal: very common and is not caused by a disease or other condition. Instead, the prostaglandin, the same chemical behind cramps. Large amounts of prostaglandin can lead to nausea, vomiting, headaches, backaches, diarrhea, and severe cramps. Fortunately, these symptoms usually last for only a day or two. Secondary dysmenorrhea : -is pain caused by some physical condition like polyps or fibroids in the uterus, endometriosis, pelvic, or adenomyosis (uterine tissue growing into the muscular wall of the uterus). -Having cramps for a day or two each month is common, but if your daughter has symptoms severe enough to keep her from her normal activities, discuss it with her doctor.

MENSTRUAL IRREGULARITIES AND ABNORMAL UTERINE BLEEDING Bleeding that is excessive in amount (more than 80mL per cycle) or frequency (more than every 21days). Occurs most often at the beginning or end of a women’s reproductive years-when ovulation is becoming establish or when it is becoming irregular at or after menopause the irregular cycle or period of menstrual that against the normal period within four weeks long. The period can be shorter or longer and it depends on the problem facing by each individual.

Menstrual patterns associated with abnormal uterine bleeding Definitions of Abnormal Menstrual Bleeding Amenorrhea: Absence of menses for 6 months or absence of menstrual cycle for three cycles Menorrhagia: Heavier and increased amount of flow occurring at regular intervals or loss of >80 mL of blood Metrorrhagia: Irregular episodes of bleeding Menometrorrhagia: Longer duration of flow occurring at unpredictable intervals Oligomenorrhea: Cycle length >35 days Polymenorrhea: Cycle length >21 days Postmenopausal bleeding: Bleeding that occurs more than 12 months after the last menstrual cycle

MENORRHAGIA called as hypermenorrhea. an abnormally long, heavy periods excessive uterine bleeding that occur at the expected intervals of the menstrual periods.

WHY?? Common among the women.. heavy menstrual bleeding. Normal total blood flow:25-80 mL. blood loss >80 ml or >7 days-leads to menorrhagia (hypermenorrhea) occurs at predictable and normal intervals that usually within 28 days. But menorrhagia refers to losing about 5 1/2 tablespoons (81mL) or more of blood during menstrual cycle.

Nursing Diagnosis Goal Intervention Evaluation Risk for fluid volume deficit r/t active fluid loss (abnormal bleeding) Patient will experiences adequate fluid volume and electrolyte balance as evidenced by urine output greater than 30 ml/hr, heart rate (HR) is 100 beats/min, consistency of weight, and normal skin turgor. Monitor and document vital signs. Monitor serum electrolytes and urine osmolality and report abnormal values. Administer parenteral fluids as ordered. Encourage patient to drink prescribed fluid amounts. Monitor active fluid loss from bleeding, maintain accurate input and output. After nurses done the interventions, patient shows some progresses which are urine output greater than 30 ml/hr, heart rate (HR) is 100 beats/min, consistency of weight, and normal skin turgor.

Patient will maintain normal arterial blood gases. Nursing Diagnosis Goal Intervention Evaluation Impaired gas exchange r/t altered oxygen supply secondary to blood loss Patient will maintains optimal gas exchange as evidenced by normal arterial blood gases (ABGs) Monitor respiration’s rate, depth and rhythm Monitor vital signs Assess for signs and symptoms of hypoxemia: tachycardia, restlessness, diaphoresis, headache, lethargy, and confusion Assess for changes in orientation and behavior Assess skin color for development of cyanosis. Maintain oxygen administration device as ordered, attempting to maintain oxygen saturation at 90% or greater. Facilitate patient to high-Fowler’s position. Patient will maintain normal arterial blood gases. Normal adult arterial pH= 7.35-7.45 pCO2 = 35-45 torr pO2 = >79 torr Normal adult venous pH = 7.31-7.41 pCO2 = 41-51 torr pO2 = 30-40 torr

Nursing Diagnosis Goal Intervention Evaluation Acute pain r/t lower abdominal cramps e/b patient’s facial expression The lower abdominal pain level will reduce to optimum level. Monitor pain characteristics Teach the use of non-pharmacologic techniques monitor signs and symptoms associated with pain positioning according patient comfort Provide rest periods to facilitate comfort, sleep, and relaxation After nursing actions are taken, level of pain complained by patient had reduced to optimum level and patient feel comfort.

Nursing Diagnosis Goal Intervention Evaluation Fear related to excessive bleeding e/b restlessness of patient and patient’s complain. The patient will report fear and anxiety are reduced to a manageable level. Patient will be able to rest without being restless. Identify patient’s perception of threat represented by the situation Encourage patient to acknowledge and express fears Provide opportunity for discussion of personal feelings or concerns and future expectations. Identify previous coping strengths of the patient and current areas of control or ability Encourage use of relaxation technique like deep breathing, guided imagery After nursing intervention is done, the patient has report fear and anxiety are reduced to a manageable level. Patient is not restless.

REFERENCES No author., 2009, Pelvic Examination. [ONLINE], New York, webmd.com, Available from http://women.webmd.com/pelvic-examination, [Accessed 31 January 2011]. No author., 2011, Transvaginal ultrasound - WrongDiagnosis.com. [ONLINE], Ashland, Network Solutions LLC, Available from http://www.wrongdiagnosis.com/medical/transvaginal_ultrasound.htm, [Accessed 01 February 2011]. STORCK, S., 2011, Transvaginal ultrasound. [ONLINE] Rockland, medlineplus.com, Available from http://www.nlm.nih.gov/medlineplus/ency/article/003779.htm, [Accessed 01 February 2011]. SHAW, J., 2010, Menorrhagia: Differential Diagnoses & Workup - eMedicine Obstetrics and Gynecology. [ONLINE] New York, emedicine.com, Available from: http://emedicine.medscape.com/article/255540-diagnosis. [Accessed 01 February 2011]. No author., 2011, Dilation and curettage - Wikipedia, the free encyclopedia. [ONLINE], Saints Petersburg, Wikipedia.com, Available from: http://en.wikipedia.org/wiki/Dilatation_and_curettage. [Accessed 01 February 2011]. No author., 2009, ACOG Education Pamphlet AP134 -- Endometrial Ablation. [ONLINE], Washington, The American College of Obstetricians and Gynecologists, Available from: http://www.acog.org/publications/patient_education/bp134.cfm. [Accessed 02 February 2011]. No author., 2011, Dilatation and Curettage - Anesthesia. [ONLINE] India, medindia.net, Available from: http://www.medindia.net/surgicalprocedures/Dilatation_Curettage_Anesthesia.htm. [Accessed 02 February 2011].