1. Dysmenorrhea, Menopause, Fibrocystic Breast Disease Ricci, pp. 110-113; 101, 150; 199-203

2. Dysmenorrhea  Painful menstruation—2 types:  Primary—no pathology; increased prostaglandins which cause uterine contractions  Secondary—pathology present; fibroids, endometriosis, PID, IUD, cervical stenosis or congenital abnormalities

3. Assessment of Dysmenorrhea  Pain characteristics  Menstrual flow—amount, pattern  Sexual activity  Accompanying symptoms  Children?  Interventions tried by client  Affect on lifestyle  Diagnosed by thorough pelvic exam and diagnostics

4. Management of Dysmenorrhea  Prostaglandin inhibitors  Low-dose oral contraceptives  Exercise  Stress reduction and relaxation  Acupuncture  Warm baths and heating pad  Limit salt  Drink lots of water  See Guidelines 4.3

5. Menopausal Transition  Begins with perimenopause which is a period of 2-8 years before menses actually stops.  Perimenopausal sx are attibuted to decreasing estrogen levels and include hot flashes, vaginal dryness, irregular periods, sleep disturbances, and irritability. Still at risk for pregnancy, altho more and more cycles are becoming anovulatory.

6. Menopausal Transition cont’d  When a woman has not had a period for a year, it is termed menopause. The average age is 51.  Because periods can be so irregular during perimenopause, it is important to educate women about when menopause actually occurs and when pregnancy is no longer a concern.  Menopausal sx include atrophy of breasts and genital organs, bone loss, vascular changes, mood swings, sleep disturbances, depression. More at risk for dyspareunia, vaginal infections, and fractures.

7. Treatment of Menopause  Vaginal lubrication  Hormone replacement therapy(HRT)—very controversial and not currently recommended by all. Helps sx, decreases endometrial hyperplasia, protects against CVD and osteoporosis, but may not be prescribed for women with hx of cancer or vascular problems.  Non-hormonal tx—Calcium, herbals, Vits B6, B12, folic acid, exercise, sleep aids  Other treatments include managing CV disease and osteoporosis.

8. Pharmacologic Treatment  HRT—estrogen, progestin, testosterone, or a combination  Antidepressants (SSRIs)  Beta blockers  Sleeping pills  Neurontin  Vitamins  Alternatives—herbs, bioidentical hormones, phytoestrogens

9. Fibrocystic Breast Dz  Benign condition; aka Benign Breast Disease  Effects of estrogen cause ducts to dilate and cysts to form.  Fluid retention causes cysts to enlarge and become painful (mastalgia) and sore.

10. Assessment of BBD  Dull, aching, cyclic breast pain before period; subsides after  Mobile, painful (opposite from cancerous lesions) nodules usually in upper outer quads  Some women have nipple discharge  Ultrasound is favored over mammogram— able to distinguish between a fluid-filled and a solid mass  Stereotactic needle aspiration is definitive

11. Management of BBD  Monthly BSE  Healthy diet; reduce sodium intake  Supportive bra  Heat  NSAIDs  BCPs  Thiamine, Vitamin E, evening primrose oil  Danocrine, bromocriptine, or Tamoxifen (male hormones) only for severe cases