Menstruation and Vaginal Bleeding Dr. Miada Mahmoud Rady EMS/473 Gynecological emergencies lecture...
-
Upload
abigail-stokes -
Category
Documents
-
view
215 -
download
0
Transcript of Menstruation and Vaginal Bleeding Dr. Miada Mahmoud Rady EMS/473 Gynecological emergencies lecture...
Menstruation and Vaginal Bleeding
Dr. Miada Mahmoud Rady
EMS/473
Gynecological emergencies lecture 2
Menstrual cycles
Menstruation: the cyclic and periodic discharge of 25 to 65
mL of blood, epithelial cells, mucus, and endometrial tissue
that normally lasts from 2-7 days and recurs every 21-35days
(28+/-7 days).
So the average duration of menstrual blood flow is 2-7 days.
Menstruation normally occur every 21- 35 days.
Menarche: the onset of first menstruation and it typically
occur between 11- 14 years of age.
Systemic Changes During Menstrual Cycle
1. Weight gain due to salt and water retention.
2. Increased muscle tonicity and susceptibility to bruising.
3. Breast pain and tenderness resulting from swelling
4. Headache including menstrual migraine ( vascular headache
resulting from the hormonal changes.
5. Severe cramping.
6. Emotional changes e.g. Irritability and depression.
Premenstrual Syndrome
Also known as PMS .
Definition : cluster of symptoms that occurs about 7-14days
before the onset of menstrual flow and generally subsides once
the flow begins.
It commonly affects premenopausal females (30-40years old).
Clinical presentation include both physical and emotional
symptoms.
Clinical Presentation of PMS
Emotional
1. Tension or anxiety.
2. Crying spells.
3. Mood swings.
4. Appetite changes.
5. Trouble falling asleep .
6. Social withdrawal.
7. Poor concentration.
Physical
1. Joint or muscle pain.
2. Headache and Fatigue.
3. Weight gain.
4. Abdominal bloating.
5. Breast tenderness.
6. Acne flare-ups.
7. Constipation or diarrhea.
Clinical Presentation of PMS
Symptoms can be exacerbated by :
1. Stress.
2. Diet.
3. Alcohol consumption.
4. drug use.
Emergency presentation of PMS : reactive hypoglycemia,
resulting in increased fatigue.
Premenstrual Tension Syndrome
Prehospital treatment :
Mainly supportive including :
1. Administration of oral or IV
glucose if glucose levels
support.
2. Administration of a small dose
of analgesics or anxiolytics to
reduce patient anxiety .
Mittelschmerz
• Definition : mid cyclic abdominal pain and cramping that
occurs at any time during ovulation usually 2 weeks before the
menstrual flow.
Criteria of the pain
1. midcyclic, with a history of similar pain episodes during
previous periods.
2. Not sever (usually mild).
3. Not referred or radiated.
4. Localized to one side , pain may be reported as "switching
sides" from month to month.
5. Associated with mild nausea and vaginal spotting.
6. Relieved by over the counter analgesic.
Management
1. Assurance and mild analgesics
2. Any persistent or sever pain or associated abnormal
symptoms ( vomiting , diarrhea , fever or abdominal
tenderness ) , should be evaluated by a physician.
Dysmenorrhea
Definition : painful menstruation .
There are two types of dysmenorrhoea :
1. Primary dysmenorrhoea .
2. Secondary dysmenorrhoea .
Primary dysmenorrhoea
No underlying pathology ( functional ).
Occurs at the beginning of menstrual blood flow and lasts for the
first 2 days .
Associated with nausea, vomiting, and diarrhea .
Management :
1. Assurance .
2. Bed rest .
3. Simple analgesics.
Secondary dysmenorrhoea
May signal an underlying pathology.
Present before, during, and after the menstrual flow.
Causes of secondary dysmenorrhoea:
1. Uterine fibroid.
2. Endometriosis.
3. Pelvic inflammatory disease.
4. Chronic pelvic congestion.
5. Intra uterine device.
Menopause
Definition : last menstrual cycle which marks the end of
childbearing age.
Typically begins between the ages of 40 and 50.
The menstrual cycles become less frequent over time and then
stops completely .
Clinical Presentation of Menopause
1. Diaphoresis ( excessive sweating ).
2. Hair loss.
3. Hot flashes (sometimes accompanied by tachycardia).
4. Severe muscle aches and pains.
5. Headache and Vertigo.
6. Dyspnea.
7. Digestive problems.
8. Emotional instability.
Complication of menopause
1. Atherosclerosis.
2. Osteoporosis.
3. Coronary heart disease.
4. Atrophy of genitourinary organs which result in :
Vaginal dryness and discomfort.
Urinary frequency.
Nocturia.
Incontinence.
Menopause
Management
1. Hormone replacement therapy.
2. Calcium .
3. Multivitamins .
Vaginal bleeding
Vaginal bleeding or dysfunctional uterine bleeding is one of the
most frequent reasons that women consult a gynecologist.
1. Hypermenorrhea : Flow of blood lasts several days longer
than normal or is excessive.
2. Polymenorrhea: Blood flow occurs more often than a 24-day
interval.
3. Metrorrhagia: Blood flow or intermittent spotting occurring
irregularly but frequently
Causes of vaginal bleeding
1. Trauma : rape , accident or during sexual intercourse.
2. Infection : vaginitis , cervicitis and endometritis.
3. Tumor : vaginal , cervical or uterine cancer .
4. Specific diseases : ovarian cyst , polycystic ovarian disease
and endometriosis.
5. Systemic disease : thyroid disease and bleeding disorders.
6. Obstetric causes of vaginal bleeding : abortion , ectopic
pregnancy , abruptioplacenta and placenta praevia.
Assessment Stress Points
1. History :
Find out if there is any possibility of pregnancy ,(LNMP).
Include questions about any incidents or events that led up
to the patient requesting EMS.
Determine the amount of blood loss.
Determine if the patient has any pain or discharge
associated with the bleeding.
Determine if the patient uses contraception and what kind.
Indicators of Sever Bleeding From History
1. Quantity .
2. Color : bright red indicates sever bleeding .
3. Associated clots : clots indicates sever bleeding.
4. Duration .
5. Associated symptoms : weakness , fainting and collapse.
Assessment Stress Points
2. Examination : if history suggests significant bleeding ,
assess for signs and symptoms of hypovolemic shock :
a. Orthostatic hypotension (first sign)
b. Resting tachycardia
c. Hypotension.
d. Finally shock .
Management
1. Maintain patent air way , if any signs of shock is present give
high-flow oxygen.
2. Keep the patient warm.
3. Provide IV fluid therapy.
4. If the bleeding is severe, apply dressings to the vaginal area.
5. Maintain professionalism and empathy
Amenorrhea
Definition : Amenorrhea is the absence of menses.
There are two types :
1. Primary amenorrhea : primary amenorrhea is the
failure of menses to occur by age 16 years, in the
presence of normal growth and secondary sexual
characteristics.
2. Secondary amenorrhea : cessation of previously
existing menstruation after menarche has started .
Causes of secondary amenorrhea
1. Pregnancy (most common cause)
2. Exercise
3. Drop of body fat below a certain percentage
4. Emotional problems or extreme stress
5. Anorexia nervosa
Home work
Enumerate :
1. Clinical Presentation of PMS .
2. Criteria of the Mittelschmerz pain .
Differentiate in table between primary and secondry
dysmenorrhoea ??
home work has to be sent to the e-mail in ward format one
day before next week lecture .
Any questions ???