Lewis et al: Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 7th
edition
Key Points
Chapter 54: Nursing Management: Female Reproductive Problems
PREMENSTRUAL SYNDROME
 Premenstrual syndrome (PMS) is a common disorder of physical and psychologic symptoms
during the last few days of the menstrual cycle and before onset of menstruation.

PMS is thought to have a biologic trigger with compounding psychosocial factors.

Physical symptoms include breast discomfort, abdominal bloating, sensation of weight gain,
episodes of binge eating, and headache. Anxiety, depression, irritability, and mood swings are
some of the emotional symptoms.

No single treatment is available to relieve symptoms. The goal is to reduce symptom severity.
DYSMENORRHEA
 Dysmenorrhea is abdominal cramping pain or discomfort associated with
menstrual
flow.
o Primary dysmenorrhea is caused by an excess of prostaglandin F2α (PGF2α) and/or an
increased sensitivity to it.
o Secondary dysmenorrhea is acquired after adolescence; pelvic causes include
endometriosis, chronic pelvic inflammatory disease, and uterine fibroids.

Treatment for primary dysmenorrhea includes heat, exercise, and drug therapy. For secondary
dysmenorrhea, it depends on the cause.

Abnormal vaginal or uterine bleeding is a common gynecologic concern and is caused by
dysfunction of hypothalamic-pituitary-ovarian axis, infection, and stressful changes in lifestyle.
Treatment varies depending on the cause but can include drug therapy and surgery.
MENOPAUSE
 Menopause is the physiologic cessation of menses associated with declining ovarian function. It
is usually considered complete after 1 year of amenorrhea.

Ovarian changes start the cascade of events that result in menopause.

Premenopausal symptoms include hot flashes, irregular vaginal bleeding, fat redistribution, and a
tendency to gain weight.

Treatment might include hormone replacement, drug therapy, and alternative therapies.
INFECTION AND INFLAMMATION OF VAGINA, CERVIX, AND VULVA
 Infection and inflammation of vagina, cervix, and vulva commonly occur when natural defenses
of the acid vaginal secretions (maintained by sufficient estrogen levels) and presence of
Lactobacillus are disrupted.
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Key Points
54-2

Abnormal vaginal discharge and reddened vulvar lesions are often noted with itching and dysuria.

Treatment includes antibiotics and antifungal preparations.
LEIOMYOMAS
 Leiomyomas (uterine fibroids) are benign smooth-muscle tumors that occur within the uterus.

Symptoms may include abnormal uterine bleeding, and pain.

Treatment depends on size of tumor and may include surgery.
UTERINE PROLAPSE
 Uterine prolapse is the downward displacement of uterus into the vaginal canal.

Symptoms are dyspareunia, dragging or heavy pelvic feeling, backache, and bowel or bladder
problems if cystocele or rectocele is also present.

Therapy depends on degree of prolapse and can include strengthening exercises, and a pessary.
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.