Women's Health

Women’s health focuses on strategies to promote the health and well-being of patients assigned female at birth. Common problems addressed in women’s health are menstrual and breast disorders.

Okay, so two common menstrual disorders are amenorrhea and abnormal uterine bleeding. Amenorrhea is the absence of menses, or a menstrual period, which can be primary or secondary.

Primary amenorrhea is when the first menses doesn't occur by age 15 or within 3 years after developing breasts. It’s often caused by disorders in the hypothalamic-pituitary-ovarian axis; chromosomal abnormalities; or structural abnormalities of the uterus, vagina, or hymen that obstruct flow.

Secondary amenorrhea is when a regular menstrual cycle stops for at least 3 months, or when an irregular menstrual cycle stops for at least 6 months.

Secondary amenorrhea can be caused by natural processes, like pregnancy, lactation, and menopause; or by underlying conditions, like polycystic ovarian syndrome, thyroid disease, or an eating disorder.

Diagnosis begins with a history and physical examination. Then, laboratory tests will be performed to identify potential causes, like human chorionic gonadotropin, or hCG to confirm pregnancy; thyroid stimulating hormone, or TSH to check for a thyroid disorder; and reproductive hormone levels, such as serum follicle-stimulating hormone, luteinizing hormone, and androgens to identify endocrine problems.

Treatment will address the underlying condition and can include hormone replacement therapy or contraceptives to restart regular menstruation and promote normal ovarian function.

Now, abnormal uterine bleeding, or AUB, refers to bleeding that’s heavy, extended, frequent, or irregular. AUB can be caused by an underlying condition, like uterine fibroids or polyps; cancerous lesions; coagulation problems, from medications like anticoagulants or clotting disorders, like von Willibrand disease; or complications of pregnancy, such as spontaneous abortion.

Diagnosis begins with a history and physical examination. Then, laboratory tests will be performed to identify potential causes, including confirmation of pregnancy, and coagulation studies to check for a clotting disorder.

Other tests include a CBC and ferritin level to evaluate for iron-deficiency anemia caused by chronic or excessive bleeding.

Lastly, a transvaginal pelvic ultrasonogram can be done to visualize any benign or malignant growths. Treatment will address the underlying condition and can include medications to regulate the menstrual cycle or clotting, as needed.

Surgical interventions can include resection of benign or malignant growths; dilation and curettage, better known as D&C, for spontaneous abortion; and in some cases, a hysterectomy is required.

Now, when caring for your patient with a menstrual disorder, teach them the importance of tracking and documenting their menstrual cycles and keeping accurate records of blood loss.

Also stress the importance of maintaining a healthy weight by eating a nutritious diet and staying physically active to reduce factors related to PCOS.

For your patients who are infertile because of their condition, provide resources for psychological and infertility counseling, as well as support groups, if indicated.

Lastly, encourage your patient to maintain all appointments for preventative screenings and gynecologic examinations to promote reproductive health.

Okay, moving on to breast disorders, which commonly include fibrocystic changes and breast cancer. Fibrocystic changes of the breast is the most common benign breast disorder.

It's characterized by fibrosis, or thickening of the breast tissue, that progresses to the formation of cysts. The cysts vary in size and are typically felt as tender, lumpy, rope-like, and movable nodules.

The size of the nodules and breast tenderness tends to fluctuate during the menstrual cycle. Non-bloody green or brown nipple discharge may also be present.

Diagnosis starts with history and physical examination, as well as imaging tests like mammography and ultrasound. Treatment is focused on providing symptom relief and includes wearing a supportive bra; limiting levels of methylxanthines, like caffeine; or taking over-the-counter pain relievers like acetaminophen.

Pain can also be controlled with medications like danazol, bromocriptine, or tamoxifen; or by aspiration of cysts. Now, breast cancer is a malignant breast disorder that typically arises from the glandular epithelium of the breast.

Risk factors include age over 50, a family history of breast or ovarian cancer, and mutations in genes such as BRCA1, BRCA2, CHEK2, and p53.

Other important risk factors include a history of menopausal hormone therapy with estrogen-progesterone, and alcohol consumption, which is dose dependent.

Clinical presentation includes development of a fixed, firm, non-tender lump; nipple discharge or retraction; skin that becomes red, thick, and tender; as well as peau d’orange, or a dimpling of the skin resembling an orange peel.

Diagnosis begins with history and physical examination, followed by mammography, ultrasound, and biopsy. Treatment is based on the type of breast cancer and stage and can include surgery to remove the tumor by lumpectomy or partial or total mastectomy.

Other treatments include local radiation, systemic immunotherapy or chemotherapy, and supportive care to manage symptoms.

When caring for your patient with a breast disorder, teach them about their condition and treatments, and offer information about community resources, like support groups.

Alright, as a quick recap...Women’s health focuses on strategies to promote the health and well-being of patients assigned female at birth.

Common disorders addressed in women’s health are menstrual