Menstrual bleeding

Irregular menstrual bleeding, spotting, prolonged episodes of bleeding, and amenorrhea may occur. These symptoms diminish with continued use. 

Menstrual bleeding patterns are usually disrupted but should normalize. Irregular bleeding, amenorrhea, and excessive or prolonged bleeding should be reported to the health care provider. 

The nurse reportsany of the following to the health care provider immediately bleeding gums easy bruising, petechiae (pinpoint hemorrhage, increased menstrual bleeding, tarry stools bloody urine, or coffee-ground emesis... 

C. checks female patients for increased menstrual bleeding... 

Side effects of contraceptives tend to occur in the first few months of therapy. Thus, schedule a follow-up visit 3 to 6 months after initiating a new contraceptive. Yearly checkups usually are sufficient for patients who are doing well on a particular product.1 At each follow-up visit, assess blood pressure, headache frequency, and menstrual bleeding patterns, as well as compliance with the prescribed regimen. 

TABLE 46-1. Pathophysiology of Selected Menstrual Bleeding Disorders1 10 11 13 15... 

TABLE 46-3. Expected Outcome Measures for Select Menstrual Bleeding Disorders8 10,11,15 1e 20 22 33 36... 

The progestin-only Minipills tend to be less effective than combination OCs, and they are associated with irregular and unpredictable menstrual bleeding. They must be taken every day of the menstrual cycle at approximately the same time of day to maintain contraceptive efficacy. They are associated with more ectopic pregnancies than other hormonal contraceptives. 

DMPA 150 mg administered by deep intramuscular injection in the gluteal or deltoid muscle within 5 days of the onset of menstrual bleeding inhibits ovulation for more than 3 months, and the dose should be repeated every 12 weeks to ensure continuous contraception. A new formulation contains 104 mg of DMPA (Depo-SubQ Provera 104), which is injected subcutaneously into the thigh or abdomen. The manufacturer recommends excluding pregnancy in women more than 1 week late for repeat injection of the intramuscular formulation or 2 weeks late for repeat injection of the subcutaneous formulation. 

The major adverse effect is irregular menstrual bleeding. Other side effects are headache, vaginitis, weight gain, acne, and breast and abdominal pain. It does not appear to decrease BMD. It is contraindicated in women who are pregnant, have active liver disease, a history of thromboembolic events, or a history of breast cancer. 

Uterine leiomyomas, or fibroids, are the most common type of solid tumors in adult women, clinically apparent in at least 25% of those of reproductive age [24-26]. Abnormal menstrual bleeding, pelvic pain, and infertility are the most commonly experienced symptoms in these women. Uterine fibroids are the leading cause of hysterectomies performed in the United States, accounting for over 200,000 of these procedures each year. Other invasive surgical interventions for the treatment of uterine fibroids include myomectomy and uterine artery embolization. Leiomyomas are estrogen-responsive tumors that can be treated... 

Most recently, Havlicek, Bartos, Dvorakova and Flegr (2006) tested women s body odour repeatedly across the whole menstrual cycle and focused specifically on axillary scents. Male subjects rated the smell of the samples as least attractive during menstrual bleeding and most attractive during the follicular (i.e. fertile) period of the cycle. 

Day regimen - Day 1 of the cycle is the first day of menstrual bleeding. Take 1 tablet daily for 21 days. No tablets are taken for 7 days. Whether bleeding has stopped or not, start a new course of 21 days. 

Bleeding irregularities Most women experience disruption of menstrual bleeding patterns. If abnormal bleeding persists or is severe, institute appropriate investigation to rule out the possibility of organic pathology, and institute appropriate treatment when necessary. 

LH secretion which induces rupture of the follicle and release of the mature egg into the fallopian tube. In the ovary a corpus luteum forms, which secretes progesterone (maximal at about day 21) to prepare the endometrium for implantation of an early embryo. If pregnancy does not occur, the corpus luteum involutes, progesterone levels fall, and the thickened endometrium is shed giving rise to menstrual bleeding, which is defined as starting on day 1 of the next cycle. 

The most common cause of iron deficiency in adults is blood loss. Menstruating women lose about 30 mg of iron with each menstrual period women with heavy menstrual bleeding may lose much more. Thus, many premenopausal women have... 

Artemisia vulgarts L. China Terpinenol-4, (3-caryophyllene, artemisia alcohol, linalool, cineol, camphore, borneol, eucalyptol.33 Reduce or stop menstrual bleeding. Antiasthmatic, antitussive. Treat chronic bronchitis, oral infection, and hypersensitivity. 

Uses Breast/endometrial CAs appetite stimulant in cachexia (CA HIV) Action Hormone progesterone analog Dose CA 40-320 mg/d PO in + doses Appetite 800 mg/d PO + dose Caution [X, -] Thromboembolism Contra PRG Disp Tabs, soln SE DVT edema, menstrual bleeding photosens, insomnia, rash, 4- BM Interactions T Effects OF warfarin EMS T Risk of CV problems, esp in smokers T effects of warfarin may T glucose T risk of photosensitivity Rxns OD Unlikely to cause life-threatening Sxs... 

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