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Common reproductive health conditions

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Common reproductive health conditions

  1. 1. A. Dysmenorrhea (Menstrual Cramps)What is dysmenorrhea?Dysmenorrhea is the medical term forpain with menstruation.There are two types of dysmenorrhea:"primary" and "secondary".
  2. 2. Primary dysmenorrhea Is common menstrual cramps that are recurrent and are not due to other diseases. Cramps usually begin one to two years after a woman starts getting her period. Pain usually begins 1 or 2 days before or when menstrual bleeding starts and is felt in the lower abdomen, back, or thighs and can range from mild to severe. Pain can typically last 12 to 72 hours and can be accompanied by nausea, vomiting, fatigue, and even diarrhea. Common menstrual cramps usually become less painful as a woman ages and may stop entirely if the woman has a baby.
  3. 3. Secondary dysmenorrhea Is pain that is caused by a disorder in the womans reproductive organs, such as endometriosis, adenomyosis, uterine fibroids, or infection. Pain from secondary dysmenorrhea usually begins earlier in the menstrual cycle and lasts longer than common menstrual cramps. The pain is not typically accompanied by nausea, vomiting, fatigue, or diarrhea.
  4. 4. What are the symptoms of dysmenorrhea? Aching pain in the abdomen (pain may be severe at times) Feeling of pressure in the abdomen Pain in the hips, lower back, and inner thighsWhat causes common menstrual cramps? Menstrual cramps are caused by contractions in the uterus (which is a muscle) by a chemical called prostaglandin. The uterus contracts throughout a womans menstrual cycle. During menstruation, the uterus contracts more strongly. If the uterus contracts too strongly, it can press against nearby blood vessels, cutting off the supply of oxygen to the muscle tissue of the uterus. Pain results when part of the muscle briefly loses its supply of oxygen.
  5. 5. What other factors influence menstrual cramps? An unusually narrow cervical canal. A retroverted uterus. Lack of exercise Psychological factorsHow can I relieve mild menstrual cramps? Take ibuprofen as soon as bleeding or cramping starts. Place a heating pad or hot water bottle on your lower back or abdomen. Rest when needed. Massage your lower back and abdomen. Avoid foods that contain caffeine. Avoid smoking and drinking alcohol. To help prevent cramps, make exercise a part of your weekly routine.
  6. 6. B. Sexually Transmitted InfectionSexually transmitted diseases (STD), also referred to as sexuallytransmitted infections (STI) and venereal diseases (VD), are illnessesthat have a significant probability of transmission between humans bymeans of human sexual behavior, including vaginal intercourse, oralsex, and anal sex. While in the past, these illnesses have mostly beenreferred to as STDs or VD, in recent years the term sexually transmittedinfections(STIs) has been preferred, as it has a broader range ofmeaning; a person may be infected, and may potentially infect others,without having a disease. Some STIs can also be transmitted via theuse of IV drug needles after its use by an infected person, as well asthrough childbirth or breastfeeding. Sexually transmitted infectionshave been well known for hundreds of years, and venereology is thebranch of medicine that studies these diseases.
  7. 7. Classification:Sexually transmitted infection is a broader term than sexuallytransmitted disease. An infection is a colonization by a parasiticspecies, which may not cause any adverse effects. In a disease theinfection leads to impaired or abnormal function. In either case thecondition may not exhibit signs or symptoms. Increasedunderstanding of infections like HPV, which infects most sexuallyactive individuals but cause disease in only a few has led toincreased use of the term STI. Public health officials originallyintroduced the term sexually transmitted infection, which cliniciansare increasingly using alongside the term sexually transmitteddisease in order to distinguish it from the former.STD may refer only to infections that are causing diseases, or it maybe used more loosely as a synonym for STI. Because most of the timepeople do not know that they are infected with an STI until they aretested or start showing symptoms of disease.
  8. 8. Here are some of the most common STDs and their symptoms. Itsimportant to remember that you can get and pass many of these diseasesthrough different forms of sex (vaginal, anal, and oral).1. ChlamydiaMost people have no symptoms. Abnormal discharge from the penis orvagina, pain in the testicles, and burning with urinating. Long-termirritation may cause lower abdominal pain, inflammation of the eyes andskin lesions. In women, it can cause inflammation of the pelvic organspelvic inflammatory disease (PID). Chlamydia an be completely cured, butcan be caught again, especially if both sex partners arent treated.Signs and symptoms may include: Painful urination Lower abdominal pain Vaginal discharge in women Discharge from the penis in men Pain during sexual intercourse in women Testicular pain in men
  9. 9. 2. Genital HerpesSmall red bumps, blisters, or open sores on the penis,vagina, or areas close by. Also, vaginal discharge inwomen. Fever, headache, and muscle aches. Pain whenurinating. Itching, burning, or swollen glands in genitalarea. Pain in legs, buttocks, or genital area. Symptomsmay go away and then come back. Some people may haveno symptoms. There is no cure. Treatment includes takinga medicine to lower severity of symptoms.When present, genital herpes signs and symptoms mayinclude: Small, red bumps, blisters (vesicles) or open sores (ulcers) in the genital, anal and nearby areas Pain or itching around the genital area, buttocks and inner thighs
  10. 10. 3. TrichomoniasisTrichomoniasis is a common STI caused by a microscopic, one-celledparasite called Trichomonas vaginalis. This organism spreads duringsexual intercourse with someone who already has the infection. Theorganism usually infects the urinary tract in men, but often causesno symptoms in men. Trichomoniasis typically infects the vagina inwomen. When trichomoniasis causes symptoms, they may rangefrom mild irritation to severe inflammationincludes taking amedicine to lower severity of symptoms.Signs and symptoms may include: Clear, white, greenish or yellowish vaginal discharge Discharge from the penis Strong vaginal odor Vaginal itching or irritation Itching or irritation inside the penis Pain during sexual intercourse Painful urination
  11. 11. 4. GonorrheaPain or burning when urinating. Yellowish and sometimesbloody discharge from the penis or vagina. But, many menhave no symptoms. Can be completely cured, but can becaught again, especially if both sex partners arenttreated.Signs and symptoms of gonorrhea may include: Thick, cloudy or bloody discharge from the penis or vagina Pain or burning sensation when urinating Abnormal menstrual bleeding Painful, swollen testicles Painful bowel movements Anal itching
  12. 12. 5. Hepatitis B Mild fever. Headache and muscle aches, joint pain.Tiredness. Loss of appetite. Nausea and vomiting. Dark-coloredurine and pale bowel movements. Stomach pain. Skin andwhites of eyes turning yellow (jaundice). About 30% of peoplehave no symptoms. Treatment inlcudes taking a medicine to help the liverfight damage from the virus. There are medications availableto treat long-lasting (chronic) HBV-infection. These work forsome people, but there is no cure for hepatitis B when you firstget it. Fortunately, routine immunization of all children withthe Hepatitis B vaccine will hopefully eliminate future HepatitisB infections.
  13. 13. 5. Hepatitis BSome people never develop signs or symptoms. But for thosewho do, signs and symptoms may occur after several weeksand may include: Fatigue Nausea and vomiting Abdominal pain or discomfort, especially in the area of your liver on your right side beneath your lower ribs Loss of appetite Fever Dark urine Muscle or joint pain Itching Yellowing of your skin and the whites of your eyes (jaundice)
  14. 14. 6. HIV Infection And AIDSMay have no symptoms for 10 years or more. Extreme fatigue.Rapid weight loss. Frequent low-grade fevers and night sweats.Frequent yeast infections (in the mouth). Red, brown, orpurplish blotches on or under the skin or inside the mouth,nose, or eyelids. Women can have vaginal yeast infections andother STDs, pelvic inflammatory disease (PID), and menstrualcycle changes. There is no cure. Treatment includes takingmedicines to stop the virus from replicating, or making copiesof itself.Early HIV signs and symptoms may include: Fever Headache Sore throat Swollen lymph glands Rash Fatigue
  15. 15. 6. HIV Infection And AIDSThese early signs and symptoms usually disappear within aweek to a month and are often mistaken for those of anotherviral infection. During this period, you are very infectious.More-persistent or -severe symptoms of HIV infection may notappear for 10 years or more after the initial infection.As the virus continues to multiply and destroy immune cells,you may develop mild infections or chronic signs andsymptoms such as: Swollen lymph nodes — often one of the first signs of HIV infection Diarrhea Weight loss Fever Cough and shortness of breath
  16. 16. 6. HIV Infection And AIDSSigns and symptoms of later stage HIV infection include: Persistent, unexplained fatigue Soaking night sweats Shaking chills or fever higher than 100.4 F (38 C) for several weeks Swelling of lymph nodes for more than three months Chronic diarrhea Persistent headaches Unusual, opportunistic infections
  17. 17. 7. Genital Warts (Human Papillomavirus (HPV)Genital warts that usually first appear as small, hard painlessbumps on the penis, in the vaginal area, or around the anus.They sometimes can be hard to see, but if left untreated canturn into a fleshy, cauliflower-like appearance. Some peoplehave no apparent symptoms. HPV is linked with a higher risk ofcervical cancer in women.Gardasil, the HPV vaccine, will hopefully decrease the risk ofgetting genital warts and cervical cancer and can be given togirls between the ages of 9 and 26 years of age.The signs and symptoms of genital warts include: Small, flesh-colored or gray swellings in your genital area Several warts close together that take on a cauliflower shape Itching or discomfort in your genital area Bleeding with intercourse
  18. 18. 8. SyphilisIn the first (primary) stage, about 10 days to six weeks after exposure: a painlesssore (chancre) or many sores that will heal on their own. If not treated, infectionspreads to the next stage. Secondary stage: skin rash that usually does not itch andclears on its own. Fever, swollen lymph glands, sore throat, patchy hair loss,headaches, weight loss, muscle aches, and tiredness. Latent (hidden) stage:symptoms disappear, but infection remains in body and can damage the brain,nerves, eyes, heart, blood vessels, liver, bones, and joints. Late stage: not able tocoordinate muscle movements, paralysis, numbness, gradual blindness, dementia,and possibly death. Can be completely cured, but can be caught again, especially ifboth sex partners arent treated.However, having no symptoms does not mean that someone does not have aninfection that needs treating or an infection that can lead to a disease or medicalcondition.The common way to prevent the transmission of STIs or STDs is to avoidunprotected sexual contact, whether it is vaginal, anal or oral. However, some STIsor STDs such as herpes can still be passed even if a condom or dental dam is used.It is important to educate yourself and others about how STIs or STDs aretransmitted and how to safeguard your sexual health, including identifyingsymptoms and seeking medical help early.
  19. 19. 8. SyphilisPrimary These signs may occur from 10 days to three months after exposure: A small, painless sore (chancre) on the part of your body where the infection was transmitted, usually your genitals, rectum, tongue or lips. A single chancre is typical, but there may be multiple sores. Enlarged lymph nodes.Signs and symptoms of primary syphilis typicallydisappear without treatment, but the underlyingdisease remains and may reappear in the second(secondary) or third (tertiary) stage.
  20. 20. 8. SyphilisSecondary Signs and symptoms of secondary syphilis may begin two to 10 weeks after the chancre appears, and may include: Rash marked by red or reddish-brown, penny-sized sores over any area of your body, including your palms and soles Fever Fatigue and a vague feeling of discomfort Soreness and achingThese signs and symptoms may disappear within afew weeks or repeatedly come and go for as long asa year.
  21. 21. 8. SyphilisLatent In some people, a period called latent syphilis — in which no symptoms are present — may follow the secondary stage. Signs and symptoms may never return, or the disease may progress to the tertiary stage.Tertiary Without treatment, syphilis bacteria may spread, leading to serious internal organ damage and death years after the original infection.Some of the signs and symptoms of tertiary syphilis include: Neurological problems. These may include stroke and infection and inflammation of the membranes and fluid surrounding the brain and spinal cord (meningitis). Other problems may include poor muscle coordination, numbness, paralysis, deafness or visual problems. Personality changes and dementia also are possible. Cardiovascular problems. These may include bulging (aneurysm) and inflammation of the aorta — your bodys major artery — and of other blood vessels. Syphilis may also cause valvular heart disease, such as aortic valve problems.
  22. 22. 8. SyphilisWhen a woman is pregnant STDs can be more serious for herand her baby. A pregnant woman with an STD can infect her baby before, during, or after the baby’s birth. She may also have early labor or early rupture of the membranes surrounding the baby in the uterus. Pregnant women should ask their doctors about getting tested for STDs, since some doctors do not routinely perform these tests.
  23. 23. C. Postpartum Psychosis This condition is uncommon. It occurs in only one to two women per 1,000 births. In most cases it begins within the first two to four weeks following the birth of the baby but can occur later than this. This is a serious and sometimes even life threatening condition and urgent treatment is required. The baby’s safety may also be at risk. The word psychosis means to be out of touch with reality. A person may be out of touch with reality if they are experiencing delusions or hallucinations (or both). is a rare illness, compared to the rates of postpartum depressions or anxiety. It occurs in approximately 1 to 2 out of every 1,000 deliveries, or approximately 1% of births. The onset is usually sudden, most often within the weeks postpartum.
  24. 24. Symptoms of Postpartum PsychosisSymptoms of postpartum psychosis are consistentwith those of a bipolar I psychotic episode but havesome special "twists" specifically related tomotherhood. They include, but are not limited to: feeling ‘high’, ‘manic’ or ‘on top of the world’ low mood and tearfulness anxiety or irritability rapid changes in mood severe confusion being restless and agitated racing thoughts
  25. 25.  behaviour that is out of character being more talkative, active and sociable than usual being very withdrawn and not talking to people finding it hard to sleep, or not wanting to sleep losing your inhibitions feeling paranoid, suspicious, fearful feeling as if you’re in a dream world
  26. 26. Causes: Most, but not all cases of postpartum psychosis are episodes of bipolar disorder. They may be due to other psychiatric conditions or other medical conditions causing delirium. These are what psychiatrists call “mixed mood states” (part of bipolar disorder) and which can result in big fluctuations in how a person is feeling and behaving. Women seem to be particularly prone to these states after having a baby. Some women are particularly vulnerable to the mental effects of sudden changes in hormone levels (this seems to set off an underlying mood disorder). Sleep deprivation may also be an important trigger.
  27. 27. Who is most likely to get postpartum psychosis? For many women with postpartum psychosis there may be no warning. For other women it is clear that they have a high risk. If you have ever had a diagnosis of bipolar disorder or schizoaffective disorder, your risk of postpartum psychosis is high. You may also be in this high risk group if you have had a diagnosis of schizophrenia or another psychotic illness. If you also have a mother or sister who has had postpartum psychosis, your risk may be even higher. Women who have had postpartum psychosis before are also at very high risk. If you are in one of these high risk groups your chance of having postpartum psychosis is between 1 in 4 and 1 in 2 (25% to 50%). You should discuss your individual risk with a psychiatrist. You may be worried about your risk if a close relative has had postpartum psychosis. If your mother or sister had postpartum psychosis but you have not had any mental illness, your risk is around 3 in 100 (3%). This is higher than the risk in the general population. It is still much lower than for the very high risk groups.
  28. 28. For women at high risk can anything be done to prevent it? Ideally let your psychiatrist and GP know that you want to get pregnant before you start trying for a baby. You can discuss with them any medications you are taking. They can advise you what you can do to ensure you are as well as possible before becoming pregnant. Many pregnancies are not planned. In that case, let people know as soon as possible. If you are pregnant it is important to tell everyone involved in your care about your previous illness. This includes your midwife, obstetrician, GP and health visitor. Your mental health team and GP need to know you are pregnant. They all need to know you have a high risk of postpartum psychosis to make sure you get the care you need. They should help you to make a plan for your care (see below). Paying attention to other factors known to increase the risk of becoming ill may be important. These could include trying to reduce other stressful things going on in your life. Try to get as much sleep and rest as you can in late pregnancy and after the birth. With a new baby this may difficult. Ask your partner or family to take on some of the night time feeds if possible. Think about any factors which usually trigger your episodes of illness. Try to do whatever you can to reduce the chance of these happening.
  29. 29. Will medication stop me getting ill after the baby is born?For women taking medication to help keep them well, the decision tocontinue or stop medication in pregnancy is very difficult. There are noright and wrong answers. There are risks involved with all possibleoptions. The options you can consider include: continuing on all or some of your current medication switching to other options which may be safer in pregnancy coming off all medications.It is important to discuss these with your psychiatrist. This will help youdecide what is best for you and your baby.Some women at high risk of postpartum psychosis may decide to startmedication in late pregnancy or after delivery. This may reduce the riskof becoming ill. There is not enough research evidence to be sure aboutthis. A number of medications are sometimes used in this way. Theseinclude antipsychotics and lithium. You should discuss this with yourpsychiatrist.
  30. 30. D. InfertilityInfertility means not being able to get pregnant after one year oftrying (or six months if a woman is 35 or older). Women who canget pregnant but are unable to stay pregnant may also beinfertile.Pregnancy is the result of a process that has many steps. To getpregnant: A womans body must release an egg from one of her ovaries. The egg must go through a fallopian tube through the uterus A mans sperm must join with (fertilize) the egg along the way. The fertilized egg must attach to the inside of the uterus (implantation).Infertility can happen if there are problems with any of thesesteps.
  31. 31. About 10 percent of women (6.1 million) in the United States ages 15-44 havedifficulty getting pregnant or staying pregnant, according to the Centers forDisease Control and Prevention (CDC).Infertility is not always a womans problem. Both women and men can haveproblems that cause infertility. About one-third of infertility cases are caused bywomens problems. Another one third of fertility problems are due to the man. Theother cases are caused by a mixture of male and female problems or by unknownproblems.Most cases of female infertility are caused by problems with ovulation. Withoutovulation, there are no eggs to be fertilized. Some signs that a woman is notovulating normally include irregular or absent menstrual periods.Ovulation problems are often caused by polycystic ovarian syndrome (PCOS). PCOSis a hormone imbalance problem which can interfere with normal ovulation. PCOS isthe most common cause of female infertility. Primary ovarian insufficiency (POI) isanother cause of ovulation problems. POI occurs when a womans ovaries stopworking normally before she is 40. POI is not the same as early menopause.
  32. 32. Less common causes of fertility problems in women include: Blocked fallopian tubes due to pelvic inflammatory disease. Endometriosos, or surgery for an ectopic pregnancy Physical problems with the uterus uterine fibroids, which are non-cancerous clumps of tissue and muscle on the walls of the uterus.
  33. 33. Many things can change a womans ability to have a baby. Theseinclude: Age Smoking Excess alcohol use Stress Poor diet Athletic training Being overweight or underweight Sexually transmitted infections (STIs) Health problems that cause hormonal changes, such as polycystic ovarian syndrome
  34. 34. Many women are waiting until their 30s and 40s to have children.In fact, about 20 percent of women in the United States now havetheir first child after age 35. So age is a growing cause of fertilityproblems. About one-third of couples in which the woman is over35 have fertility problems.Aging decreases a womans chances of having a baby in thefollowing ways: Her ovaries become less able to release eggs She has a smaller number of eggs left Her eggs are not as healthy She is more likely to have health conditions that can cause fertility problems She is more likely to have a miscarriage
  35. 35. Women 35 or older should see their doctors after six months oftrying. A womans chances of having a baby decrease rapidly everyyear after the age of 30.Some health problems also increase the risk of infertility. So,women should talk to their doctors if they have: Irregular periods or no menstrual periods Very painful periods Endometriosis Pelvic inflammatory disease More than one miscarriage
  36. 36. In women, the first step is to find out if she is ovulating eachmonth. There are a few ways to do this. A woman can track herovulation at home by: Writing down changes in her morning body temperature for several months Writing down how her cervical mucus looks for several months Using a home ovulation test kit (available at drug or grocery stores)
  37. 37. Doctors can also check ovulation with blood tests. Or theycan do an ultrasound of the ovaries. If ovulation is normal,there are other fertility tests available.Some common tests of fertility in women include: Hysterosalpingography: This is an x-ray of the uterus and fallopian tubes.Doctors inject a special dye into the uterus through thevagina. This dye shows up in the x-ray. Doctors can thenwatch to see if the dye moves freely through the uterus andfallopian tubes. This can help them find physical blocks thatmay be causing infertility. Blocks in the system can keep theegg from moving from the fallopian tube to the uterus. Ablock could also keep the sperm from reaching the egg.
  38. 38.  Laparoscopy: A minor surgery to see inside the abdomen. Thedoctor does this with a small tool with a light called alaparoscope. She or he makes a small cut in the lowerabdomen and inserts the laparoscope. With the laparoscope,the doctor can check the ovaries, fallopian tubes, and uterusfor disease and physical problems. Doctors can usually findscarring and endometriosis by laparoscopy.Finding the cause of infertility can be a long and emotionalprocess. It may take time to complete all the needed tests
  39. 39. Treatment:Infertility can be treated with medicine, surgery, artificialinsemination or assisted reproductive technology Many timesthese treatments are combined. In most cases infertility is treatedwith drugs or surgery.Doctors recommend specific treatments for infertility based on: Test results How long the couple has been trying to get pregnant The age of both the man and woman The overall health of the partners Preference of the partners
  40. 40. Intrauterine insemination (IUI) is an infertility treatment that isoften called artificial insemination. In this procedure, the woman isinjected with specially prepared sperm. Sometimes the woman isalso treated with medicines that stimulate ovulation before IUI.IUI is often used to treat: Mild male factor infertility Women who have problems with their cervical mucus Couples with unexplained infertility
  41. 41. Assisted Reproductive Technology is a group of different methods used to helpinfertile couples. ART works by removing eggs from a womans body. The eggsare then mixed with sperm to make embryos. The embryos are then put back inthe womans body.Some things that affect the success rate of ART include: Age of the partners Reason for infertility Clinic Type of ART If the egg is fresh or frozen If the embryo is fresh or frozenThe U.S. Centers for Disease Control and Prevention (CDC) collects success rateson ART for some fertility clinics. According to the 2006 CDC report on ART, theaverage percentage of ART cycles that led to a live birth were: 39 percent in women under the age of 35 30 percent in women aged 35-37 21 percent in women aged 37-40 11 percent in women aged 41-42
  42. 42. ART can be expensive and time-consuming. But it has allowed many couples to havechildren that otherwise would not have been conceived. The most commoncomplication of ART is multiple fetuses. But this is a problem that can be preventedor minimized in several different ways.Common methods of ART include: In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most effective ART. It is often used when a womans fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the mans sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the womans uterus. Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF. Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus. Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the womans fallopian tube. So fertilization occurs in the womans body. Few practices offer GIFT as an option. Intracytoplasmic sperm injection (ICSI) is often used for couples in which there are serious problems with the sperm. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or fallopian tube.
  43. 43. ART procedures sometimes involve the use of donor eggs (eggs fromanother woman), donor sperm, or previously frozen embryos. Donoreggs are sometimes used for women who cannot produce eggs. Also,donor eggs or donor sperm is sometimes used when the woman or manhas a genetic disease that can be passed on to the baby. An infertilewoman or couple may also use donor embryos. These are embryos thatwere either created by couples in infertility treatment or werecreated from donor sperm and donor eggs. The donated embryo istransferred to the uterus. The child will not be genetically related toeither parent.SurrogacyWomen with no eggs or unhealthy eggs might also want to considersurrogacy. A surrogate is a woman who agrees to become pregnant usingthe mans sperm and her own egg. The child will be genetically related tothe surrogate and the male partner. After birth, the surrogate will give upthe baby for adoption by the parents.
  44. 44. Gestational CarrierWomen with ovaries but no uterus may be able to use a gestationalcarrier. This may also be an option for women who shouldnt becomepregnant because of a serious health problem. In this case, a womanuses her own egg. It is fertilized by the mans sperm and the embryo isplaced inside the carriers uterus. The carrier will not be related to thebaby and gives him or her to the parents at birth.Recent research by the Centers for Disease Control and Preventionshowed that ART babies are two to four times more likely to have certainkinds of birth defects. These may include heart and digestive systemproblems, and cleft (divided into two pieces) lips or palate. Researchersdon’t know why this happens. The birth defects may not be due to thetechnology. Other factors, like the age of the parents, may be involved.More research is needed. The risk is relatively low, but parents shouldconsider this when making the decision to use ART.Nurse’s Role:The role of the infertility nurse is continually expanding and changing tomeet the demands of couples undergoing assisted reproduction..
  45. 45. E. OsteoporosisOsteoporosis or porous bone is is a disease in which bone tissue isnormally minerized but the mass (density) of the bone is decreasedand the structural integrity of trabecular bone is impaired. The old bone is reabsorbed faster than the new bone is being made causing the bone to lose density , becoming thinner and more porous A natural process breaks down bones or removed (resorption) and builds them back up again (formation) at the microscopic level. Children and young adults build more bone than they break down. Pregnant women release bone to transfer needed minerals to the developing fetus and then build up their own bone strength again after giving birth. In women, bone loss is most rapid in the first five years after menopause but persists throughout the postmenopausal years, possibly because they no longer need extra stores of minerals to support a developing fetus. People who have osteoporosis are at greater risk for fracturing their bones, especially in the hip, vertebrae (spine) and wrist
  46. 46. The WHO has defined osteoporosis based on density: Normal is greater than 833mg/cm ^2 Osteopenia or decreased bone mass is 833 to 648 mg/cm ^2 Osteoporosis is below 648 mg/cm ^2.Risk factors:Genetic Family with osteoporosis White race Increase age Female sexAnthropometric Small stature Fair or pale skinned Thin build
  47. 47. Hormonal and metabolic Early menopause ( natural or surgical) Late menarche Nulliparity obesity Hypogonadism Gaucher disease Weight below normalDietary Low dietary calcium and vitamin D Low endogenous magnesium Excessive protein High in caffeine Anorexia Malabsorption
  48. 48. Lifestlye Sedentary Smoker Alcohol consumption (excessive)Drugs Heparin-promote bone resorption by increasing collagen breakdown Depo-medroxyprogesterone acetate corticosteroids Dilantin Loop diuretics Methotrexate
  49. 49. Osteoporosis Symptoms:Early in the course of the disease, osteoporosis may cause nosymptoms. Later, it may cause dull pain in the bones or muscles,particularly low back pain or neck pain.Later in the course of the disease, sharp pains may come onsuddenly.The pain may not radiate it may be made worse by activity thatputs weight on the area, may be accompanied by tenderness, andgenerally begins to subside in one week. Pain may linger morethan three months.
  50. 50. Osteoporosis screening: DXA X-ray (Dual x-ray absorptiometry) scan the most common screening tool is a, which measures bone mineral density in the hip spine or elsewhere. Radiologic examination Computed tomography-are also helpful Test for level of serum calcium, phosphate, alkaline phosphatase, protein electrophoresis Serum and urinary biochemical markers like urinary N- telopeptide (NTx), C- telopeptide (CTx) and deoxypyuridinoline –markers of resorption
  51. 51. Drug Treatments:The goals of osteoporosis treatment are to slow down therate of calcium and bone loss and to stop the disease toprogresses too far.Women diagnosed with osteoporosis or osteopenia areusually told they need to take prescription medication toprevent further bone loss and reduce the risk of fractures.The most common drugs are the ff:
  52. 52. Hormones:1. Estrogen and progestin treatment to prevent osteoporosis— but not to treat it. Both estrogen alone and combinationsof estrogen and progestin reduce women’s risk ofosteoporosis and bone fracture. But, the hormones alsoincrease the risk of breast cancer, heart attack, stroke, andpulmonary embolism. So, these hormones should be the lastchoice for osteoporosis prevention and should be used onlywhen other prevention methods are not safe or appropriatefor a particular woman.
  53. 53. 2. Teriparatide (brand name: Forteo) is a derivative of human parathyroid hormone (PTH), the primary regulator of calcium and phosphate metabolism in bones A daily 20mg inj shown to stimulate new bone formation and prevent spine, hip, wrist and other bone fractures in women with osteoporosis. generally used only for women with severe osteoporosis, side effects can include nausea, leg cramps, and dangerously high calcium levels. It’s also very expensive, and some insurance companies are reluctant to cover it.
  54. 54. 3. Calcitonin (brand names: Fortical or Miacalcin; not the same ascalcium supplements has been shown to prevent fractures of the spine but not of the hip and wrist. Slow bone loss in post menopausal women, increase bone density , relieves pain associate to bone fracture and reduces risk of spinal fracture. It is approved to treat women with osteoporosis, but its approval was based on weaker evidence than more recently approved drugs, and its use is not generally recommended. Women who take calcitonin must watch their intake of foods with high calcium levels (e.g. milk, cheese) as excessive calcium can be dangerous. Calcitonin is administered through a nasal spray; side effects may include nasal congestion and nausea.
  55. 55. Bisphosphonates widely prescribed for osteoporosis treatment and prevention. The FDA has approved eight bisphosphonates to prevent bone loss and fractures in post-menopausal women: alendronate (Fosamax), etidronate (Didronel), ibandronate (Boniva), risedronate (Actonel), tiludronate (Skelid), pamidronate (Aredia) and zoledronic acid (Reclast and Zometa)2. Some are taken daily; others are formulated for weekly monthly or yearly use. The drugs are also incorporated into newly formed bone and can persist in them for years, so the effects last well beyond cessation of use.
  56. 56. In May 2012, in an important update, the FDA expressed concernsabout the safety and effectiveness of bisphosphonate use beyond3 to 5 years. According to these studies3,4,5, women who receivedcontinuous bisphosphonate treatment for 6 or more years had afracture rate between 9.3% and 10.6%, while patients who did notcontinue the treatment after 3-5 years actually had a lowerfracture rate of between 8.0 and 8.8%. In light of these studies, the FDA states that they believe that women at low risk of fracture should consider stopping bisphosphonates after 3-5 years In addition to questions of efficacy, there are safety concerns. Bisphosphonates seem to have fewer risks than hormones, at least in the first five years, Bisphosphonates also can cause severe heartburn and ulcers and damage the stomach and esophagus if not taken in a very careful regimen (on an empty stomach, with a full glass of water, while sitting upright for up to an hour and also risk f oesophageal cancer
  57. 57. Selective Estrogen Receptor Modulators (SERMs)@Raloxifene (Evista) are compounds that act like estrogenon some tissues (eg. bone tissue) and have an anti-estrogeneffect on other tissues (eg. breast and sometimes uterus). The FDA has approved) to prevent and treat osteoporosis. The drug has been tested more extensively than bisphosphonates and although it reduces the risk of spine fractures, it does not reduce hip fracture risk. It also raises different safety concerns that include increased risks of blood clots, hot flashes, nausea, and leg cramps.
  58. 58. @lasofoxifene, treatment of osteoporosis in postmenopausal women. appears to reduce spine fractures in the first three years of use. Like raloxifene, it increases the likelihood of blood clots, and it also increases vaginal bleeding and women taking the drug were subjected to more invasive procedures such as endometrial biopsies, D&Cs and even hysterectomy. The NWHN recommended to the FDA that approval of lasofoxifene be delayed until the agency can fully review the research on extended use so that we’ll know more about the effects and effectiveness of using the drug for extended periods of time. NWHN also expressed concern that Pfizer, the company that makes lasofoxifene, will encourage women to take this drug for other uses that haven’t been fully evaluated by the FDA. Subject to FDA’s request for more information, in 2010 Pfizer decided to withdraw its application for approval of lasofoxifene.
  59. 59. @Bazedoxifine( Aprela) This year (2012) Pfizer is seeking approval for a new hormone therapy with claims of delivering benefits of HT without the risks by combining estrogen with bazedoxifene. Bazedoxifene, a similar SERM to lasofoxifene is approved for treatment of osteoporosis in Europe, but not in the USA due to FDA’s concerns about its side effects of strokes and blood clots7. NWHN will monitor the FDA approval process for this proposed new drug very carefully and will report our findings as soon as possible.
  60. 60. Monoclonal antibodiesDenosumab(Prolia) A new class of medication (denosumab) is a monoclonal antibody that inactivates the natural bone breakdown mechanism. In 2010, the FDA approved denosumab for osteoporosis treatment. , it is an injection given twice a year for osteoporotic patients in whom other treatments have failed or who have severe osteoporosis and a high risk for fractures. While the drug has been shown to be effective in reducing fractures and preventing bone loss, it also causes significant health problems. Denosumab’s cellular target in bone also exists in the immune system and serious infections requiring hospitalization (eg. heart infections), skin reactions, atypical fractures and slow healing of fractures are among the side effects Concerns exist that its immune system effects could include ovarian and cervical cancer, pancreatic cancer and breast cancer recurrences. Prolia is an expensive medication with uncertain effects of long term use. The NWHN is concerned that for most postmenopausal women the benefit of Prolia does not outweigh the risks. We recommend that women requiring osteoporosis treatment not try denosumab until they’ve tried other FDA-approved osteoporosis medications.
  61. 61. Alternatives Alternatives to drugs exist for making and keeping bones strong. The National Institutes of Health’s 2000 Consensus Statement on Osteoporosis reviewed the research on osteoporosis prevention and treatment and found strong scientific evidence that calcium and Vitamin D intake are crucial to develop and preserve strong bones. Regular exercise (especially resistance and high-impact activities) contributes to the development of bone mass. Other promising interventions focus on preventing fractures: balance training reduces the risk of falling, which is often responsible for broken bones in older people.
  62. 62. = A few small studies have shown that hip protectors, alongwith training on how to use them can help reduce the risk offracture if a fall occurs.= Large randomized trials didnt find any benefits, though.Other practical ways to reduce the risk of falling includemaking sure that vision prescriptions are up-to-date,= checking prescriptions for drug interactions that mightcause dizziness, eliminating fall-causing hazards in the home(like slippery rugs, grandkids’ toys with wheels),= wearing appropriate shoes.
  63. 63. HEALTH ALERT (Anderson M. Delmas PD 2001)www.karger.com/gazette/65/anderson2/index.htm Worldwide, osteoporosis affects approximately 1 in 3 women over the age of 50 years A woman is more likely to have hip fracture caused by osteoporosis than she is getting any of the common cancers such as breast, endometrial or ovarian cancer In the middle east, the number of hip fracture will triple in the next 20years Asian expects the most dramatic increased in hip fractures during the next decades, mainly because of an aging population but also due to a changing lifestyle.
  64. 64. F. MenopauseThe permanent cessation of menses that may occurnaturally or occurs following certain surgeries,chemotherapy or radiation therapy.The mean age of onset of menopause is typicallybetween the ages of 45 to 55.When you have not had a period (or even lightspotting) for 12 consecutive months.
  65. 65. Perimenopause (before menopause) denotes the years prior to menopause those encompass the symptoms associated with normal menstrual cycles and cessation of menses. This period is marked by irregularity of menstrual cycles. When you start noticing something is a little “off”, (usually with your periods) or maybe it seems like you’re more irritable than usual.
  66. 66. Causes of Menopause: Natural physiological mechanism in a women’s body wherein she stops menstruating. During menopause a woman’s hormone mechanisms undergo numerous changes that finally lead to the cessation of menstrual cycles. Surgery – ex. Hysterectomy (surgical menopause) Chemotherapy or radiation therapy – ex. Cancer (chemical menopause)
  67. 67. Risk Factors of Menopause:Smoking – has been linked to earlier onset of themenopausal process wherein it is dependent on thenumber of cigarettes smoked and the duration of thehabit.Complications:Menopausal women may experience bleeding even aftercessation of menses. They may also be at increased riskof developing osteoporosis, cardiovascular disorders orcancer of the colon.
  68. 68. Common Signs and Symptoms: Hot flashes, flushes, night sweats and/or cold flashes, clammy feeling Irregular heart beat Irritability Mood swings, sudden tears Trouble sleeping through the night/sleeplessness (with or without night sweats) Irregular periods; shorter, lighter periods; heavier periods, flooding; phantom periods, shorter cycles, longer cycles
  69. 69. Common Signs and Symptoms: Incontinence, especially upon sneezing, laughing; urge incontinence (urgency of urination, burning or pain during urination) Itchy, crawly skin Aching, sore joints, muscles and tendons Increased tension in muscles Breast tenderness Headache change: increase or decrease
  70. 70. Common Signs and Symptoms: Loss of libido Dry vagina Crashing fatigue Anxiety, feeling ill at ease Feelings of dread, apprehension, doom Difficulty concentrating, disorientation, mental confusion Disturbing memory lapses
  71. 71. Common Signs and Symptoms: Gastrointestinal distress, indigestion, flatulence, gas pain, nausea Sudden bouts of bloat Depression Exacerbation of existing conditions Increase in allergies Weight gain Hair loss or thinning, head, pubic, or whole body; increase in facial hair
  72. 72. Common Signs and Symptoms: Dizziness, light-headedness, episodes of loss of balance Changes in body odor Electric shock sensation under the skin and in the head Tingling in the extremities Gum problems, increased bleeding Burning tongue, burning roof of mouth, bad taste in mouth, change in breath odor
  73. 73. Common Signs and Symptoms: Osteoporosis (after several years) and bone fracture Changes in fingernails: softer, crack or break easier Tinnitus: ringing in ears, bells, whooshing, buzzing etc.*Note: Some symptoms may also be signs of thefollowing (hypothyroidism, diabetes, depression withanother etiology, and/or other medical conditions).
  74. 74. How to diagnose: Diagnosis is based on factors such as the age of the woman and signs and symptoms observed. Absence of periods for a span of one year along with other features of menopause is usually diagnostic. Measurement of the FSH levels in the body Additional tests that may need to be repeated periodically in order to check for any abnormal changes in the body.
  75. 75. Treatment: Therapy is based on the severity of the symptoms of menopause. Lifestyle modifications such as  Diet modifications (high fiber, low fat, foods rich in antioxidants, soya)  Exercise  Smoking cessation  Decreased alcohol intake  Relaxation and stress reduction Hormone replacement therapy (HRT) – is generally advised for women who are symptomatic and are at high risk of developing cardiovascular disorders, osteoporosis, Alzheimer disorder or colonic cancer. Menopausal women may also be required to take calcium and vitamin supplements.
  76. 76. BARROGA, Marilyn Richelle DIGUEL, Brenda Lee GRAGERA, Jennifer C. MASIGMAN, Mary Ann PAESTE, Gloria SERRANO, CecilleVALENTON, Kathleen Anne Marie