Weight management in gynecologic care.

Body mass index (BMI) should be assessed at every health care visit. Overweight and obesity are associated with higher risks of hypertension, type 2 diabetes, irregular ovulation, infertility, and pregnancy and birth complications. Family planning and annual gynecology examinations give primary care providers the opportunity to share basic weight management guidelines with women. Weight management to normalize BMI or reduce overweight and obesity is vital to reduce future comorbidities. This article demonstrates integration of basic weight management into gynecologic care.

Reproductive health in women with eating disorders.

Medical complications are often the precipitants that lead women with eating disorders to seek health care. Complications can be wide ranging but frequently include symptoms associated with reproductive health. Unfortunately, because of the denial, embarrassment, shame, and secrecy associated with these psychiatric illnesses, the underlying cause of these complications can often go unacknowledged, delaying assessment and intervention. This article provides an overview of anorexia nervosa and bulimia nervosa, identifies the reproductive health issues that may occur in women with these disorders, and discusses the associated clinical implications for nursing practice.

Proactive management of menstrual cycle abnormalities in young women.

The goal of an integrative science of women's health is bringing together childbearing with women's health during the lifespan. Enhancing a woman's ability to conceive and maintain a pregnancy is influenced by decisions made well before the beginning of a pregnancy. Identifying ovulatory disorders makes it possible to intervene early in a young woman's childbearing years. Gynecologic charting typically used in natural family planning provides information to the woman and to the healthcare provider that is useful for diagnosis. If young women have a better understanding of fertility and menstrual cycle function, they are in a stronger position to make informed decisions about how they wish to manage their reproductive and sexual health. It may be possible to educate the young woman in health habits that will lead to a healthy pregnancy when she chooses and/or to treat the cause of the ovulatory disorder. This article focuses on polycystic ovary syndrome and hypothalamic dysfunction which can cause menstrual cycle abnormalities in which gynecologic charting is useful in young women.

Common menstrual disorders in adolescence: nursing interventions.

Menstrual disorders such as amenorrhea, excessive uterine bleeding, dysmenorrhea, and premenstrual syndrome are common reasons for visits to healthcare providers by adolescent girls. Although menstrual irregularity can be normal during the first few years after menarche, other menstrual signs and symptoms may indicate a pathological condition that requires prompt attention and referral. This article discusses four common menstrual disorders seen in adolescent girls and focuses on specific nursing interventions aimed at eliciting an accurate menstrual history, providing confidentiality and communicating therapeutically, administering culturally sensitive care, and promoting independence and self-care.

Gynecologic care for women with HIV infection.

The purpose of this article is to review the gynecologic conditions encountered among women with HIV and to outline elements of gynecologic care for these women. The most prevalent problems are vulvo-vaginal candidiasis and cervical dysplasia; however, other sexually transmitted diseases, pelvic inflammatory disease, genital ulcer disease, and menstrual abnormalities are also seen. Drug interactions may limit the effectiveness or increase the toxicities associated with hormonal contraception. Intrauterine devices are contraindicated.

Menstrual dysfunction in athletes: assessment and treatment.

The reported incidence of exercise induced menstrual dysfunction varies among adolescent athletes from 12% to 66%. Women who experience amenorrhea associated with exercise are at risk for irretrievable bone mineral density loss and increased rate of stress fractures. Nurses should provide information to parents, coaches, and athletes about changes in exercise intensity and frequency, dietary modifications, and estrogen and progesterone replacement therapy to minimize the sequelae of exercise induced menstrual dysfunction.

Menstrual response to running: nursing implications.

Overt (length of menstrual cycle, duration of menses, and amount of menses) and covert (luteal surge indicative of ovulation and length of luteal phase) menstrual cycle characteristics were studied in a sample of 146 women who participated in four levels of running intensity. Menstrual and running data were collected for 4 months or 3 cycles. There was a significant difference among the four groups in duration of menses and in the amount of menses, with nonrunners having significantly more days of menses and larger amounts of menses than the two highest intensity running groups. However, when a history of skipping menstrual periods between menarche and age 18 was controlled, the differences between the groups were not significant. There were no significant differences among the four groups in incidence of luteal surge or length of luteal phase. When runners were compared to nonrunners, runners reported, on average, a shorter luteal phase than nonrunners. This difference remained when controlling for age and history of skipping menstrual periods. There was no significant difference between the four groups on incidence of ovulatory disturbances (anovulation or more than one cycle with a shortened luteal phase). But, when compared to nonrunners, runners were found to have significantly more ovulatory disturbances. The best predictors of the variance in menstrual cycle characteristics were history of skipping periods between menarche and age 18, and running versus nonrunning.

Menstrual disorders during adolescence.

Concerns about menstrual function are a frequent reason for primary care visits during adolescence. Following a review of normal pubertal development and menstrual function, primary care assessment and management of delayed menarche, amenorrhea, and dysfunctional uterine bleeding during adolescence are presented.

Evaluation of abnormal genital bleeding.

Irregularities of the menstrual cycle, including abnormal genital bleeding, can occur throughout a woman's life cycle. An understanding of the normal menstrual cycle is necessary before evaluation and management of an irregular cycle. Several disorders are defined and described, including appropriate evaluation and management protocols.

Menstrual disorders. Premenstrual syndrome, dysmenorrhea, amenorrhea.

The nurse practitioner, with skills in clinical management and concern for the psychosocial and emotional well-being of clients, is in a unique position to intervene on behalf of those who suffer menstrual disorders. Premenstrual tension, dysmenorrhea, and amenorrhea are discussed with attention to patient education, as well as to diagnosis and management.