Nursing Interventions: Once she is stable, various interventions such as lifestyle changes, dietary alterations, and conventional and complementary care approaches can be initiated that will become an important part of her long-term health promotion and maintenance.
Diseases that mimic PMS, how to rule it out
Other Conditions That Mimic PMS
When interviewing patients with premenstrual disorder symptomatology, it is essential to obtain a detailed history.
· Dysmenorrhea,
· Hypothyroidism,
· Depressive disorders,
· Pain disorders, and
· Generalized anxiety disorders are other conditions that may produce similar symptoms.
Hypothyroidism, for example, may be associated with fatigue, bloating, irritability, and depression. Breast disease (breast tenderness) or anemia (fatigue) may be responsible for other common symptoms.
Various gynecological disorders such as:
Polycystic ovary syndrome PCOS or
Endometriosis may also cause symptoms that can be confused with PMS.
2 0r 3 months with the symptoms
MENOPAUSE
Menopause refers to the last menstrual period and can be dated with certainty when there has been at least 1 whole year without menstruation .
Drastic changes in the body occur to prepare for and enter menopause, resulting in a range of physical and emotional symptoms. Many women have just a few mild symptoms, but others have severe symptoms that interfere with activities of daily living.
Premenopause is the time up to the beginning of perimenopause, but the term is also used to define the time up to the last menstrual period.
Perimenopause is the time preceding menopause, usually starting between 2 and 8 years before menopause and lasting an average of 4 years
Postmenopause begins when ovarian estrogen terminates, ovulation ceases, and menstrual p Irregular menses
PREMENOPAUSE
Hot flushes
Vaginal dryness
Dyspareunia
Mood changes
MENOPAUSE
Hot flushes
Night Sweats
Vaginal dryness
Discomfort during sex
Difficulty sleeping
Low mood or anxiety
Reduced sex drive (libido)
Problems with memory and concentration
Body Changes during MENOPAUSE
· Menopause commence with a decrease in the production of hormones.
· Periods become progressively more irregular.
· “Vasomotor symptoms,” “hot flash,” and “hot flush” are often used to describe the same phenomenon.
· The mucous membranes, previously supported by estrogen stimulation, become thin, dry, and fragile. The vagina loses its rough texture and dark pink coloration and becomes smooth and pale. The vagina also shortens and narrows
· Alteration in the normal vaginal flora results in a decrease in the normal protective mechanisms of the vagina. Declining estrogen secretion is accompanied by a corresponding reduction in the lactobacilli needed to maintain a healthy acidic vaginal environment. With these changes in pH, normally harmless pathogens may colonize the more alkaline vagina, potentially leading to infection. When the vaginal mucosa becomes inflamed, the condition is termed “atrophic vaginitis,” a condition characterized by burning, leukorrhea, and malodorous yellow discharge.
· The breasts may lose their fullness, flatten, and drop. The nipples may become smaller and flatter.
· Rapid bone loss begins within 3 years of cessation of menstruation.
Treatment of Menopause Symptoms:
Hormonal Therapies:
Estrogen is the only pharmacological therapy that is government approved in the United States and Canada for treating menopause-related symptoms.
two categories: estrogen therapy (ET) and combined estrogen-progestogen therapy (EPT).
Alternative Medical Systems, Mind-Body Medicine, Manipulative and Body-Based Methods, and Energy Medicine.
TRADITIONAL CHINESE MEDICINE (TCM)
AYURVEDA
HOMEOPATHIC MEDICINE
Herbal therapies intended for ingestion may be administered in a variety of ways, such as:
■ Tea infusions (soft, aromatic parts of the plant are steeped, not boiled, in water)
■ Tea decoctions (barks and roots, boiled in water)
■ Essential oils (highly concentrated)
■ Tinctures and fluid extracts (herbs macerated into water-alcohol mixtures)
■ Dried standardized extract (these typically contain part of a plant but can contain the whole plant; extracts are standardized to one ingredient only)
■ Homeopathic preparations (extremely diluted) (NAMS, 2021)
Fibrocystic Changes:
BENIGN BREAST MASSES
Also termed: Fluid-filled cysts, palpable thickening in the breasts often associated with pain and tenderness that fluctuates with the menstrual cycle.
Nurses can reassure them that fibrocystic changes are common and benign and tend to appear during the second and third decades of life and suggest strategies for coping with Mastalgia: use of a well-fitting supportive bra, analgesics, NSAIDs, and consumption of dietary flaxseed (25 g/day).
Fibroadenomas: are solid cysts composed of stromal (connective) and glandular tissue. the most common benign breast tumor, occurring in 25% of women and usually located in the upper outer quadrant of the breast.
Lipomas are mobile, nontender fat tumors that are soft with discrete borders. Lipomas may develop anywhere in the body, including the breasts.
Intraductal papilloma are small, wartlike growths in the lining of the milk ducts near the nipple.
Mammary duct ectasia is an inflammation of the ducts located behind the nipple.
SCREENING:
Annual CBEs performed by a trained health-care professional are an important tool in the early detection of breast cancer, often before a woman has any signs or symptoms.
Screening methods include clinical breast examinations (CBE), mammography, and ultrasonography.
Breast self-awareness, and breast self-examination (BSE), can also assist in early detection and early treatment.
BSE: BSE is 7 to 9 days after menses, when the breasts are least likely to be swollen or tender due to hormonal changes. BSE can be perform in front of a mirror so that the women can see clearly, in the shower so the hand can easily slide along the wet skin, or when lying down on a comfortable surface.
Fine Needle Aspiration (FNA): use of a fine needle that is carefully guided into the suspicious area while the practitioner palpates the lump.
ultrasound or a stereotactic biopsy can be used to help locate and ensure an adequate sampling of the suspicious tissue.
Core Needle Biopsy: Is a technique where a large-bore needle is used to remove a small cylinder of tissue. is often guided as with the FNA procedure.
BREAST DRAINAGE:
Nipple Discharge:
Galactorrhea (the continuation of milk secretion after breastfeeding has ceased) is characterized by a spontaneous bilateral, milky, sticky discharge.
False discharge refers to fluid that appears on the nipple or areola but is not secreted by breast tissue. False discharge may be bloody, clear, colored, purulent, serous, or viscous. Various conditions such as eczema, dermatitis, nipple trauma, and Paget’s disease may be associated with false nipple discharge.
Mondor disease of the breast is a rare, self-limiting condition characterized by thrombophlebitis of the superficial veins.
BREAST CANCER:
Risk factors for breast cancer may be related to demographics, personal health history, lifestyle choices, and defects in certain genes .
Alcohol use increases breast cancer risk, especially for women who drink more than one alcoholic beverage per day.
DUCTAL CARCINOMA IN SITU: DCIS is considered a stage 0 breast cancer and is considered a noninvasive or preinvasive cancer.
LOBULAR CARCINOMA: LCIS is not considered a true cancer, although this neoplasm is sometimes classified as a type of noninvasive breast cancer.
INVASIVE (INFILTRATING) LOBULAR CARCINOMA: Invasive (infiltrating) lobular carcinoma (ILC) originates in the lobules (milk-producing glands) and spreads to surrounding breast tissue.
Can metastasize to other parts of the body.
INFLAMATORY BREAST CANCER: IBC Inflammatory breast cancer (IBC) is a rare neoplasm that occurs more often in younger women and women of color and tends to grow more quickly and aggressively than the more common types of breast cancers.
Tips for Reducing Breast Cancer Risk
Nurses can teach families about simple at-home strategies that may reduce breast cancer risk:
Diet and exercise: Reducing calories and engaging in regular exercise may slow tumor growth and lower the amount of circulating leptin, a fat-released protein that has been linked to breast cancer.
Extra-virgin olive oil: This oil contains polyphenol compounds that suppress a breast cancer-promoting gene.
Apples: Phenols found in apples may combat malignant tumors.
Vitamin D: This vitamin prevents the division of cancer cells and activates a tumor-suppressing protein.
Folate: Consuming foods that contain the B-vitamin folate (e.g., leafy green vegetables, beans, and fortified cereals) may help to mitigate the increased breast cancer risk associated with drinking alcohol.
Soy supplements: Soy contains isoflavones, substances that act like estrogen and may stimulate the growth of certain types of breast cancers. Supplements that contain concentrated amounts of isoflavones should be avoided. However, healthy soy foods such as edamame, soy milk, and tofu are not considered harmful.
AXILARY NODES:
Lymphedema (an accumulation of fluid and protein in the extravascular space from trauma to the lymphatic system or supporting structures; results in swelling of the arm).
CANCER STAGING SYSTEM:
The stage of cancer is based on the size of the tumor, the number of lymph nodes involved, and whether the cancer has spread.
The TNM staging system classifies cancers based on their T, N, and M stages:
T = Tumor: size and spread within the breast and to nearby organs
N = Nodes: spread to the lymph nodes
M = Metastasis: spread to distant organs
Stage 0: Ductal carcinoma in situ (DCIS)
Stage I: The tumor measures 2.0 cm in diameter or less and there is no involvement of the lymph nodes and no distant metastasis.
Stage II: The tumor measures 2.0 cm in diameter to 5.0 cm. Depending on the specific findings, the cancer may have spread to the axillary or internal mammary lymph nodes but has not spread to distant sites.
Stage IIIA: 1) The tumor is not more than 5.0 cm
2) The tumor is larger than 5.0 cm
Stage IIIB: The tumor has grown into the chest wall or skin.
Stage IIIC: The tumor is any size, and it has spread.
Stage IV: The cancer can be any size (any “T”), may or may not have spread to nearby lymph nodes (any “N”). It has metastasized (“M”) to distant organs or to distant lymph nodes.
EDUCATION:
■ New lump in the breast or underarm (armpit)
■ Thickening or swelling of part of the breast
■ Irritation or dimpling of breast skin
■ Redness or flaky skin in the nipple area or the breast
■ Pulling in of the nipple or pain in the nipple area
■ Nipple discharge other than breast milk, including blood
■ Any change in the size or the shape of the breast
■ Pain in any area of the breast
Breast Symptoms:
Nipple discharge
Skin changes
Breast Pain (Mastalgia)
Breast Cancer Screening:
BSE
CBE
