Nursing 209

N209: Reproductive Health Study Guide • Laparoscopic-assisted vaginal hysterectomy (LAVH): Vaginal hysterectomy with laparoscopic assistance for greater visibility by the surgeon • Abdominal: Low transverse abdominal incision • Laparoscopic-assisted abdominal hysterectomy (LAAH): Used when the cervix is left in place • Robotic-assisted laparoscopic hysterectomy: Surgeon performs laparoscopic hysterectomy from a remote control; has not shown better outcomes • Long-term risks of a Hysterectomy o Increased risk for heart attack and stroke when ovaries are removed o Menopause if ovaries are removed o Urinary incontinence o Increased urinary tract infections o Decrease in sexual sensation and lubrication o Depression related to reproductive loss Hormone Replacement Therapy • Estrogen and progesterone supplementation to relieve signs and symptoms of menopause • Increased risk for breast cancer, blood clots, heart disease, and stroke • Decreased risk for osteoporosis • Can use no longer than five years • Should be initiated at lowest possible dose • Progesterone is also given to those women who still have their uterus to reduce the risk of endometrial cancer • Side effects: Bloating, breast tenderness, headaches, mood swings, nausea, fluid retention, and irregular bleeding Atrophic Vaginitis (Urogenital Atrophy) • Thinning and inflammation of vaginal tissues caused by estrogen decrease • Primarily caused by menopause due to decreased levels of estrogen (40% of postmenopausal women) • Can also result from radiation, chemotherapy, immune disorders, or the removal of ovaries • Some medications used to treat endometriosis, infertility, fibroids, and breast cancer also cause a drop in estrogen • Estrogen levels also decrease after childbirth and during lactation • Predisposes women to vaginal and urinary tract infections • Signs and symptoms: Decreased vaginal lubrication (earliest symptom), urinary pain and frequency, hematuria, UTI, stress incontinence, and vaginal dryness, itching, and pressure • Can lead to sexual dysfunction and emotional problems

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