Women's Reproductive Disorders Flashcards

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28 days

• Follicular (proliferative) phase are the first days of the cycle
• Ovulation is the beginning of the luteal (secretory) phase
• If no implantation occurs, menses begins

• A rise of follicle-stimulating hormone (FSH) stimulates a number of follicles
• Estrogen causes cells of the endometrium to proliferate, which stimulates the production luteinizing hormone (LH)
• A surge in both FSH and LH is required for final follicular growth and the next phase

• Ovulation marks the beginning of this phase
• Follicle begins its transformation into the corpus luteum
• LH from the anterior pituitary gland stimulates the corpus luteum to secrete progesterone
• Which, in turn, initiates the secretory phase: glands and blood vessels in the endometrium branch and curl throughout the functional layer, and the glands begin to secrete a thin fluid; the egg will either implant or not
• If the egg does not implant, then the ischemic or menstrual phase occurs

• Cessation of menses; no menses x 1 year
• Caused by ovarian failure
• Low estrogen and progesterone levels, high FSH and LH
• Average age is 51
• Other changes:
  • Vaginal lubrication decreases
  • Pelvic muscle tone loss
  • Bone density loss
  • Increase in CV disease risk
  • Mood swings
  • Weight gain
  • Depression
• Treatment for symptoms:
  • Hormonal replacement (but must weigh risk vs benefit)

• Perimenopause:
  • Transitional period between reproductive and non-reproductive years, can last 1-8 years
• Vasomotor symptoms “hot flashes”:
  • Occur due to rapid changes in estrogen levels

• Primary dysmenorrhea
• Painful menstruation associated with prostaglandin release in ovulatory cycles
• Secondary dysmenorrhea
• Painful menstruation related to pelvic pathologic conditions at any time in the menstrual cycle; occurring later in life
• Treatment
• NSAIDs (which are prostaglandin inhibitors)
• Regular exercise and stress reduction
• Heat
• Acupuncture

• Primary amenorrhea
• Failure of menarche and the absence of menstruation by 13 years of age without the development of secondary sex characteristics or by 15 years of age, regardless of the presence or absence of secondary sex characteristics
• Secondary amenorrhea
  
  • Absence of menstruation in women who have previously menstruated
• Causes
  
  • Pregnancy (most common cause)
  • Anovulation
  • Dramatic weight loss
  • Malnutrition or excessive exercise
  • Thyroid disorders
  • Hyperprolactinemia
  • Polycystic ovary syndrome
• Common during early adolescence, perimenopause, and lactation

Clinical manifestations

• Depends on the cause
• Infertility, vasomotor flushes, vaginal atrophy, acne, osteopenia, hirsutism

Treatment

• Depends on the cause
• Replace deficient hormones (estrogens, thyroid hormone, glucocorticoids, gonadotropins)
• Correct underlying pathologic condition

• Abnormal bleeding in duration, volume, frequency, or regularity; present for majority of previous 6 months
• Classified by: the cause of bleeding using the PALM-COEIN acronym
  • Polyp, Adenomyosis, Leiomyoma, Malignancy [and hyperplasia]
  • Coagulopathy, Ovulatory disorders, Endometrial, Iatrogenic, and Not otherwise classified)

The first group, PALM, consists of disorders of tissue or structure that are diagnosed through imaging or biopsy. The second group, COEIN, consists of nonstructural causes of AUB.

Clinical manifestations

• Metrorrhagia: Irregular bleeding
• Menorrhagia: Excessive bleeding
• Menometrorrhagia: Irregular bleeding + Excessive bleeding

• NSAIDs (can decrease amount of bleeding)
• Oral contraceptive pills that contain both estrogen and progesterone
• Long-term treatment with medroxyprogesterone (Depo-Provera)
  • Although the U.S. Food and Drug Administration (FDA) black-box warning about the potential loss of bone has drastically curtailed the use of this therapy.
  • Depo use should be limited to 2 years
• Levonorgestrel intrauterine device (LNG-IUD)

• Leading cause of infertility in the United States; most common anovulation and ovulatory dysfunction in women
• Associated with metabolic dysfunction, including dyslipidemia, insulin resistance, and obesity
• Those with this syndrome have a three times greater chance of uterine cancer later in life

Patho

• There is a dysfunction in ovarian follicle development
• PCOS is characterized by excessive production of both androgen and estrogen

Diagnosis

• Can diagnose if patient has 2 of the following:
  
  • Irregular ovulation
  • Elevated levels of androgens (Sex hormones)
  • Appearance of polycystic ovaries on ultrasound
• Polycystic ovaries do not have to be present; their presence alone does not establish the diagnosis.

Clinical manifestations

• Dysfunctional bleeding or amenorrhea, hirsutism, acne, acanthosis nigricans, and infertility

Treatment

• Combined oral contraceptives (COCs)
• Metformin
• Antiandrogens
• Fertility agents
• Weight loss

• Cyclic physical, psychologic (mental or emotional), or behavioral changes that impair interpersonal relationships or interfere with usual activities
• PMDD is more severe and more disruptive to daily activities
• Both occur in the luteal (postovulatory) phase

Symptoms of PMS and PMDD begin after ovulation during the luteal phase and persist up to 4 days into the menstrual cycle.

Clinical manifestations

• Depression, anger, irritability, and fatigue

Treatment

• Hormonal cycle regulation
• Selective serotonin-uptake inhibitors
• Antidepressants
• Counseling

• Is an acute inflammation caused by infection
• Causes permanent changes to the epithelium of the fallopian tubes
• May involve any or all organs of the upper reproductive tract
• Salpingitis: inflammation of the fallopian tubes
• Oophoritis: inflammation of the ovaries
• Sexually transmitted diseases migrate from the vagina to the upper genital tract

Gonorrhea and chlamydia are the main infectious causes of PID

Clinical manifestations

• Sudden, severe abdominal pain with fever or no symptoms at all

Evaluation

• Sexually active women who have abdominal or pelvic tenderness and one of the following signs
• Cervical motion tenderness
• Uterine tenderness
• Adnexal tenderness

Treatment

• Antibiotics
• Treat sexual partners

Complications

• Infertility
• Ectopic pregnancies

• Is an inflammation of one or both ducts that lead from the vaginal opening to the Bartholin glands
• Inflammation narrows the distal portion of the ducts, leading to obstruction and stasis of glandular secretions
• Is caused by microorganisms that infect the lower female reproductive tract

Clinical manifestations

• Cyst may be reddened and painful with pus at the opening

Treatment

• Administer broad-spectrum antibiotics
• Drain the cyst using hot soaks, needle aspiration, insertion of a catheter

• Cervix or entire uterus descends into the vaginal canal

- bladder, urethra, and rectum are supported by the endopelvic fascia and the perineal muscles

- muscular and fascial tissue loses tone and strength with aging and may not maintain the pelvic organs in the proper position

Treatment options

• Pelvic floor physical therapy
• Kegel exercises: repetitive isometric tightening and relaxing of the pubococcygeal muscles
• Estrogen therapy in menopausal women
• Maintain a healthy body mass index, prevent constipation
• Pessary: placement of a removable mechanical device that holds the uterus
• Surgical repair with or without a hysterectomy

Cystocele

• Descent of a portion of the posterior bladder wall and trigone into the vaginal canal
• Usually caused by childbirth

Clinical Manifestations:

• If large, vaginal pressure and bulging and descent of the anterior vaginal wall and urethra

Rectocele

• Bulging of the rectum and posterior vaginal wall into the vaginal canal
• Usually caused by childbirth but can occur after menopause
• Can have a genetic predisposition
• Lifelong constipation may contribute
• Clinical manifestations: vaginal pressure, rectal fullness, incomplete bowel evacuation