12. Reproductive System - Pathologies Flashcards
What is in-vitro fertilisation (IVF)?
Artificial fertilisation of the ovum by sperm outside the body
What does the IVF process entail?
- The drug Clomiphene causes oocytes to develop
- Ova are retrieved from ovaries, examined and incubated with sperm on a petri dish to allow fertilisation (or sperm injected into ovum)
- Embryo is transferred to uterus
Amenorrhoea: definition
Absence of periods
Primary amenorrhoea: definition
Failure to have a period by aged 16/17 (expected onset)
Secondary amenorrhoea: definition
Lack of menstruation for 3 months in previously menstrual woman
Primary amenorrhoea: aetiology
Congenital defects: failure of the ovarian follicles to develop
(Turner’s syndrome)
Secondary amenorrhoea: aetiology
Excessive exercise (endorphins inhibit GnRH)
Stress (cortisol inhibits GnRH)
Anorexia (neuropeptide Y surpresses GnRH)
Pregnancy!
Pituitary tumour
PCOS (increased testosterone promoting male functions not female)
Uterine obstruction
Hypothyroidism
Medications (e.g. antipsychotics)
Dysmenorrhoea: definition
Painful periods
Primary dysmenorrhoea: definition
Excessive release of uterine prostaglandins during menstruation, causing the myometrium to contract
Primary dysmenorrhoea: aetiology
Raised prostaglandins may be due to low progesterone before menses
No association with identifiable pelvic disease
Secondary dysmenorrhoea: aetiology
Associated with specific pelvic or systemic pathologies such as endometriosis, fibroids, pelvic inflammatory disease
When does primary dysmenorrhoea usually occur?
6-12 months after menarche
Dysmenorrhoea: allopathic treatment
Contraceptive pill (inhibits ovulation) NSAIDs
Premenstrual Syndrome (PMS): definition
Physiological, psychological and behavioural changes during the luteal phase (post-ovulatory phase of menstrual cycle)
Premenstrual Syndrome (PMS): aetiology
Variable: definitive cause unknown
Hormone imbalance - rapid shifts in levels of oestrogen and progesterone which can influence neurotransmitters
Drop in progesterone in the luteal phase of cycle
Increase in prostaglandins
Serotonin deficiency is thought to be a key neurotransmitter relationship
Premenstrual Syndrome (PMS): signs and symptoms
Over 150 symptoms have been attributed to PMS
Tension, anxiety, reduced concentration, depression, fatigue, palpitations
Headache, bloating, backache, pelvic pain, aching legs, sweating, fluid retention, hot flushes
Low blood sugar, cravings, increased appetite, greasy skin/hair
Premenstrual Syndrome (PMS): allopathic treatment
Oral contraceptive pill
Counselling
Pelvic Inflammatory Disease (PID): definition
Infectious and inflammatory disorder of the upper female genital tract including the uterus, fallopian tubes and ovaries
Pelvic Inflammatory Disease (PID): aetiology
Spread of bacteria ascending from the cervix
Sexually transmitted infective causes include gonorrhoea and chlamydia
Insertion of intra-uterine device (IUD) e.g. coil
Abortion
Delivery under non-sterile conditions
Pelvic Inflammatory Disease (PID): signs and symptoms
Lower abdominal pain (gradual or sudden/severe) - may increase with walking
Deep dyspareunia
Purulent discharge - pus/foul odour
Occasional dysuria, fever, nausea, vomiting
Pelvic Inflammatory Disease (PID): complications
Ectopic pregnancy
Infertility
Peritonitis, abscesses
Septicaemia
Pelvic Inflammatory Disease (PID): allopathic treatment
Antibiotics
Endometriosis: definition
Endometrial tissue found outside uterine cavity
Endometriosis: pathophysiology
Ectopic endometrial tissue follows the menstrual cycle but there’s no exit point for that blood that accumulates during menstruation
This leads to irritation, inflammation and pain
Endometriosis: aetiology
Altered immune surveillance in pelvic cavity affecting the body’s ability to recognise ectopic endometrial tissue
Oestrogen dominance, causing endometrial tissue (wherever it is) to proliferate
Retrograde menstruation - migration of endometrial tissue back through fallopian tubes/transplant of tissue during surgery
Primordial cells lining other body cavities or organs differentiate into endometrial cells
Transfer of tissue through blood/lymph
Endometriosis: signs and symptoms
Dysmenorrhoea Menorrhagia Pelvic pain occurring around menstruation and lessening after Dyspareunia Bloating Lower back pain Bowel changes e.g. diarrhoea Infertility
Endometriosis: diagnostics
Ultrasound
Laparoscopy
Endometriosis: complications
Recurrent inflammation = formation of fibrous tissue = adhesions
Adhesions = obstruction of uterus/fallopian tubes = infertility
Chocolate cysts - sac containing old blood
Endometriosis: allopathic treatment
Combined oral contraceptive pill
Surgery to remove ectopic tissue (45% grows back within a year)
Where does endometriosis commonly affect?
Ovaries Fallopian tubes Utero-sacral ligaments Pelvic cavity Intestines
Which women are at risk of developing endometriosis?
Family history
Women who haven’t given birth
Periods longer than 7 days
Fibroids: definition
Benign tumours of the uterus myometrium
Can vary significantly in number and size
Fibroids: aetiology
Development is linked to levels of oestrogen and progesterone
Increased risk with obesity (excess oestrogen)
Earlier menses (more oestrogen)
Family history
Contraceptive pill (more oestrogen!)
Fibroids: signs and symptoms
50-80% are asymptomatic
Menstrual changes - menorrhagia, prolonged menses, spotting/mid-cycle bleeding
Leading to iron deficient anaemia
Urgent/frequent urination, constipation
Bloating, heaviness in abdomen
Infertility - 2-10% of infertility cases
Fibroids: diagnostics
Ultrasound
Fibroids: complications
Large fibroids can occlude their blood supply causing necrosis
They can calcify which causes pain
Fibroids: allopathic treatment
NSAIDs
Hormonal therapies (inc oral contraceptive pill)
Surgery (myomectomy or hysterectomy)
What do fibroids consist of?
Smooth muscle cells
Connective tissue
When are women more likely to develop fibroids?
More common in reproductive years, tending to subside post-menopause
Ovarian Cysts: definition
Fluid-filled sac within the ovary
Ovarian Cysts: signs and symptoms
Often asymptomatic (and often harmless)
Dull ache
Sudden sharp/severe pain if ruptured (if on rhs could present as appendicitis)
Large cysts may affect bladder function
Ovarian Cysts: diagnostics
Ultrasound
Laparoscopy
Ovarian Cysts: allopathic treatment
Surgery (if >5cm)
What is the most common type of ovarian cyst?
Follicular cyst - failure to ovulate and instead fills with fluid
Polycystic Ovarian Syndrome (PCOS): definition
An endocrine metabolic condition associated with menstrual dysfunction, ovulatory dysfunction, hyperandrogenism and metabolic disturbances e.g. hyperinsulinemia
Polycystic Ovarian Syndrome (PCOS): pathophysiology
Dysfunction of the hypothalamic-pituitary (HPA) axis - LH:FSH imbalance
High circulating LH promotes increase in ovarian androgen formation
Polycystic Ovarian Syndrome (PCOS): aetiology
Genetic links - increased risk with first degree relatives
Polycystic Ovarian Syndrome (PCOS): signs and symptoms
Amenorrhoea/oligomenorrhoea, lack of ovulation, infertility, hirsutism, acne/oily skin, weight gain/difficulty losing weight, increased risk of miscarriage (all due to increased testosterone)
Acanthosis nigricans - sign of insulin resistance
Alopecia/baldness
Anxiety/depression
Polycystic Ovarian Syndrome (PCOS): diagnostics
Blood tests - increased androgens, low sex hormone binding globulin (SHBG), high LH, low/normal FSH, hyperinsulinemia, elevated blood glucose levels
Ultrasound
Laparoscopy
What criteria must be present for a PCOS diagnosis?
Oligo/anovulation AND/OR polycystic ovaries
Clinical or biochemical signs of hyperandrogenism (hirsutism,
acne, elevated testosterone)
Exclusion of other causes of hormonal and metabolic dysfunction (androgen secreting tumours, Cushing’s)
Polycystic Ovarian Syndrome (PCOS): complications
Infertility
Amenorrhoea (increases risk of endometrial cancer) Increased risk of T2D and cardiovascular disease
Polycystic Ovarian Syndrome (PCOS): allopathic treatment
Oral contraceptive pill
Metformin (to deal with insulin resistance, but causes nausea and increases levels of an amino acid when in excess (homocysteine: which can lead to atherosclerosis)
Anti-androgen topical creams
Clomiphene = stimulates ovulation
Ectopic Pregnancy: definition
When a fertilised egg implants outside of the uterine cavity
Where can an ectopic pregnancy occur?
Fallopian tube (97%) Ovary Cervix Abdomen
Ectopic Pregnancy: aetiology
Increased risk with intra-uterine devices
Endometriosis
PID
Ectopic Pregnancy: signs and symptoms
Initially no symptoms but amenorrhoea
Unilateral pelvic pain
Vaginal bleeding
If ruptures - sudden acute abdominal pain
When does an ectopic pregnancy generally occur?
6-8 weeks after ovulation
Ectopic Pregnancy: complications
May cause spontaneous abortion, haemorrhage, peritonitis
Infertility: definition
Failure to conceive after 1 yr of unprotected intercourse
Infertility: aetiology (males)
Low sperm count
Poor sperm viability or motility
Blocked sperm ducts
Undescended testes
Infertility: aetiology (females)
PCOS Endometriosis (blocked fallopian tubes) Fibroids PID Menopause Hypothyroidism STIs
Infertility: aetiology (both sexes)
Metal toxicity Radiation Malnutrition Body weight Smoking Alcohol Heat Stress
Infertility: allopathic treatment
Clomiphene (induces ovulation)
IVF
Balanitis: definition
Inflammation of glans penis
Balanitis: aetiology
Infectious - candida albicans, bacterial infection
Non-infectious - lichen sclerosus (autoimmune), ezcema, psoriasis, inadequate cleaning under foreskin
Phimosis - foreskin narrowing, preventing retraction
Balanitis: signs and symptoms
Pain
Irritation
Dyspareunia
Balanitis: complications
Chronic infections can result in foreskin fibrosis
Balanitis: allopathic treatment
Antibiotics
Surgery
Hygiene
Undescended Testes: definition
When one testicle fails to descend in late foetal development
Undescended Testes: aetiology
Premature birth - affects 30% of premature boys
Undescended Testes: complications
Damaged sperm = infertility
Testicular cancer
Undescended Testes: allopathic treatment
May descend independently a few months after birth
hCG injection (acts like LH and increases testosterone)
Surgery (6-18 months)
Prostatitis: definition
Inflammation of the prostate gland
What percentage of men are likely to develop prostatitis?
8%
Prostatitis: aetiology
Infectious - bacterial (UTIs or STIs)
Non-infectious - trauma, stress
Prostatitis: signs and symptoms
Recurrent UTIs - increased urination, urgency, dysuria, nocturia, hesitancy and incomplete voiding
Painful ejaculation
Fever, malaise
Prostatitis: allopathic treatment
Antibiotics
Painkillers
Benign Prostatic Hyperplasia (BPH): definition
Enlargement of the prostate tissue leading to compression of the urethra
Who is more likely to develop Benign Prostatic Hyperplasia (BPH)?
Men >60 yrs
Benign Prostatic Hyperplasia (BPH): aetiology
Risk factors - obesity, genetics, sedentary lifestyle, sympathetic activity, pesticides
Increase in 5-alpha-reductase activity
Benign Prostatic Hyperplasia (BPH): signs and symptoms
Obstructed/poor urinary flow Increased urinary frequency Intermittent urine flow and dribbling of urine Nocturia Cystitis (recurrent) Reduced sexual function
Benign Prostatic Hyperplasia (BPH): diagnostics
Elevated PSA levels
Digital rectal exam (DRE)
Ultrasound
What is 5-alpha-reductase?
An enzyme that converts testosterone to dihydrotestosterone (DHT)
Need this conversion for testosterone to affect the prostate
Benign Prostatic Hyperplasia (BPH): allopathic treatment
5-alpha-reductase inhibitors (finasteride)
Surgery (when obstruction is severe)
What are the success rates of IVF ?
32.3% women under 35
27.7% aged 35–37
20.8% aged 38–39
13.6% aged 40–42
