12. Reproductive System Pathologies Flashcards
Amenorrhoea
•‘Amenorrhoea’ = absence of menstruation.
PRIMARY AMENORRHOEA:
•Failure of the menses to occur by expected onset (16, 17 years).
•Mostly caused by congenital defects: failure of ovarian follicles to develop (Turners syndrome).
SECONDARY AMENORRHOEA:
•Lack of menstruation for 3 months in previously menstrual woman.
•Pituitary tumour, PCOS, hypothyroidism, stress.
•Anorexia, excessive exercise (endorphins inhibit GnRH), uterine obstruction, medications (i.e. antipsychotics).
Dysmenorrhoea
PRIMARY DYSMENORRHOEA:
• Excessive release of uterine prostaglandins during menstruation causing the myometrium to contract.
• Usually occurs shortly (6-12 months) after menarche.
• No association with identifiable pelvic disease.
SECONDARY DYSMENORRHOEA:
• Associated with specific pelvic or systemic pathologies such as endometriosis, fibroids, pelvic inflammatory disease.
Dysmenorrhoea Treatment
Contraceptive pill (inhibits ovulation) NSAIDs.
Premenstrual Syndrome (PMS)
• Characterised by cyclic physiological, psychological and behavioural changes during the luteal phase(the second half of the menstrual cycle).
Premenstrual Syndrome (PMS): Causes
- Definitive cause unknown –variable.
- Hormone imbalance: rapid shifts in levels of oestrogen and progesterone, which can influence neurotransmitters.
- Drop in progesterone in the luteal phase of the cycle and an increased production of prostaglandins.
- A serotonin deficiency is thought to be a key neurotransmitter relationship.
PMS: Signs & Symptoms
Over 150 symptoms have been attributed to PMS
- Tension
- Anxiety
- Reduced concentration
- Aggression
- Depression
- Listlessness
- Confusion
- Fatigue
- Insomnia
- Headache (migraines)
- Boating
- Oedema
- Backache
- Pelvic pain
- Aching legs
- Ovarian pain
- Sweating
- Hot flushes
- Bladder problems
- Constipation
- Excessive weight gain
- Fluid retention
- Low blood sugar
- Cravings -sugar
- Pica
- Increased appetite
- Thirst
- Breast tenderness
- Greasy skin and hair
- Pimples
- Palpitations
Premenstrual Syndrome: Treatment
• Oral contraceptive pill, counselling.
Pelvic Inflammatory Disease (PID)
An infectious and inflammatory disorder of the upper female genital tract including the uterus, fallopian tubes and ovaries.
Pelvic Inflammatory Disease (PID): Causes
- Infection typically results from spread of microorganisms (bacteria) ascending from the cervix.
- Sexually transmitted infective causes include Neisseria gonorrhoea & Chlamydiatrachomatis.
- Insertion of intra-uterine device (IUD).
- Abortion or delivery under non-sterile conditions.
Pelvic Inflammatory Disease (PID): Signs & Symptoms
- Lower abdominal pain (gradual orsudden & severe) -may increase with walking.
- Deep dyspareunia. Purulent discharge.
- Occasional dysuria, fever, nausea & vomiting.
Pelvic Inflammatory Disease (PID): Complications
Ectopic pregnancy Infertility Peritonitis Abscesses Septicemia.
Pelvic Inflammatory Disease (PID): Treatment
Anitbiotics
Endometriosis
Endometrial tissue found outside uterine cavity.
• Commonly affects ovaries, fallopian tubes, utero-sacral ligaments, pelvic cavity, intestines. Rarely more distant places e.g. lungs, joints.
• Affects up to 25% of women, estimated that 30-40% of women with infertility are affected.
• Greater risk with family history, women who haven’t given birth, menses >7 days.
• Ectopic endometrial tissue follows the menstrual cycle but there is no exit point for blood that accumulates during menstruation. This leads to irritation, inflammation and pain.
Endometriosis: Causes
- Altered immune surveillance in pelvis, affecting the ability of the body to recognise ectopic endometrial tissue.
- Oestrogen dominance.
- Retrograde menstruation: migration of endometrial tissue back through the fallopian tubes or transplant of tissue during surgery.
- Primordial cellslining 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, lessening after.
- Dyspareunia.
- Bloating, lower back pain.
- Bowel changes e.g. diarrhoea.
- Infertility.
Endometriosis: Diagnosis
- Ultrasound.
* Laparoscopy
Endometriosis: Complications
- Recurrent inflammation leads to formation of fibrous tissue, which can produce adhesions.
- Adhesions can obstruct the uterus or fallopian tubes, which can contribute to infertility.
- Chocolate cysts–sac containing old blood.
Endometriosis: Treatment
- Combined oral contraceptive pill.
* Surgery to remove ectopic tissue (45% grows back within a year).
Fibroids
- Benign tumours of the myometrium of the uterus.
- Can vary significantly in number and size.
- Consist of smooth muscle cells and connective tissue.
- More common in reproductive years, tend to subside post menopause.
Fibroids: Causes
- Development is linked to levels of oestrogen and progesterone.
- Increased risk with obesity (excess oestrogen), earlier menses, family history and the contraceptive pill.
Fibroids: Signs and Symptoms
- 50-80%are asymptomatic.
- Menstrual changes: menorrhagia, prolonged menses, spotting/mid-cycle bleeding iron deficiency anaemia (fatigue etc.)
- Fibroids can press on bladder/rectum causing urgency, frequent urination, constipation.
- Bloating & heaviness in abdomen.
- Infertility (2-10% of infertility cases)
Fibroids: Complications
• Large fibroids can occlude their blood supply causing necrosis. They can calcify which causes pain.
Leads to hysterectomy
Fibroids: Investigation
Ultrasound
Fibroids: Treatment
- NSAIDs
* Hormonal therapies (including OCP), surgery (myomectomy or hysterectomy)
Ovarian Cysts
- Fluid-filled sac within the ovary.
- Most common type is a follicular cyst: failure to ovulate and instead fills with fluid.
- Diagnosis is usually made by ultrasound and/or laparoscopy.
Ovarian Cysts: Signs and Symptoms
- Often asymptomatic (and often harmless)
- Dull ache or sudden sharp/severe pain if rupture.
- Large cysts may affect bladder function.
Ovarian Cysts: Treatment
Surgery (>5cm)