13. Reproductive INCOMPLETE got to 6.5 LUSUMA notes Flashcards
What is amenorrhoea?
Absence of periods for at least 6 months.
What is the difference between primary and secondary amenorrhoea?
Primary is never having a period by age 14 with absence of secondary sexual characteristics or by 16 with SSC, secondary is when established menstruation has ceased for three month in a woman with history of regular cyclic bleeding or nine months with irregular cyclic bleeding.
What is oligomenorrhoea?
Infrequent period occurring at intervals of 35 days to 6 months.
What is dysmenorrhoea?
Painful periods.
What is menorrhagia?
Heavy periods: excessive (>80ml) or prolonged (>7 days).
What is cryptomenorrhoea?
Periods occur but not visible due to obstruction in outflow tract.
What is dysfunctional uterine bleeding?
Abnormal bleeding, no obvious organic cause.
What are anovulatory cycles?
No ovulation/luteal phase, oligo/amenorrhoea +/- menorrhagia.
What are ovulatory cycles?
Normal menstrual cycles + dysmenorrhoea/mastalgia (sore breasts).
What is the pathophysiology behind hypothalamic/pituitary amenorrhoea?
Inadequate levels of FSH lead to inadequately stimulated ovaries, which then fail to produce enough oestrogen to stimulate endometrium of uterus.
What is a primary hypothalamic cause of amenorrhoea?
Kallmann syndrome - inability to produce GnRH.
What are some secondary hypothalamic causes of amenorrhoea?
Exercise amenorrhoea from physical exercise, stress amenorrhoea, eating disorders (weight drops below critical weight 47kg).
What are some secondary pituitary causes of amenorrhoea?
Sheehan syndrome (hypopituitarism), hyperprolactinaemia, haeocrhomastosis.
What is the pathophysiology behind gonadal/end-organ amenorrhoea?
Ovary does not respond to pituitary stimulation so oestrogen levels are low, lack of negative feedback from oestrogen causes elevated FSH levels.
What are some causes of primary gonadal/end-organ amenorrhoea?
Gonadal dysgenesis (e.g. Turner syndrome), androgen insensitivity syndrome, receptor abnormalities for FSH and LH, congenital adrenal hyperplasia.
What are some causes of secondary gonadal/end-organ amenorrhoea?
Pregnancy, anovulation, menopause, polycystic ovarian syndrome, drug-induced.
What are some primary outflow tract obstruction causes of amenorrhoea?
Uterine - Mullerian agenesis.
Vaginal - vaginal atresia, cryptomenorrhoea, imperforate hymen.
What is a secondary outflow tract obstruction cause of amenorrhoea?
Intrauterine adhesion (Asherman’s syndrome).
How can amenorrhoea be managed?
Depends on cause, if insufficient in a hormone - hormone replacement, if due to lifestyle - modify factors.
What is the pathophysiology behind dysfunctional uterine bleeding?
90% cases from no ovulation as corpus luteum doesn’t form to produce progesterone so oestrogen is made continuously -> overgrowth of uterine bleeding and subsequent bleeding.
10% from prolonged progesterone secretion with ovulation, low levels of oestrogen means irregular shedding of uterine lining and erratic bleeding.
How is menorrhagia managed?
With progesterone.
What are some of the common clinical problems of the ovary?
Ovarian cysts and tumours of the ovary.
What is polycystic ovaries?
More than 10 cysts in ovary, associated with infertility.
What cells of the ovaries have tumours most commonly?
Epithelial components or from germ cells.
What is salpingitis?
Inflammation of the uterus tube caused by microorganisms causing fusions or adhesions of the mucosa and blocked lumen.
How can salpingitis lead to trouble conceiving?
Fusions of adhesions of the mucosa of the uterine tube can block the lumen -> infertility. This could lead to ectopic pregnancy or implantation outside the uterus.
What is endometriosis?
Ectopic endometrial tissue is dispersed to various sites along the peritoneal cavity and beyond.
What are some of the complications of endometriosis?
Severe period pain (dysmenorrhoea), infertility.
Where do most neoplasms form in endometrial carcinomas?
In the transformation zone - junction between columnar cells of endocervix and squamous cells of exocervix.
What is the major symptoms of endometrial carcinoma?
Abnormal uterine bleeding.
What are some of the clinical conditions affecting the greater vestibular glands (Bartholin glands)?
Bartholinitis (infection/inflammation), bartholin gland cyst (duct of gland is blocked -> cyst).
What is vaginitis?
Inflammation of the vagina.
What is vaginismus?
Condition making any vaginal penetration painful (e.g. tampon insertion, sexual intercourse) due to reflex of pubococcygeus muscle.
What is ectopic implantation?
Implantation anywhere but the body of the uterus.
What is the peritoneal cavity a risk of infection spread in females?
If is open via the ostium of the uterine tube.
What is an episiotomy?
Cutting medio-lateral in labour to avoid perineal body rupture.
How can the pelvic floor be damaged by stretching of nerves, muscles, and ligaments?
Stretch pudendal nerve -> neuropraxia and muscle weakness.
Stretch and damage of pelvic floor and perineal muscle -> muscle weakness.
Stretch/rupture of ligament supports of muscles -> ineffective muscle action.
What are some risk factors for pelvic floor dysfunction?
Age, menopause (atrophy of tissue without oestrogen), obesity, chronic cough, intrinsic connective tissue laxity.
Outline how pelvic floor dysfunction can be managed.
Pelvic floor muscle exercises, continence surgeries (tension-free vaginal tape), prolapse procedures.
What are the pathogens causing the following sexually transmitted infections?
HPV, herpes, chlamydia, gonorrhoea, syphilis, trichomoniasis.
HPV - human papillomavirus Herpes - herpes simplex virus type I (oral) or II (genital) Chlamydia - Chlamydia trachomatis Gonorrhoea - Neisseria gonorrhoeae Syphilis - Treponema pallidum Trichomoniasis - trichomonas vaginalis
What are the differential diagnoses for genital skin and mucous membrane lesions?
Genital ulcers, vesicles or bullae, genital papules, anogenital warts.
What are the differential diagnoses for urethritis (discharge, dysuria, frequency)?
Gonococcal urethritis, chlamydial urethritis, non-specific urethritis, post-gonococcal urethritis, non-infectious urethritis.
What are the differential diagnoses for vulvo-vaginitis and cervicitis?
Vulvo-vaginitis, cervicitis, bacterial vaginosis, Bartholinitis.
What are the differential diagnoses for infection of the female pelvis?
Pregnancy-related, pelvic inflammatory disease.
