Ch 6 Reproductive System Concerns Flashcards
What is the first step in the menstrual cycle?
The hypothalamus release GnRH (gonadotropin releasing hormone)
Gonadotropin releasing hormone (GnRH) is going to stimulate the…
Pituitary gland to produce follicle stimulating hormone (FSH) and luteinizing hormone (LH)
What does FSH and LH being secreted do?
They stimulate the ovaries to produce estrogen first and then later progesterone
In response to estrogen and progesterone being secreted by the ovaries, what will happen?
The endometrial lining will proliferate and then shed
When does the menstrual cycle regulate?
About 1-2 years after puberty
What is the most common age for menarche?
Ages 9-12
What is the most common age for perimenopause?
Ages 40s and 50s
What is the normal interval for a menstrual cycle?
21-35 days
What is the normal range for length of flow?
2-8 days, average is 4-7 days
What is a normal amount of flow?
Less than 1 pad or tampon every 3 hours
What is considered severe acute bleeding or HMB, heavy menstrual bleeding?
More than a tampon or a pad an hour
What is considered abnormal uterine bleeding?
Irregular bleeding that many be light, heavy, or spotting only
Amenorrhea generally =
Anovulation
Absence of both menarche AND sexual secondary characteristics by…
13
Absence of absence of menses by age…
15, regardless of normal growth and development
If someone has normal growth and development but no period by age 15 that would be considered…
primary amenorrhea
Absence of menstruation within__ years of breast development is primary amenorrhea
5
6 months of more of absence of period after menses is considered…
secondary amenorrhea
Primary versus secondary amenorrhea
Primary - never had a period
Secondary - they used to but now it’s gone
Inner layer of the uterus
endometrium
Muscular layer of the uterus, middle layer
myometrium
Outside layer of the uterus
perimetrium
What structure of the fallopian tubes takes up products of the ovaries?
fimbriae
Where do sperm and egg usually meet?
ampulla in the fallopian tube
50% of abnormal uterine bleeding occurs in women over the age of..
45
Only 20% of abnormal uterine bleeding occurs in
adolescents
What is an anovulatory cycle?
a menstrual cycle in which ovulation, or the release of an egg from the ovaries, does not occur.
What is the cause of ovulatory problems?
Problems affecting the release of hormones from the hypothalamus or anterior pituitary
What are three primary causes of abnormal uterine bleeding?
Ovulatory problems
Uterine cancer
Endometrial problems
What are two potential causes of endometrial problems?
Ectopic pregnancy
Infection
Ovulatory dysfunction makes up only 10% of what?
abnormal uterine bleeding
Hormonal causes of ovulatory dysfunction are most commonly due to…
Obesity
PCOS
Perimenopause
Menarche
What is the most common cause of ovulatory dysfunction?
PCOS
What does iatrogenic mean?
relating to illness caused by medical examination or treatment
What are iatrogenic causes of ovulatory dysfunction?
Contraception
Anticoagulant drugs
Some seizure medications
Antipsychotic meds
How can antipsychotics cause anovulation?
Blockade of dopamine D2 receptors cause an increase in the levels of prolactin. Elevated prolactin levels can lead to irregular menstrual cycles and anovulation by altering levels of estrogen and FSH
How do antipsychosis and some seizure medications cause anovulation?
They interfere with the release of GnRH
Endometrial cancer the the __ leading cause of cancer deaths among women
4th
Endometrial cancer most often occurs in women who are…
Peri or postmenopausal
Overweight
What race is most likely to get endometrial cancer?
Black women, and they are also less likely to survive
What is the FIRST symptom of uterine cancer?
Abnormal bleeding
Is pain common with early uterine cancer?
No
Pain is a __ sign of uterine cancer
late
Abnormal bleeding is a __ sign of uterine cancer
early
When are endometrial disorders likely to occur?
In the presence of normal ovulatory function when other abnormalities have been ruled out
Endometrial disorders may include…
ectopic pregnancy and infection, endometritis, or UTI
What should you ask a patient about if they have heavy menstrual bleeding?
Coagulopathy, family history of bleeding disorders
About 13% of women with heavy menstrual bleeding have…
Coagulopathy
An adolescent presents with extremely heavy menstrual bleeding but her cycles are regular
Suspicious of undiagnosed bleeding disorder
Menopause, menarche, uterine cancer, and uterine infection are all potential causes of what disorder?
abnormal uterine bleeding
When a patient presents with amenorrhea, what are the four things you need to assess?
Absence of menarche and secondary sex characteristics by age 13
Absence of menses by 15 regardless of normal growth and development
Absence of menstruation within 5 years of breast development
6 month or more absence of periods after a period of menstruation
What are potential causes of primary amenorrhea? List 7
Stress Pregnancy Premature menopause Eating disorders Strenuous exercise Thyroid disease Medications that elevate prolactin levels (esp seizure medications)
Things to test for when a patient has primary amenorrhea
Pregnancy test
UA
CBC
Endocrine test such as FSH, TSH, Estradiol
OVULATORY cycles are characterized by… List 6
Regularity Mid-cycle discomfort (Mittelschmerz pain) Spinbarkeit mucus Mid-cycle thermal shift Cramping with menses Cycle of generally 4-7 days
What is Spinnbarkeit mucus?
the elastic quality that is characteristic of mucus of the uterine cervix especially shortly before ovulation
What is Mittelschmerz pain?
mid-cycle pain
How is Spinnbarkeit pronounced?
Spin-bar-keet
How is Mittelschmerz pronounced?
Mittel-schmerz
When does abnormal uterine bleeding (AUB) most often occur?
A times of anovulation. So, at the beginning of menstrual cycles, and at the beginning of menopause
What are the secondary sex characteristics?
Breast and pubic hair developement
How can we classify the secondary sex characteristics?
Tanner stages, 1-5
What is the definition of secondary amenorrhea:
Absence of menses for 6 months in a women whom normal menstruation has been established (for at least 3 previous cycles)
What is thelarche?
Onset of breast development
When does thelarche usually begin?
2 years before first menstrual period
What is menarche?
First menstrual period
When does menarche occur?
Ages 10-16 years in most developed countries
The first initial menstrual cycles are…
anovulatory
How do we know when a girl’s cycles become ovulatory?
Cycles become regular and she starts having cramps
Major causes of PRIMARY amenorrhea
Genetic causes such as Turner’s syndrome
Hormonal imbalances such as PCOS
What are symptoms of PCOS? 12 listed
Excessive body hair, weight gain, ovarian cysts, irregular or missed periods, low sex drive, alopecia, high testosterone levels, insulin resistance, fatigue, acne, mood changes, trouble conceiving or infertility
PCOS is a __ disorder
endocrine
In PCOS, there are very high levels or what 3 hormones?
Estrogen, testosterone, and luteinizing hormone (LH)
What hormone is decreased in PCOS?
FSH (follicle stimulating hormone)
What is Turner’s syndrome?
a condition affecting women having only one X chromosome, characterized by distinctive physical characteristics including short stature and webbed neck, and by failure of normal development of the ovaries, uterus, and breasts.
What are the major causes of secondary amenorrhea? List 6
Pregnancy Contraception Asherman's syndrome Hormonal imbalances Pituitary tumor Menopause
What is Asherman’s syndrome?
A rare condition where scar tissue, also called adhesions or intrauterine adhesions, builds up inside your uterus. This extra tissue creates less space inside your uterus.
What can cause Asherman’s syndrome? 4 listed
Too vigorous myomectomy
Complicated D&C
Abortion
C section
What is characteristic of Asherman’s syndrome?
Intrauterine band like adhesions that cause pain and interfere with the menstrual cycle
An increase in the hormone __ can cause amenorrhea
prolactin
What can cause hyperprolactinemia? List 7
Hyperthyroidism Stress Some medications Excessive exercise Excessive sleep Pituitary adenoma Weight loss: Anorexia or bulimia
How does hyperthyroidism cause an increase in prolactin levels?
Thyroid relising hormone (TRH) stimulates prolactin synthesis through the activation of ERK
What medications can increase prolactin levels?
OCPs
Phenothiazines
Anti-HTN
Narcotics
Most causes of secondary amenorrhea are caused by…
The hypothalamus not the pituitary gland
What is a rare syndrome of the pituitary gland that can cause secondary amenorrhea?
Sheehan Syndrome
What is Sheehan syndrome?
Postpartum hypopituitarism caused by necrosis of the pituitary gland. It is usually the result of severe hypotension or shock caused by massive hemorrhage during or after delivery.
How does postpartum hemorrhage lead to Sheehan syndrome?
Hypovolemia and vasospasm causes cellular swelling. The pituitary gland is surrounded by a bony prominence that inhibits blood flow, which causes the necrosis
What is the treatment for amenorrhea when the cause is hypothalamic failure?
GnRH replacement
What is the treatment for amenorrhea when the cause is hypothyroidism?
TSH replacement
What is the treatment for hyperprolactinemia?
Bromocriptine
What is the treatment for amenorrhea when anovulation is the cause?
Cyclic progesterone
How is Sheehan syndrome ruled out?
By way of hysteroscopy and hysterosalpingogram
What is primary dysmenorrhea?
Prostaglandin released from uterine lining ONLY in ovulatory cycles
What is prostaglandin responsible for?
Cramps, N/V, HA and other associated symptoms
How can you suppress prostaglandin release?
Use NSAIDS 24-48 hours BEFORE the onset of menses
Primary dysmenorrhea is associated with an…
ovulatory cycle
Primary dysmenorrhea is most common for women in what age group?
Early teens - early 20s
Secondary dysmenorrhea most common causes
Endometriosis
Fibroids
Adenomyosis
What is endometriosis?
Presence and growth of endometrial tissue outside of the uterus
Endometrial tissue can be as far away from the uterus as the…
Thoracic cavity, heart
Endometrial tissues contains…
uterine glands and stroma
Uterine glands and stroma that is outside of the uterus will..
respond to the menstrual cycle
What happens when the endometrial tissue responds to the menstrual cycle?
Those tissues bleed and cause the inflammatory process. This can cause adhesions and fibrosis to the adjacent tissues and organs
What is a well known theory of endometriosis etiology?
Transplantation or retrograde menstruation
What is transplantation or retrograde menstruation?
Endometrial tissue that’s reflux through the uterine tubes into the uterine cavity where it can implant into the ovaries and other organs
Risk factors for endometriosis
Increasing age Family history Short menstrual cycles (less than 28 days) Long menstrual flow (over a week) Age at menarche <12 years Few or no pregnancies
What does the provider look for on the exam when assessing for endometriosis?
Nodularity
Retroverted uterus
Pain with exam
How is endometriosis diagnosed?
Laparoscopy
What is a retroverted uterus?
A uterus that is tilted backwards
What are the most common s/s of endometriosis?
Pain and infertility
What is dyspareunia?
Pain with intercourse
What are other s/s of endometriosis?
dysuria, depression, fatigue, chronic pelvic pain, premenstural vaginal spotting, dyspareunia, pain with bowl movement
What are endometriomas?
“Chocolate cysts” that are found on the uterus due to endometriosis
Endometriosis lesions can cause distortions of the…
pelvic anatomy that can lead to infertility
Endometriosis can NOT be identified through…
ultrasound
Pelvic endometriosis can only be identified through…
laparoscopy
How else is endometriosis diagnosed besides laparoscopy?
CT scan may localize an incisional lesion and biopsy confirms the diagnosis
How is endometriosis treated?
OCP, NSAIDs, GnRH agonist
Surgery to remove lesions
What is the only cure for endometriosis?
Hysterectomy with bilateral oophrectomy
What is an oophrectomy?
A surgical procedure to remove one or both of your ovaries
What are the two main classes of medications used to treat endometriosis?
GnRH agonist and androgen derivatives
How would a GnRH agonist help endometriosis?
It will help to stop the releasing of FSH and LH
What is a total hysterectomy?
The uterus and cervix
What is a radical hysterectomy?
Uterus with the surrounding lymph nodes/tissue
What is a hysterectomy with a bilateral oophorectomy?
Uterus and both ovaries
What is a supracervical hysterectomy?
Just the uterus, no cervix or anything else
What is PMS?
Physical or mood changes day before menstruation
When are mood swings or physical symptoms considered PMS?
Symptoms happen month after month and affect a women’s normal life
What are 3 potential causes of PMS?
Cyclic changes in hormones
Chemical changes in the brain
Undiagnosed depression
Undiagnosed depression is related to PMS…
NOT the cause
What is the diagnostic criteria for PMS?
Symptoms must be present within the 5 days leading to her period and for at least 3 cycles in a row
Symptoms must end within 4 days after her period starts
Interfere with some of her normal activities
What are dietary considerations for preventing PMS?
Diet rich in complex carbs to reduce cravings
Calcium rich foods instead of salt, sugar, fat
Avoid caffeine to reduce irritability
Eat small meals (6 instead of 3) or add snack in between meals
What health considerations for preventing PMS?
Reduce stress with yoga, mindfulness, massage
Aerobic exercise
Get enough sleep
What pharmacological considerations for preventing PMS?
OCPs
Low dose SSRIs (once a month before period)
