chap 17 - female reproductive tract Flashcards
normal cycle
Follicular vs. luteal phase
-Hormones
-Estrogen
-Progesterone
If no pregnancy occurs
-Corpus luteum degrades
-Secretory endometrium shed with blood
-New cycle begins
female reproductive system
Ovaries
Gametogenesis
Hormone production
Fallopian tubes
Pathways from ovary to uterus
Cervix
Opening to uterus
Uterus
House and protect the developing fetus
most frequent and serious problems
Menstrual abnormalities
Amenorrhea
Absence of menstruation
Irregular or excessive menses
Can be caused by underlying hormonal derangement
Sexually transmitted diseases (STDs)
Gonorrhea and chlamydia
Can cause pelvic inflammatory disease
Herpes simplex disease
Causes outbreaks of vesicles in cervix, vagina, and vulva
Human papillomavirus (HPV)
Causes genital warts and carcinoma of the cervix
signs, symptoms and tests
Dysfunctional bleeding
- Menorrhagia = heavy menstrual bleeding
- Menorrhagia = uterine bleeding at irregular intervals
Pain
- Dysmenorrhea
Vaginal discharge
- Can be associated with superficial infections
Menstrual history
- Length of the cycle
- Duration
- Amount
- Regulatory
Pelvic examination
- Direct inspection of the vulva, vagina, and cervix
- Bimanual examination
Pap test
- Can detect HPV and neoplastic lesions
Cone biopsy
- Removal of a cone or tissue for histological exam
inspection of the reproductive tract
Types
Sti
- Chlamydia
- Gonorrhea
- Syphilis
- HPV
- Fungus
Can lead to
- Vaginitis
- Cervicitis
- Salpingitis - fallopian tubes
- PID
disorders of the cervix
Polyps
Cervical dysplasia
Cervical carcinoma
cervical polyps
Benign tumors on surface of cervical canal
Many asymptomatic, but can lead to irregular menstrual bleeding
Treatment = removal
cervical dysplasia
Abnormal growth of cervical squamous epithelium
Range from mild-severe dysplasia
- Mild = may regress
- Severe = precancerous
Screening
- Pap smear
Risk factors
- HPV infection
- Multiple sex partners
- Genetics
vaginal cancer
Rare
Two types
- Squamous cell
- Adenocarcinoma
Signs and symptoms
- Typically asymptomatic
- Often found in routine gynecological exam
Risk factors
- HPV
disorders of uterus
Uterus anatomy
- Endometrium
- Myometrium
Conditions
- Irregular bleeding
- Endometriosis
- Leiomyomas
irregular uterine bleeding
Leading cause
- Follicle fails to mature and no corpus luteum is formed (anovulatory cycle)
- No corpus luteum = no progesterone
Uterus is subjected to continuous estorgen stimulation and responds by shedding and bleeding in an irregular manner instead of shedding all at once
Other causes of uterine bleeding
- Endometrial and cervical polyps
- Uterine leiomyomas
- Uterine carcinoma
disorders of uterus
Endometriosis
- Presence of functioning endometrial tissue outside of uterus
- Ectopic
- Responds to hormone fluctuations
Possible causes
- Retrograde menstruation
- Spread through vascular or lymphatic systems
- Genetic predisposition
Symptoms
- Pelvic pain
- Infertility
- Bleeding of ectopic endometrium, causing pooling of blood
- Adhesions of internal organs
endometriosis
Diagnosis
- Laparoscopy or biopsy
Treatment
- Surgical removal of ectopic endometrium
- Oral contraceptives
- Medication to inhibit pituitary release of gonadotropins
- Medication to suppress production of gonadotropin-releasing hormone
- Complete hysterectomy
disorders of uterus
Uterine leiomyoma
- Fibroids
- Benign tumors of myoma
Etiology
- Unknown
Risk factors
- Age of at least 30
- Obesity
- Family history of fibroids
uterine fibroids
Signs and symptoms
- Abdominal fullness
- Change in menstruation
- Bleeding at times other than menstruation
Some symptoms related to location
- Bladder region: urinary frequency and dysuria
- Rectal region: anal-sphincter spasm
- Dysmenorrhea
- Pain
Treatment
- No treatment if small
- Oral contraceptives
- Removal
amenorrhea
Etiology
Hypothalamic, pituitary, or endocrine dysfunction
Congenital or acquired abnormalities of the reproductive tract
Extreme weight loss
Consequences
Treatment
dysmenorrhea
Painful menstruation
Types
Primary
- Pelvic organs normal
Secondary
- Pelvic organs disease
Examples = endometriosis
Etiology
- Prostaglandins
- Synthesized in uterus under progesterone
- Menstruation leads to release
- Cause cramping of myometrium
endometrial carcinoma
Most common cancer of female reproductive tract
- Cancer of endometrium
- Account for almost all cancers of the uterus
Symptoms
- Abnormal uterine bleeding
- Risks
- Age
- Obesity
- Excessive estrogen exposure
Treatment
- Hysterectomy
- Good prognosis
disorders of the ovaries
Ovarian cyst
Etiology
- Unknown
Contributors
- Hypothyroidism
- Early age of menarche
Signs and symptoms
- Most women are asymptomatic
- Abdominal fullness
- Low back pain
- Nausea and vomiting
- Abnormal uterine bleeding
Risk for?
Diagnosis
- Ultrasound
Treatment
- Oral contraceptives
- Laparoscopic procedure to drain or remove the cyst
polycystic ovary syndome
One of most common female endocrine disorders
- Follicles develop
But they do not ovulate after the LH surge
- Anovulation = infertility
- Amenorrhea
- High LH levels persist
- LH stimulates androgen production
- Male pattern hair growth
- This interferes with ovulation even more
Associated with
- Insulin resistance
- Hypertension
- Dyslipidemia
Treatment
- No cure
- Based on whether you want to get pregnant or not
- Birth control pills or fertility medication
- Diabetes modifications
ovarian cancer
Ovarian cancer is the leading cause of death among gynecological malignancies
Ovarian cancer mortality has been rising, whereas cervical and uterine cancer mortality rates have been falling
The prognosis is generally poor for ovarian cancer patients of whom only 25% survive for less than 5 years
Ovarian cancer risk factors
Hereditary
10% of ovarian cancer are hereditary
90% if the hereditary cases are linked to breast-ovarian cancer genes 1 and 2
With BRCA the lifetime risk varies between 15% and 66%
Childbirth and pregnancy
Women who had children about half the risk as do women who have not
Increasing # of children appears to reduce risk a further 15% each
Miscarriage or abortion provide smaller risk reductions
Risk factors
Lactation (breastfeeding)
Reduces the risk of ovarian cancer (as it does for breast cancer)
Oral contraceptives
Ever-users have about half the risk as do never-users
Long term use seems to further enhance protection against ovarian cancer
Hormone replacement therapy
Appears to increase the risk for ovarian cancer, particularly long term use
pelvic inflammatory disease
Infection of women’s reproductive organs
Etiology
Untreated STD’s
Symptoms
Pain in lower abdomen
Fever unusual discharge
Complications
Scar tissue
Infertility
Ectopic pregnancy
menopause or climacteric
Decreased ovary function
Low estrogen
Osteoporosis risk
Atherosclerosis risk
Less inhibition of pituitary
Increased FSH and LH
Hot flashes
Hormone replacement therapy?
contraception
Types
Natural family planning
Artificial contraception
Barrier methods and oral contraceptives
Side effects of oral contraceptives = increased tendency for thromboembolic complications, especially among smokers, hypertension
Intrauterine contraceptive devices
Increased incidence of tubal infections and tubal pregnancies
