Chapter 27Common GynecologicalConditions Flashcards
Exam 4 (Final)
Expected Uterine Bleeding:
When does normal uterine bleeding begin?
Normal uterine bleeding begins every 24 to 38 days.
Expected Uterine Bleeding: When is a female’s period considered regular?
A female’s period is considered regular if the difference between her shortest and longest cycle is no more than 7-9 days.
Expected Uterine Bleeding:
What length of bleeding is considered normal
Bleeding duration of 8 days or less for a single menstrual period is considered normal.
Expected Uterine Bleeding:
How is the volume of blood loss in females? When is it considered normal?
The volume of blood loss varies between females and is considered normal when it does not interfere with physical or emotional health or quality of life.
Abnormal Uterine Bleeding (AUB):
What classification system is used?
AUB that consists of heavy menstrual bleeding or bleeding between periods is summarized in the PALM-COEIN classification system.
Abnormal Uterine Bleeding:
What are the different types?
Heavy menstrual bleeding (AUB/HMB)
Intermenstrual bleeding (AUB/IMB)
Abnormal Uterine Bleeding:
PALM- structural causes
Polyp (AUB-P)
Adenomyosis (AUB-A)
Leiomyoma (AUB-L)
Malignany and hyperplasia (AUB-M)
Abnormal Uterine Bleeding
COEIN- nonstructural causes:
Coagulopathy (AUB-C)
Ovulatory dysfunction (AUB-C)
Endometrial (AUB-E)
Iatrogenic (AUB-I)
Not yet classified (AUB-N)
Abnormal Uterine Bleeding: Causes
Adenomyosis or endometrial-type tissue within the myometrium (muscle tissue of the uterus)
What does it cause?
Causes heavy menstrual bleeding and dysmenorrhea
Abnormal Uterine Bleeding: Causes
Adenomyosis or endometrial-type tissue within the myometrium (muscle tissue of the uterus)
How may it be treated?
May be treated with hormonal contraceptives,
a levonorgestrel intrauterine device or
uterine artery embolization
or hysterectomy
Abnormal Uterine Bleeding: Causes
Leiomyomas are benign tumors of the uterus.
What may they cause?
May cause abnormal, often heavy uterine bleeding and pelvic pain.
Abnormal Uterine Bleeding: Causes
Leiomyomas are benign tumors of the uterus.
What kind of problems can it cause?
Leiomyomas can cause problems with infertility and pregnancy.
Abnormal Uterine Bleeding: Causes
Leiomyomas are benign tumors of the uterus.
What does treatment include
Treatment may include hormonal contraception, myomectomy, endometrial ablation, or hysterectomy.
Abnormal Uterine Bleeding: Causes
What are Hyperplasia and malignancy of the endometrium are evidenced by?
Hyperplasia and malignancy of the endometrium are evidenced by postmenstrual bleeding, intermenstrual, or heavy menstrual bleeding that are otherwise unexplained.
Abnormal Uterine Bleeding: Causes
What is a cardinal sign of endometrial cancer?
Vaginal bleeding after menopause is a cardinal sign of endometrial cancer.
Abnormal Uterine Bleeding: Causes
What may be a cause for heavy menstrual bleeding?
Coagulopathy issues may be a cause for heavy menstrual bleeding.
Abnormal Uterine Bleeding: Causes
What is von willebrand disease?
von Willebrand disease is a common clotting disorder that may be hereditary or acquired.
Abnormal Uterine Bleeding: Causes
von willebrand disease: How is diagnosis made?
Diagnoses made after careful history taking and laboratory assessment.
Abnormal Uterine Bleeding: Causes
When would ovulatory dysfunction be suspected?
Ovulatory dysfunction may be suspected if females experience varying cycles for more than one year with blood volumes that vary from light to heavy.
Abnormal Uterine Bleeding: Causes
What is the cause of ovulatory dysfunction?
Cause of ovulatory dysfunction often cannot be identified.
Abnormal Uterine Bleeding: Causes
What medications may cause ovulatory disorders?
Medications that may cause ovulatory disorders include antidepressants, antipsychotics, corticosteroids, chemotherapy, and hormonal contraceptives
Abnormal Uterine Bleeding: Causes
What may be a cause of AUB?
Endometrial issues may be cause for AUB.
Abnormal Uterine Bleeding: Causes
What are diagnostic tests for endometrial related AUB?
There are no diagnostic tests for endometrial related AUB.
Abnormal Uterine Bleeding: Causes
Endometrial issues may be cause for AUB.
When is endometrial issues diagnosed?
Diagnosed when other disorders are excluded.
Abnormal Uterine Bleeding: Causes
Endometrial issues may be cause for AUB.
What MAY be the cause of endometrial issues that may cause of AUB?
May be caused by inflammation related to STIs (such as chlamydia and gonorrhea).
Abnormal Uterine Bleeding: Causes
Iatrogenic causes of AUB mean what?
Iatrogenic causes of AUB mean the AUB is caused by medical examinations or treatment.
Abnormal Uterine Bleeding: Causes
What are examples of Iatrogenic causes of AUB?
Examples of iatrogenic causes are anticoagulation therapy or intrauterine devices.
Abnormal Uterine Bleeding: Causes
How about not otherwise classified causes of AUB?
Not otherwise classified causes for AUB are very rare and poorly defined (e.g., malformation of the vasculature).
Dysmenorrhea: What is it?
Dysmenorrhea is pain with menstruation that limits daily activities and responsibilities.
Dysmenorrhea: What are the two types?
Primary dysmenorrhea
Secondary dysmenorrhea
Dysmenorrhea:
Primary dysmenorrhea: How does it occur?
Primary dysmenorrhea occurs in the absence of another cause.
Dysmenorrhea:
Primary dysmenorrhea: When does it begin?
Usually begins 2 to 5 years after menarche.
Dysmenorrhea:
Primary dysmenorrhea: What are symptoms?
Symptoms include cramps to lower abdomen that may also be felt in the back or thighs, fatigue, headache, diarrhea, nausea, and malaise.
Dysmenorrhea:
Secondary dysmenorrhea: What are symptoms? What is an underlying cause?
Secondary dysmenorrhea has similar symptoms (to primary) but also an underlying cause such as endometriosis or adenomyosis.
Dysmenorrhea: What is first line cause?
First-line treatment for dysmenorrhea includes nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptives.
Dysmenorrhea: What are self care measures?
Self-care measures include warm packs to the lower abdomen, exercise, and a low-fat or vegetarian diet.
Endometriosis: What is it?
Endometriosis is the presence of endometrial tissue outside the uterus.
Endometriosis: What are symptoms?
Symptoms include dysmenorrhea, dyspareunia, infertility, pelvic mass, heavy menstrual bleeding, bowel and/or bladder dysfunction, low back pain, and chronic fatigue.
Endometriosis: How is the cause explained?
The cause of endometriosis is not well understood but often explained as retrograde menstruation.
Endometriosis: What is first line treatment?
First-line treatment generally includes NSAIDs and hormonal contraception.
Endometriosis: What is first line treatment?
First-line treatment generally includes NSAIDs and hormonal contraception.
Endometriosis: What happens if a woman does not respond to first line treatment?
If the female does not respond to first-line measures, she may receive a GnRH agonist, which produces a hypoestrogenic effect or a laparoscopy for definitive diagnosis and removal of endometrial lesions.
Pelvic Prolapse:
How are pelvic organs usually held in place?
Pelvic organs are held in place by a combination of connective tissue and the muscles of the pelvic floor.
Pelvic Prolapse:
What does pelvic organ prolapse involve?
Pelvic organ prolapse may involve prolapse of the bladder (cystocele), rectum (rectocele), bowel (enterocele), or uterus.
Pelvic Prolapse:
What is prolapse of the bladder?
prolapse of the bladder (cystocele),
Pelvic Prolapse:
What is prolapse of the rectum?
rectum (rectocele)
Pelvic Prolapse:
What is prolapse of the bowel?
bowel (enterocele)
Pelvic Prolapse:
Risk for pelvic floor prolapse include:
Giving birth (risk increases with the number of births)
Vaginal births are associated with higher risk than cesarean births
Obesity
Pelvic Prolapse: Classifications by Stage
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Pelvic Prolapse: Symptoms and Treatment
Signs and symptoms may include:
Vaginal pressure
Pelvic pain
Bulge at the opening of the vagina
Problems with defecation or urination
Sexual dysfunction
Pelvic Prolapse: Symptoms and Treatment
When is treatment indicated?
Treatment is indicated when the females experience distressing symptoms.
Pelvic Prolapse: Symptoms and Treatment
What is included in treatment?
Treatment may include vaginal pessaries to assist with pelvic organ support, pelvic floor physical therapy, or surgery.
Urinary Incontinence
What are risks for developing urinary incontinence?
Risks for developing incontinence include aging, past pregnancy, vaginal birth, obesity, or family history.
Urinary Incontinence:
There are three main types of incontinence:
Stress incontinence
Urge or urgency incontinence
Overflow incontinence
Urinary Incontinence:
There are three main types of incontinence: Stress incontinence
What is it caused by and what are examples?
Stress incontinence due to increased intrabdominal pressure (e.g., sneezing, coughing, laughing, exercise)
Urinary Incontinence:
There are three main types of incontinence: Urge or urgency incontinence
What is it caused by?
Urge or urgency incontinence, which is often referred to as an overactive bladder is caused by overactivity of the muscles of the bladder.
Urinary Incontinence:
There are three main types of incontinence: Overflow incontinence
What is it caused by?
Overflow incontinence, which is caused detrusor underactivity.
Urinary Incontinence:
There are three main types of incontinence:
What does treatment depend on?
Treatment depends on the type of incontinence and contributing factors and
Urinary Incontinence:
What may treatment include:
may include pelvic floor exercises, weight loss, limiting alcoholic and caffeinated beverages, and avoiding dehydration.
Normal Transition to Menopause
When is natural menopause achieved?
Natural menopause is achieved when a female has not menstruated for a full 12 months in the absence of any other reason.
Normal Transition to Menopause
When does menopause typically occur?
Menopause typically occurs around age 51 or 52.
Normal Transition to Menopause
What is the time prior to menopause referred to as? How long does that last?
The time prior to menopause is referred to as perimenopause and typically lasts around 4 years.
Normal Transition to Menopause:
What are perimenopause symptoms include?
Perimenopause symptoms include menstrual irregularities, vaginal dryness (decreased estrogen), disturbed sleep, depression, sleep apnea, insomnia, and mood symptoms.
Normal Transition to Menopause:
What are long term consequences of menopause?
Long-term consequences of lower estrogen include bone loss and cardiovascular disease.
Normal Transition to Menopause:
What is no longer recommended for symptoms of menopause? Why?
Estrogen replacement therapy is no longer recommended for symptoms due to the risk for cardiovascular disease and breast cancer.
Ovarian Cysts:
What are the two broad groups?
Functional ovarian cysts
Nonfunctional ovarian cysts
Ovarian Cysts
Functional ovarian cysts include:
- Follicular cysts
- Corpus luteum cysts
Ovarian Cysts
When do follicular cysts occur?
Follicular cysts occur when the follicle does not rupture during ovulation.
Ovarian Cysts
What does follicular cysts commonly occur with?
Commonly occurs with polycystic ovarian syndrome.
Ovarian Cysts
How are symptoms of follicular cysts?
Generally asymptomatic unless rupture or torsion occurs.
Ovarian Cysts
When does Corpus luteum cysts occur?
Corpus luteum cysts occur when the corpus luteum fails to involute.
Ovarian Cysts
When does Corpus luteum cysts resolve?
Typically resolves within a few weeks or months.
Ovarian Cysts
Nonfunctional ovarian cysts include what?
Dermoid cysts
Ovarian Cysts
Dermoid cysts are what?
What do they contain?
Dermoid cysts, or mature cystic teratomas, are benign ovarian tumors containing ectodermal, mesodermal, and endodermal tissues.
They often contain teeth, hair, or nails.
Ovarian Cysts
Nonfunctional ovarian cysts: How are symptoms?
Generally asymptomatic unless torsion or rupture occurs.
Ovarian Cysts
Nonfunctional ovarian cysts: How is a definitive diagnosis made?
Definitive diagnosis made surgically.
What is the most common cause of infertility and subfertility in women?
PCOS is the most common cause of infertility and subfertility in women.
Polycystic Ovarian Syndrome (PCOS):
What is it?
PCOS is an endocrine disorder
Polycystic Ovarian Syndrome (PCOS):
What is it characterized by?
characterized by ovulatory dysfunction (causes irregular menstrual cycle) and hyperandrogenism (causes excess face and body hair and acne).
Polycystic Ovarian Syndrome (PCOS):
Who does it commonly appear in?
Most commonly appears in adolescence and persists throughout the reproductive life span.
Polycystic Ovarian Syndrome (PCOS):
What could be a cause of PCOS?
Obesity and insulin resistance may be causative, a result of the syndrome, or both
Polycystic Ovarian Syndrome (PCOS):
What are treatment goals for PCOS based on?
Treatment goals for PCOS are based on the specific clinical manifestation of the patient.
Polycystic Ovarian Syndrome (PCOS):
How is ovulation and pregnancy in patients with PCOS?
Patients with PCOS may ovulate intermittently and should use contraception if they do not want to get pregnant.
PCOS Diagnostic Criteria for Adolescents:
What does diagnosis require?
Diagnosis requires at least one indication from the category of abnormal uterine bleeding and one indication from the category of evidence of hyperandrogenism
PCOS Diagnostic Criteria for Adolescents:
How is abnormal uterine bleeding pattern?
Abnormal for age or for first time since first menses
Symptoms persist for 1 or 2 years
PCOS Diagnostic Criteria for Adolescents:
How is evidence of hyperandrogenism?
Moderate to severe hirsutism
Persistent lab elevation of testosterone
Gynecological Cancers:
What do they include
Gynecological cancers include uterine, cervical, ovarian, vaginal, and vulvar.
Gynecological Cancers:
How are cancers staged?
Cancers are staged based on the TNM staging system:
Gynecological Cancers:
Cancers are staged based on the TNM staging system:
T refers to the size and extent of the primary tumor.
N refers to the number of lymph nodes to which the cancer has spread.
M refers to metastasis.
Gynecological Cancers: Uterine
What is the fourth most common diagnosed cancer in the US?
Cancer of the uterus is the fourth most common diagnosed cancer in the United States.
Gynecological Cancers: Uterine
What are the two main types of uterine cancer?
The two main types are uterine sarcoma and endometrial adenocarcinoma.
Gynecological Cancers: Uterine
The two main types of uterine sarcoma are endometrial adenocarcinoma.
What does treatment include?
Treatment often includes hysterectomy with or without bilateral salpingo-oophorectomy, followed by staging of the cancer to determine further treatment.
Gynecological Cancers: Uterine
How common are endometrial adenocarcinomas? How are they diagnosed?
Endometrial adenocarcinomas are more common and are diagnosed with a pathology examination of the tissue.
Gynecological Cancers: Uterine
What is treatment for endometrial adenocarcinomas?
Treatment may include surgical removal of the cancerous tissue followed by chemotherapy and radiation as needed.
Gynecological Cancers: Cervical
How does cervical cancer develop?
Cervical cancer develops from abnormal changes in cervix cells often as a result of human papillomavirus (HPV) infection.
Gynecological Cancers: Cervical
What happens to abnormal changes in cervix cells?
Abnormal changes are biopsied and assessed by a pathologist.
Gynecological Cancers: Cervical
When abnormal changes in cervix cells are biopsied and assessed by a pathologist what may the results be?
Results may be negative, cervical intraepithelial neoplasia (CIN), or adenocarcinoma in situ (AIS).
Gynecological Cancers: Cervical
Cervical intraepithelial neoplasia (CIN): What is it?
CIN refers to abnormal squamous cells of the cervix that can develop into squamous cell carcinoma of the cervix.
Gynecological Cancers: Cervical
Adenocarcinoma in situ (AIS): What is it?
AIS refers to glandular cell abnormalities that can develop into adenocarcinoma of the cervix.
Gynecological Cancers: Cervical
How does cervical cancer spread?
Cervical cancer can spread by extension to the uterus, vagina, or abdominal cavity.
It can also spread by the lymph system to other organs.
Gynecological Cancers: Cervical
What is treatment for cervical cancer?
Treatment may include cone biopsy, hysterectomy, chemotherapy, or radiation.
Gynecological Cancers: Ovarian
What is the leading cause of death from gynecological cancer in the US? Why?
Ovarian cancer is the leading cause of death from gynecological cancer in the United States because of vague symptoms and late diagnosis.
Gynecological Cancers: Ovarian
When are most ovarian cancer identified?
Most ovarian cancers are identified at stage III or IV.
Gynecological Cancers: Ovarian
What are symptoms of ovarian cancer?
Symptoms include abdominal pain, bloating, and increased abdominal girth.
Gynecological Cancers: Ovarian
How may ovarian cancer be identified?
When is diagnosis made?
May be identified with ultrasound or CT scan, followed by diagnosis after surgery by pathology.
Gynecological Cancers: Ovarian
What is treatment for ovarian cancer usually?
Treatment is often chemotherapy.
Gynecological Cancers: Ovarian
What happens to survivors of ovarian cancer?
Survivors of ovarian cancer often have lifetime issues associating with treatment (e.g., hearing loss, neuropathy of the feet, and ambulation difficulties).
Gynecological Cancers: Vaginal
How common is it?
Rare cancer diagnosed in about 1 in 100,000 females.
Gynecological Cancers: Vaginal
What is vaginal cancer associated with?
Vagina cancer is associated with HPV.
Gynecological Cancers: Vaginal
How are the majority of females with vaginal cancer symptom-wise?
The majority of females are asymptomatic and their cancer is discovered incidentally during examination.
Gynecological Cancers: Vaginal
What are symptoms of vaginal cancer?
Symptoms may include postcoital bleeding or postmenopausal bleeding or a vaginal mass.
Gynecological Cancers: Vaginal
What is treatment for vaginal cancer?
Treatment is similar to cervical cancer.
Gynecological Cancers: Vaginal
What are complications of vaginal cancer?
Complications include fistulas and strictures.
What is the fourth most common gynecological cancer?
Gynecological Cancers: Vulvar
Gynecological Cancers: Vulvar
What is diagnosis based on?
Diagnosis is based on vulvar biopsy.
Gynecological Cancers: Vulvar
How may vulvar cancer appear?
Vulvar cancer may appear as a plaque, ulcer, or mass, often on the labia majora.
Gynecological Cancers: Vulvar
What is a common complaint/symptoms?
Pruritus is a common complaint.
Some females may experience vulvar or rectal bleeding, dysuria, dyschezia (pain with defecation), or edema of the lower extremities.
Breast Cancer:
Approximately, how many people will be diagnosed with breast cancer?
Approximately 1 in 8 females will be diagnosed with breast cancer during their lifetime.
Breast Cancer:
How are the majority of breast cancers discovered?
A majority of breast cancers are discovered by mammogram and diagnosed by needle biopsy of the core lesion.
Breast cancer:
What are prognostic factors?
Prognostic factors include the age and race of the patient, smoking status, tumor stage, tissue markers, gene expression, proliferation markers, tumor assays, and circulating tumor cells.
Breast Cancer:
Treatment may include:
Surgery (breast-conserving surgery, mastectomy [radical], modified radical, simple mastectomy, skin-sparing, and nipple- and areola-sparing)
Chemotherapy
Radiation therapy
Hormone therapy
Slide 27
Benign Breast Variations:
What is micromastia?
Micromastia refers to the underdevelopment of breast tissue and is not considered to be pathological.
Benign Breast Variations:
What are conditions that may contribute to micromastia?
Conditions that may contribute to macromastia include ovarian failure, androgen excess, hypothyroidism, mitral valve prolapse, chest radiation, and connective tissue disorders.
Benign Breast Variations:
What is Accessory breast tissue?
Accessory breast tissue refers to any breast tissue beyond the two breasts typical for humans.
Benign Breast Variations:
What are Breast cysts?
are palpable masses or masses identified by ultrasound that are common in females 35 to 50 years old.
Benign Breast Variations:
What can be done to Breast cysts if they are painful?
Breast cysts can be aspirated if painful.
Benign Breast Variations:
What should be done with Breast cysts?
What are simple breast cysts?
Simple breast cysts do not increase cancer risks, but complex cysts should be biopsied.
Benign Breast Variations:
How are fibrocystic breasts?
Many females of reproductive age have fibrocystic breasts that have a ropey, lumpy texture but are not at risk for breast cancer.
