Chapter 33 - Alterations In Female Reproductive Systems Flashcards
Dysmenorrhea
Painful menstruation
Dysmenorrhea results from
Excessive prostaglandin secretion
Prostaglandin results in
Myometrial (smooth muscle cells of uterine wall) stimulation and vasoconstriction
Dysmenorrhea result:
Constriction of endometrial tissue, and nerve hypersensitivity = PAIN
Dysmenorrhea: pain is directly related to
Length and amount of menstrual flow
TX Dysmenorrhea
NSAIDs
Layers of uterus inner to outer
- Endometrium
- Myometrium
- Uterus
Primary amenorrhea
Absence of menstruations by 13 yoa without development of secondary characteristics by 15 yoa
Secondary amenorrhea
Absence of menstruation for 3 cycles in women with previous cycles
Important for amenorrhea is to understand
Compartmentalizations
amenorrhea compartment 1:
Disorder due to anatomical defects
-absence of vagina and uterus
amenorrhea compartment 2:
Disorder of ovary/genetic disorders
-Turner’s syndrome
amenorrhea compartment 3:
disorder of anterior pituitary gland
-results in failure of FSH and LH to properly signal ovaries s
Amenorrhea compartment 4:
Disorder due to CNS that prevents release of hypothalamic GnRH
What is the leading cause of infertility in NA?
PCOS
Diagnosis of PCOS
Anovulatory (skipped ovulations) and menstrual cycles
-elevated levels of androgen
PCOS is related to
Genetics and obesity prone lifestyle
Obesity and PCOS
-PCOS predisposes for obesity
-obesity predisposes to PCOS
Obesity prone lifestyle =
Inc insulin resistance and excess of insulin + androgens
-hyperinsulinemia = overstimulation of ovarian androgen secretion
Overstimulation of ovarian androgen secretion causes
-inc free androgen which inc follicular growth
-inc insulin suppresses follicular apoptosis = survival of follicles that would normally disintegrate
Result of PCOS
Ovaries become enlarged and contain fluid filled sacs (follicles) that surround eggs
Exogenous
Most often sexually transmitted
Endogenous
Microorganism that have normal residence of vagina, bowel and vulva
Pelvic inflammatory disease affects
Upper gentian tract (uterus, fallopian tubes, ovaries)
Risk factors for pelvic inflammatory disease
Earlier untreated sexually transmitted disease, or having multiple sex partners
pelvic inflammatory disease develops when
Pathogens ascend from an infected cervix to infect fallopian tubes
Main sexually transmitted infections
Gonorrhoea and chlamydia
Aerobic bacteria alter vaginal pH =
Decrease integrity of mucus blocking cervical canal
TX pelvic inflammatory disease
Broad spectrum antibiotics to ensure all causative agents are eliminated
Salpingitis
Inflammation of fallopian tubes
-changes columnar epithelia of upper reproductive tract
Salpingitis causes
Local edema and possibly necrosis
Gonorrhoea and chlamydia in Salpingitis
G: attach to fallopian tubes and secrete a toxin that damages mucosa
C: enters damaged cells and replicates = pathogens burst cell membrane causing scarring
Chronic consequences of PID
Infertility, tubul obstruction, ectopic pregnancy
Vaginitis
Vaginal inflammation with inc of WBC
Vaginosis
Vaginal irritations without WBC
Causes of vaginitis
Overgrowth of normal flora
-STI
-low estrogen levels during menopause
vaginitis is related to alterations in
Vaginal pH
-normal levels of 4 to 4.5 depending on cervical secretions and presence of normal flora
-changes in pH = predisposition to infection
Diagnosis of vaginitis
Change in colour and amount of menstrual discharge
TX for vaginitis
Support acidic environment
-probiotics encourage proliferation of normal vaginal flora
Cervicitis
Inflammation of cervix
Diagnosis fo Cervicitis
- Purulent discharge (pus)
- Mucopurulent discharge (pus and mucus)
Mucopurulent Cervicitis
Infection becomes red and edematous (related to or affected by edema)
-drains from external cervix
-pelvic pain
-bleeding may be present
Mucopurulent Cervicitis is a symptom of
Pelvic inflammatory disease
Women under 26 yoa should receive
TX for PID while waiting for exudate examination
Benign ovarian cysts occur in
Reproductive years around puberty and menopause
Benign ovarian cysts are related to
Hormone imbalances
-reason for 1/3 gynaecological hospital admissions
Two causes for Benign ovarian cysts
Ovary/follicular cysts and corpus luteum cysts
During normal menstrual cycle ___ follicles are stimulates
120
-but only one reaches ovulation
Follicular cyst
Dominant follicle does not rupture normally, or non dominant follicles do not regress
Ovary cysts
Development occurs when no dominant follicle develops and completes maturation process
Corpus luteum cysts
May form from granulosa cells left behind after ovulation
Endometriosis
Presence of functional endometrial tissue outside uterus
-ovaries, fallopian tubes, bladder
Problem with functional endometrial tissue outside uterus
Tissue still responds to menstrual cycle hormonal fluctuations
-causing infertility and pain
Endometriosis causes
-high levels of estrogen
-cells switching fates during development
-new bv to support lesions (angiogenesis)
-stem cells play role
-ectopic pregnancy
Second leading cause of death in women, with an 1 in 8 chance of development
Breast cancer
On average per day, __ canadian women will be diagnosed with breast cancer and ___ will die from the cancer
75, 14
In 2022 ___ men will be diagnosed with breast cancer, and __ will likely die from breast cancer
240, 55
Four hypothesis for breast cancer
- Ovarian androgen (testosterone) excess
- Blood elevation in both estrogen and progesterone
- Estrogen alone : estrogen circulating in breast cancer in post menopausal women
- Local biosynthesis of estrogen in breast tissue
Diagnosis of breast cancer
Clinical breast exam, mammography, biopsy
Risk factors for breast cancer in women
BRCA1 and BRCA2 gene mutation
-normally these protect against cancer but mutations lead to cancer
Family history
Menstruation before 12 yoa
Menopause after 55 yoa
Nulliparou (no children)
Oral contraceptives
Obesity
Hormonal factors of breast cancer in women
-progesterone affects early first pregnancy or removal of ovaries and pituitary gland
-inc risk associated with early menarche, late menopause, nulliparity
Gynecomastia
Overdevelopment of breast tissue in males
-results in hormonal alterations
Who is at risk for Gynecomastia
Klinefelters syndrome
-males with an extra X chromosome
Hormonal imbalance in Gynecomastia
Estrogen is very low or testosterone is very low
In young males Gynecomastia resolves in
4-6 months
Males > 60 yoa risks/Gynecomastia
-BRCA1 and BRCA2 mutations
-nipple crusting and discharge
-enlarged auxiliary nodes
TX for Gynecomastia
Modified mastectomy with hormone therapy
