CM: Intro to Female Repro Flashcards
What does anovulatory mean and how can it be recognized?
pt not ovulating
irregular, dark color, painless, short or long in duration
What routine STD screening is recommended in sexually active adolescents?
chlamydia and gonorrhea
What does intermittent or colicky pain suggest?
muscle contraction in a hollow viscus
What does dull or throbbing pain suggest?
chronic inflammatory dz or changes internal to pelvic tumor
What is dysmenorrhea? primary and secondary?
painful menses
primary (30-40% of teenagers) - no pelvic pathology, usually begins w onset of menstrual cycles, starts 2-3 days prior to menses and goes away w full flow
secondary - older age of onset, begins well before menses and persists throughout flow –> pathology
What is the pathophysiology of dysmenorrhea?
retention of menstrual blood –> myometrial distension
higher PGF-2alpha concentration
How can ovulatory pain (mittelschmerz) be recognized?
occurs mid cycle - “day of ovulation”
lasts 2-3 days
can be treated w analgesics and OCPs
What is the pathophysiology of endometriosis? What percentage of premenopausal women does it affect?
benign - endometrial glands and stroma found in extrauterine locations (ovary)
5-15%
What are the theories proposed for the etiology of endometriosis?
Sampson’s theory of retrograde menstruation, tissue metaplasia, lymphatic or hematogenous spread, decreased immune response
What is the clinical presentation of endometriosis?
dysmenorrhea, dyspareunia, infertility, rectal pain, premenstrual bloody staining, backache
pelvic tenderness, fixed retroflexed uterus, nodularity of uterosacral ligaments, enlarged ovaries
How is endometriosis diagnosed?
laparoscopy w biopsy of lesions - hemosiderin laden macrophages
What is the pathophysiology of PID?
infection of upper reproductive tract organs
usually ascending bacteria
N gonorrhoeae, C. trachomatis (asymptomatic)
What is the presentation of PID?
constant pain - unilaterial progresses to bilateral
yellow discharge, fever, cervical motion tenderness, leukocytosis, elevation of ESR, cultures + or - (if above cervix already)
What are the possible complications of PID?
tubo-ovarian abscess
infertility
What are the generalities of the menstrual cycle?
day 1 is first day of menses
proliferative and luteal phases - both around 14 days (if 1 changes, it is proliferative)
menses w progesterone withdrawal if no pregnancy
What are the major effects of estrogen?
endometrial proliferation
vaginal cornification
watery cervical mucus
positive and negative feedback
What are the major effects of progesterone?
thermogenic
secretory endometrium, viscous mucus
modulates feedback
lobuloalveolar growth of breasts
What is the effectiveness of condoms with regard to STIs?
no evidence of risk reduction of HPV or trichomonas vaginalis
syphilis, chlamyida, and gonorrhea all have reduced risk
still 60% relative risk of herpes
still 15% risk of HIV
