Conditions of Female Reproductive System Flashcards
Describe the state of menopause
Definition:
- not a pathology, a physiological state
- cessation of menses for 12 consecutive months
Physiology:
- ovarian follicles and oestrogen produced by granulosa cells diminish with age
- climacteric phase - menopause preceded by 5 yrs of increasingly anovulatory cycles
- menstruation eventually ceases
Presentation:
- 20% asymptomatic
- 20% severe SSX
- 60% mild - moderate SSX
SSX:
- reproductive
- genital tract atrophy, reduced breast size, vaginal dryness, dyspareunia, UTIs - neuro:
- mood and memory changes
- headache and dizziness
- paraesthesia - MSK
- osteoperosis
- arthralgia and myalgia - Systemic
- hot flushes, night sweats
- fatigue / lethargy - CVD
- HTN
- increased risk AMI
Hormone Therapy:
- decreases SSX and prevents early bone loss
- causes PMS type SSX
- increases risk for thromboembolic disease, CVD, breast and endometrial cancer, and gall bladder disease
Describe the condition of polycystic ovarian syndrome (PCOS)
Diagnostic criteria:
- menstrual irregularity
- clinical hyperadrogenism
- ultrasonic evidence of polycystic ovaries (more than 12 enlarged follicles in each ovary)
Incidence:
- 8-11% of women
- most common endocrine pathology in women
Aetiology:
- inappropriate gonadotrophins
- elevated LH (causes increased androgens)
- FSH decreased - hyperinsulinaemia
- stimulates androgen secretion from theca cells
Pathophysiology:
- hormone imabalance affects maturation of ovarian follicles
- follicular growth constantly stimulated but not to maturation
- hyperinsulinaemia suppresses normal follicular apoptosis and permits survival of folliclces that would normally disintegrate
- net result: anovulation and enlargement of ovaries with cyst formation
SSX:
- reduced fertility
- menstrual disturbance
- hyperandrogenism (acne, hirsuitism, male pattern baldness)
- obesity
- increased risk for T2D, CVD, endometrial cancer
Management:
- OCP (suppresses androgen production)
- anti androgen agents (decreases effect of androgens)
- insulin sensitizers (decreases risk for T2D, can restore ovulation and menstruation)
Describe the condition of pelvic inflammatory disease
Definition:
- umbrella term for any inflammatory disorder in the genitourinary tract
Types:
- endometritis (endometrium)
- salpingitis (fallopian tubes)
- oopheritis (ovaries)
- peritonitis (peritoneum)
Aetiology:
- inflammation caused by an untreated infection
- 50-60% of cases caused by untreated chlamydia / gonorrhea
- sexual activity, surgical procedures (abortion, D/C, IUD insertion)
Incidence:
- 10% women reproductive age
SSX:
- variable and can be asymptomatic
- irregular bleeding
- mucoprurulent discharge
- dyspareunia
- dysuria
- low abdo pain
Complications:
- infertility
- abscess formation
- ectopic pregnancy
- chronic pain
Management:
- antibiotics
- surgery for adhesions or abscess
What are the 4 types of PID?
- endometritis (endometrium)
- salpingitis (fallopian tubes)
- oopheritis (ovaries)
- peritonitis (peritoneum)
Describe the condition of endometriosis
Definition:
- deposits of endometrial tissue outside uterine endometrium
Sites:
- common: fallopian tubes, surface of uterus, bowel, bladder, ureters
- post surgical: vagina, perineum
Incidence:
- 10-15% women reproductive age
- majority diagnosed are childless
Pathophysiology:
- deposits behave like normal endometrium (proliferate, break down and bleed in response to ovarian hormones)
Aetiology theories:
- retrograde menstruation (backflow of endometrial tissue during menstruation)
- embryonic deposit of endometrial cells outside endometrium in embryological development
- endometrial emboli that travel via blood or lymphatics to other sites
SSX:
- variable depending on site (vicarious bleeding causes pain and inflammation in surrounding tissues)
- pain (pelvic, dysmenorrhea, dyspareunia)
- bleeding (menorrhagia, irregular menstruation, spotting)
- bowel / bladder (dysuria, dyschezia, cyclical IBS SSX)
- other (infertility, reduced fertility, fatigue, depression)
Treatments:
- pain relief
- suppression of ovulation (OCP)
- laprascopic ablation of ectopic tissue / adhesions (high recurrence rate: 45% in 5 years)
Describe the condition of uterine fibroids
Definition:
- benign tumour arising from smooth muscle cells of myometrium in uterus
Incidence:
- peak age 20-50
- incidence decreases with menopause
Pathophysiology:
- fibroid develops in myometrium and usually remains there
- submucosal: protrude into uterine cavity
- subserosal: protrude into perimetrium
- pendunculated: extended on stalksk
Complications:
- ulceration
- bleeding
- malignant changes to uterine sarcoma (rare)
SSX:
- usually asymptomatic
- abdo (bloating, heaviness, palpable mass)
- menstrual (menorrhagia, dysmenorrhea, IDA)
- pressure on surrounding organs (urinary frequency, urgency, dysuria, leg oedema or varicosities, constipation)
What is the incidence of female reproductive cancers?
Ovarian:
- 8th most common cancer in Aus
Uterine:
- most common gynaecological Ca in Aus
Cervical:
- rates dramatically reduced since HPV vaccine
What are the most common types of ovarian, uterine and cervical cancers?
Ovarian:
- 90% are epithelial (from cells on outside of ovary)
Uteriene:
- 75% are adenocarcinomas (from secretory epithelium of endometrium)
Cervical:
- 80% are squamous cell carcinomas
What are the risk factors for female reproductive cancers?
Ovarian and uterine:
- greater exposure to oestrogen (early puberty, late menarche, nulliparity, oestrogen therapy)
Ovarian:
- family or personal Hx of ovarian or breast cancer (presence of altered BRCA gene)
Uterine:
- obesity (adipose tissue highly metabolic and has endocrine capacities)
- family Hx of cancer
- pelvic radiation
Cervical:
- HPV (70% of cases) - early sexual intercourse, multiple partners, no barrier contraception, HIV
What are protective factors against the development of ovarian and uterine cancers?
Decreased oestrogen over lifetime
- having children
- use of COCP
- prolonged lactation (prolactin inhibits GnRH secretion)
What are the SSX of ovarian, uterine and cervical cancers?
Onset:
- ovarian: vague and very late
- uterine: present
- cervical: usually asymptomatic until metastatic spread occurs
Pain:
- ovarian: back, abdomen, pelvis
- uterine: lower abdo, maybe radiations to iliac fossa
- cervical: pelvic
GIT:
- ovarian only: abdo bloating, indigestion, nausea, fullness
Bladder / bowel:
- ovarian only: urinary frequency and urgency, constipation
Vaginal:
- uterine and cervical: vaginal discharge, irregular bleeding
What is the only type of female reproductive cancer to present with GIT and bladder / bowel symptoms?
Ovarian
GIT: abdo bloating, fullness, nausea
Bladder / bowel:
- urinary frequency and urgency, constipation
What are the locations of pain for the different female reproductive cancers?
Ovarian:
- pain / pressure in back, abdomen, pelvis
Uterine:
- lower abdomen, radiations to iliac fossa
Cervical:
- pelvic
What is the management of the female uterine cancers?
Ovarian:
- surgery and radiotherapy
- chemotherapy
- immunotherapy
Uterine:
- hysterectomy
- radiotherapy
- hormone therapy (progesterone)
Cervical:
- biopsy of small tumours
- surgery and chemoradiotherapy / hysterectomy for large tumours
- metastatic spread: chemotherapy / palliative care
Describe the pathophysiology and classifications of cervical cancer
Classifications:
(based on thickness of epithelium affected by neoplastic cells)
- CIN
- pre invasive form of cervical cancer - CIN1/LSIL
- low grade squamous intraepithelial lesion
- managed with observation
- can regress or remain stationary: only a small amount progress to HSILs - CIN2, CIN3 / HSIL
- high grade squamous intraepithelial lesion
- managed with surgery
Pathophysiology:
- SCJ (transformation zone)
- squamo-columnar junction between cervix and vagina undergoes metaplasia in puberty (from columnar to squamous cells)
- vulnerable to HPV metaplasia during puberty - HPV
- causes metaplasia of cervical cells
- pre cancerous lesions can progress to invasive cervical cancer (pathogenesis 10-15 years)
