female repro case studies vallano

Question 1

menopause

Answer 1

• symptoms of menopause are because of a deficiency is estrogen
• if you give a woman estrogen w/o progesterone, the hormone imbalance is dangerous
• menopause is diagnosed by a rise in circulating FSH. LH also goes up, but LH only goes up 3X whereas FSH goes up 17X.
• hormone replacement therapy (estrogen and progesterone) can reduce menopause symptoms, but they increase the risk of cardiovascular disease, breast cancer, and cerebrovascular disease. hormone replacement therapy is being replaced by SERM selective estrogen receptor modulatory. good for bone and doesnt target uterus or breasts.

Question 2

hypothalamic amenorrhea- young girl, not pregnant, 8 months w/o menses. losing weight and exercises alot.

Answer 2

• puberty is characterized by pultatile GnRH secretions first at night, then in day.
• children have high sensitivity to steroids and adults have low sensitivity to steroids. adolescents are intermediate.
• after puberty, GnRH SECRETION can be diminished by exercise, weight loss, and stress. anorexics, ballerinas, etc
• hypothalamic amenorrhea diagnosis is obtained by measuring high FSH and high LH levels after giving exogenous GnRH. problem is at the level of hypothalamus. everything else intact. patient wasnt releasing GnRH at hypothalamus bc of too much exercise and weight loss.

Question 3

polycystic ovary syndrome- irregular menstrual periods, and heavy flow. bark hair growing on face, upper arms, chest, abdomen. acne. no children. little high BMI

ovarian enlargement, 20 follicles w/o a dominant follicle. thin endometrium, elevated LH and FSH, high testosterone, glucose tolerance abnormal

Answer 3

• polycystic ovary syndrome characterized by:
• reduced estrogen from granulosa cells,
• reduced progesterone by granulosa and thecal cells
• continued production of androgen by thecal cells throughout the cycle
• irregular and absent menses
• not alot of estrogen since the dominant follicle is the one that would make estrogen.
• androgens are given by the thecal to the granulosa cells to make estrogen normally. doesnt happen so you make androgens and get acne and hair growth.
• treatment::
  1. birth control estrogen and progesterone to restore regular menses
  2. clomiphere to restore ovulation
  3. 5 alpha reductase inhibitor to stop androgen production stops conversion of testosterone to dihyrotestosterone
• weight loss to control the abnormal blood glucose and the diminished insulin senstiity.

Question 4

endometriosis
-28 yr old woman, never had kids, pelvic pain along with her menses. pain starts 1 week before menses and becomes worse till the flow stops which is when pubic pain stops.

been worse last couple months. menses no longer regular, and are heavier now.

discomfort in intercourse.

Answer 4

-endometriosis occurs when tissue from uterine endometrium spreads to the peritoneal caviity, often around the ovaries
-expereince pain bc the expression of inflamatory mediators go up.
-the tissue locates to around the ovaries, and it responds just like the tissue in the unterine endometrium, proliferates in response to estrogen, becomes secretory in response to progesterone in the luteal phase, and when hormone levels go down, necrosis occurs.
-you cant get rid of the tissue, so you get pelvic pains.
-shows necrosis which is how you would get inflammatory response and necrosis.
can cause intertility.
-some woman get preganant though and even though hormone levels increase, the endometriosis SUBSIDES!
-leading theory for cause of endometriosis is: retrograde menstruation
other possible causes: surgical scar implantation,endometrial cell transport thorugh blood and lymph, and embryonic cell growth or an immune system disorder
-treatment is: oral contraceptive therapy to regulate hormone balalnce and pevic pain, OTC pain relievers, or surgical removal f the endometrial tissues

Question 5

ectopic pregnancy-

left lower quadrant pain, abnormal vaginal blleding 1 hr duration

• pain radiates to lower back
• no nausea or volmiting, and has history of abnormal periods and pelvic inflammatory disease

last period 2 weeks ago

HCG present
no intrauterine pregnancy, but swollen left fallopian tube w/ a mass

Answer 5

• ectopic pregnancy characteristics: abnormal fetal development, nutrition, inadequate blood supply, and no placenta bc placenta cant deelop in fallopian tube. all have to do with the fact that uterus is primed for baby holding with glandular secretions and stuff, not the fallopian tube
• for regular ppl, if youre pregnant, in the first trimester, you double the hCG levels you produce every 2 days. ectopic pregancies dont double. the hCG levels will be hgier, but wont double b/c you dont have all the resources the uterus has
• the most dangerous fallopian tube ectopi pregnancy region is interstitial area which ruptures 12-16 weeks gestation.
• leads to massive hemmorgage bc lots of blood vessels there
• treatment for ectopic pregnancy is:
  1. single dose methotrexate if early in pregnancy to inhibit rapidly dividing cells
  2. methotrexate series
  3. laproscopy and salpingectomy- removal of fallopian tubes.