Female Reproduction Case Studies Flashcards
what is the immediate cause of menopause?
lack of estrogen production in the ovaries
how is menopause diagnosed? why does this occur?
diagnosed by rise in FSH
occurs because there is a release of negative feedback by estrogen on the pituitary
what is HRT therapy? what is it used for?
HRT therapy is a combination of estrogen and progesterone used to decrease the symptoms of menopause
why is HRT therapy controversial?
because it increases the risk for CVD, cerebrovascular disease and breast cancer
what therapy is replacing HRT therapy in menopausal women and what does it do?
selective estrogen receptor mediators (SERM)
mimic effects of estrogen on bone
what hormonal change brings about puberty?
pulsitile GnRH secretion beginning at night and eventually moving into the day as well
what happens if constant GnRH is given instead of pulsitile? what is this used to treat?
there is a decrease in receptors for GnRH in the anterior pituitary
used to treat precocious puberty
what three lifestyle factors can decrease GnRH secretion after puberty? (hypothalamic amenorrhea)
significant weight loss, exercise and stress
what is hypothalamic amenorrhea and how is it diagnosed?
it is a lack of menstrual and ovulatory cycles brought about by lack of hypothalamic secretion of GnRH.
test by giving the patient GnRH and then testing LH and FSH levels. `
what is the most common cause of infertility? what happens in the ovarian cycle in these patients?
polycystic ovarian syndrome
many follicles mature but none become dominant and no follicle emerges
what are some common clinical findings with polycystic ovarian syndrome?
irregular periods, abnormal body hair growth, persistent acne, infertility and overweight
upon ultrasound of the ovaries and uterus, what is found in patients with polycystic ovarian syndrome?
2-5 fold ovarian enlargement with thickened tunica albuginea. many follicles without one emerging as dominant. thinning of the endometrium
what hormonal abnormalities are found in women with polycystic ovarian syndrome?
elevated LH/FSH ratio, high testosterone, low estrogen and progesterone production and glucose intolerance due to insulin insensitivity
why are testosterone levels high in polycystic ovarian syndrome?
because there is continued production of androgen by theca cells but it is not being turned into estrogen or progesterone
what are the four treatments for polycystic ovarian syndrome?
birth control to restore period
clomiphene to restore ovulation
s alpha reductase to inhibit testosterone->DHT
weight loss to increase insulin sensitivity
what are some clinical presentations of endometriosis?
intense pelvic pain accompanying menses that has gotten progressively worse, irregular and heavy periods, and infertility in 1/2 of cases
what is the cause of endometriosis?
the spread of endometrial tissue into the peritoneal cavity
why is there so much pelvic pain associated with endometriosis?
because blood pools in the peritoneal cavity and is not easily absorbed causing pain
that is the accepted theory of the origin of endometriosis?
that it is caused by retrograde flow during menstruation seeding the peritoneal cavity with endometrial tissue
what three treatments exist for endometriosis?
oral contraception to regulate hormones, over the counter pain medication and surgical removal of ectopic endometrial tissue
what are the clinical findings associated with ectopic pregnancy?
severe left lower quadrant pain, abnormal vaginal bleeding, history of PID, missed period
what are the treatments for ectopic pregnancy?
methotrexate to inhibit rapid production of cells (single or multi dose)
laproscopy and salpingectomy (removal of fallopian tube
how do the levels of hCG in ectopic pregnancy compare to regular pregnancy? non pregnancy?
less than regular pregnancy but still more than a non pregnant woman
what is culdocentesis?
withdrawal of fluid from the retrouterine pouch to test for blood
where is the most dangerous area for ectopic pregnancy? why?
the interstitial area of the fallopian tube
because it is close to larger arteries that would be effected by a rupture
what determines how long after fertilization the fallopian tube ruptures in ectopic pregnancy?
the size of the lumen at the point of implantation
