Female Reproductive Health Flashcards
Benign Breast Disease etiology/patho
common in teens & 20s fibrocystic disease fibroadenoma intraductal papilloma abscess
proliferative
increased cell production = increased risk of cancer
benign breast disease s/s
pain
palpable mass
nipple discharge
benign breast disease DX
palpation
ultrasound
mammogram
biopsy
benign breast disease TX
often not needed
self-breast exam
education
mastitis
erythema/inflammation of breast
most common in breast feeding
mastitis trigger
nipple irritation tissue trauma chafing from ineffective infant latch nipple fissures yeast infections fatigue stress poor nutrition plugged milk ducts
mastitis s/s
usually 4-6 wks post birth local tenderness swelling warmth erythema pain while breastfeeding systemic: flue-like symptoms, loss of appetite
mastitis TX
lactation consult (improve BF technique) analgesics antipyretics cold compresses rest healthy diet lancing (culture if needed)
galactorrhea
discharge of milk (or milk-like substance) from breast in absence of pregnancy (or more than 6 mon postpartum in those that did not BF)
galactorrhea causes
medications (oral contraceptives, psych meds, codeine, morphine)
pituitary tumors (most common)
thyroid disorders (increased TRH in hypothryoidism)
chronic renal failure (increased prolactin from impaired kidney fx)
neurogenica cause, injury etc
galactorrhea s/s
systemic: headache weight changes appetite changes history of thyroid or endocrine disorders visual changes
galactorrhea DX
prolactin >5x normal
increased T4/TSH
galactorrhea TX
dopamin agonist
breast cancer RF
age gender family hx of 1st degree relative <50 y/o BRCA1 or 2 mutation menarche <12 menopause <55 proliferative benign breast disease high-fat diet HRT
breast cancer classification
estrogen receptors
progesterone receptors
human epidural growth factor receptor 2
BRCA1/2
breast cancer s/s
may be asym dimpling inverted nipple thickening of skin blood-tinged discharge
benign ovarian cysts types
follicular: form when ovum fails to be released during follicular phase
corpus luteal: form in absence of pregnancy, corpus luteum does not dissolve
lutein: form from excessive hCG from multiple gestations or ovarian hyperstiumulation
benign ovarian cyst s/s
pelvic/ab pain painful intercourse abnormal menses ab pressure polyuria urgency ab distension fullness w/out eating
benign ovarian cysts DX and TX
ultrasound/lab
oral contraceptives or laparoscopic removal/drainage for larger cysts
polycystic ovary syndrome PCOS
abnormal function of hypothalamic-pituitary-ovarian axis or elevated hormones/androgens causes excessive cysts
PCOS s/s
menstrual dysfunction anovulation (infertility) hyperandrogenism (hirsutism & acne) irregular menses obesity metabolic syndrome diabetes insulin resistance
PCOS DX and TX
endocrine testing
oral contraceptives (hyperandrogenism)
clomiphene (infertility)
meformin (insulin resistance)
ectopic pregnancy
any gestation that occurs outside endometrial lining (usually in fallopian tube)
ectopic pregnancy RF
damage to fallopian tubes previous ectopic preg smoking infertility meds mulitple sex partners advanced maternal age history of STD
ectopic pregnancy s/s
triad: ab pain, amenorrhea, vaginal bleeding dizziness weakness fever vomiting syncope
ectopic pregnancy DX and TX
serum hCG and ultrasound
methotrexate (based on gestational age)
surgery (to prevent rupture)
ovarian cancer
unknown cause
most common cause of GYN cancer death
linked to genetics (BRCA) high-fat diet and talc powerders
ovarian cancer s/s
silent ab bloating pelvic/ab pain frequency painful intercourse back pain constipation weight loss fullness w/out eating
ovarian cancer DX
no good screening test exists
CA125 & surgical staging of disease
ovarian TX
aggressive debulking surgery
chemo
poor prognosis due to typically advanced disease
abnormal uterine bleeding prepuberty
precocious puberty (hypothalamic, pituitary or ovarian in origin)
adolescene ab uterine bleeding
anovulatory cycle
ab uterine bleeding reproductive age
comp of pregnancy
or porliferations
ab uterine bleeding perimenopause
anovulatory cycle
irregular shedding
proliferations
postmenopausal ab uterine bleeding
proliferations
endometrial atrophy
dysfuncitonal uterine bleeding
hemorrhaging that occurs on noncyclic basis or in abnormal amounts
frequently reported by women (common reason for a hysterectomy)
variety of causes (often an imbalance between estrogen and progesterone)
estrogen causes
proliferation of endometrium
progesterone
limits and stabilizes endometrial growth
dysfunctional uterine bleeding TX
drugs for uterine bleeding
conjugated estrogens w/ medroxyprogesterone
NSAIDS sometimes adjunct therapy
dysfuncitonal uterine bleeding s/s (6 cat)
menorrhagia intermenstrual bleeding metrorrhagia menometrorrhagia polymenorrhagia dysmenorrhea
dysfunctional uterine bleeding DX adn TX
CBC, hCG, testosterone, TSH, ultrasound
NSAIDs, hormone therapy
severe: ablation/hysterectomy
amenorrhea
abscence of spontaneous menstruation in women of reproductive age
absence by age 15 (primary)
cessation of regular menstruation for at least 3 months not preg/lactation/hormone meds/menopause (secondary)
amenorrhea s/s
no periods
amenorrhea DX and TX
pregnancy test, progesterone, LH, FSH
depends on causative factors
psychological treatment (if cause is ex: anorexia, bulimia)
dysmenorrhea
primary (painful menstrual cycle in absence of pelvic disease)
secondary: result of underlying idsease (PID, endometriosis)
pain increased to prostaglandin levels
dysmenorrhea s/s
primary: occurs w/in 6 mo of menarche
secondary: usually in 20/30s
high intensity cramping w/ menses
heavy, irregular flow
painful intercourse
vaginal discharge
poor response to analgesics
dysmenorrhea DX and TX
suspect PID: lab to rule out infection/preg
NSAIDS, oral contraceptives, lifestyle management
premenstrual syndrome
unknown causes
deficiency/ imbalance of hormones, MG, CA, serotonin etc
PMS s/s
emotional: mood swings, irritability, withdrawal, poor concentration, insomnia, depression, changes in sexual desire
physical: increased thirst, cravings, breast tenderness, bloating, weight gain, HA, fatigue, swelling of hands/feet, skin/GI problems, ab pain
premenstrual syndrome TX
diet: add complex CHO/calcium rich foods, avoid sugar, caffeine/alcohol
SSRIs may improve mood
NSAIDs for pain
endometrial polyps
exact cause unknown
hyperplastic growth of endometrial glands & stoma
may be d/t imbalance of estrogen & progesterone
endometrial polyps s/s
abnormal heavy bleeding ab pain post-menopausal bleeding infertility miscarriage
endometrial polyps DX and TX
ultrasound, hysteroscopy, biopsy
typically no TX
if symptomatic (bleeding) = surgical removal
adenomyosis
exact etiology unknown
invasion of glandular endometrial tissue into myometrium
r/t invasive procedures (c-section)
adenomyosis s/s
menorrhagia pelvic pain intercourse pain dysmenorrhea 30-50s obese mulitple children early menses hx of uterine surgery
adenomyosis DX & TX
MRI
oral contraceptives
mirena IUD
(goal is to control diameter)
leiomyomas (fibroids)
exact etiology unknown
estrogen/progesterone promote growth
most common in reproductive years (regress in menopause tho can cause bleeding)
leiomyomas (fibroids) s/s
pelvic “fullness”
bloating
intercourse discomfort
infertility
leiomyomas (fibroids) Dx & TX
exam/ultrasound
only TX if symptomatic: surgery
endometriosis
unkonwn cause
endometrial cells move from uterus and implant outside of uterous
increased incidence w/ 1st degree relative
endometriosis s/s
pelvic pain before/during menstruation
painful intercourse
infertility
bleeding between menses
endometriosis DX and TX
NSAIDs leuprolid acetate (suppresses ovarian function) surgical removal (reduces overgrowth of tissue)
endometrial cancer
most common GYN cancer
starts as endometrial hyperplasia
type 1: estrogen
type 2: non-hormonal (genetics/leiomyomas)
RF: obesity, DM, high-fat diet, increased exogenous estrogen, early menarche, hx anovulation, infertility, nulliparity
if stage 1: excellent survival rate
endometrial cancer s/s
vaginal bleeding (post-menopausal bleeding)
pelvic pain
pelvic fullness
unintentional weight loss
endometrial cancer DX & TX
biopsy
surgical removal, chemo,radiation
pelvic organ prolapse
pelvic floor muscles become weak (age) or injured (childbirth) = organs drop
RF: decreased estrogen, menopause, pelvic tumors, obesity, COPD, chronic constipation, marfans
pelvic organ prolapse s/s
sensation of fullness vaginal spotting painful intercourse palpable bulge frequency urgency incontinence cystocele rectocele enterocele uterine prolapse
pelvic organ prolapse DX & TX
post-void residual
pessaries (support): vagina/uterus/bladder/rectum
exercises (kegel): PT
surgery
exocervix
stratified squamous epithelium
endocervix
columnar epithelium
transformation zone
transforms columnar epithelium to squamous epithelium (more likely to become cancerous)
cervicitis
inflammatory conditions associated w/ purulent drainage
infections vs noninfectious
related to STDS
cervical cancer
3rd most common cancer in woemn
HPV cause
RF: age of first intercourse, multiple sex partners, hx of STD
cervical cancer s/s
abnormal vaginal bleeding
malodorous discharge
dysuria
lower ab pain
cervical cancer DX & TX
papsmear, colposcopy, biopsy
surgery radiation chemo
vaginitis
inflammation of vagina due to change in normal flora
decreased estrogen after menopause
vaginitis s/s and DX
itching, discharge, malodorous discharge, pain
exam, microscopic ID
vaginitis TX
ABX
personal hygiene education
perfume/dye free soaps
if atrophic: moisturizing products
vulvovestibulitis
pain in vestibule (surrounds vaginal opening)
vulvovestibulitis s/s & DX
pain
redness
burning in vestibule
DX: severe pain w/ pelvic exam
vulvovestibulitis TX
topical A & D ointment
witch hazel
lidocaine gel
surgery (last resort)
bartholinitis
inflammation of bartholin gland (lubrication & mucus secretion)
buildup of fluid causes cyst & discomfort
batholinitis s/s and DX
unilateral mass w/ or w/out pain
physical exam
bartholinitis TX
excision & drainage
ABX
analgesics
recurrent/extreme: excision of gland
vaginal cancer
very rare
most often >60 w/ HX of HPV
if squamous: slow spread
adenocarcinoma: likely to mets
vaginal cancer s/s
abnormal bleeding dysuria painful intercourse vaginal lump pain/swelling in legs
vaginal cancer DX & TX
pap smear, colposcopy, biopsy
surgery radiation chemo
vulvar cancer
vulvar intraepithelial neoplasia (VIN) r/t HPV
chronic irritation
history of lichen sclerosis
not common <70
vulvar cancer s/s
lump or sore causing itching (repeated injury)
vulvar cancer DX & TX
biopsy, imaging
surgery, chemo, radiation
causes of infertility
cervix (stenosis or pH imbalance) uterus (congenital or acquired defects) ovaries (failure to ovulate most common) fallopian tubes (abnormalities or drainage) peritoneum (defects, infection, adhesion, masses)
infertility DX
failure to conceive after 1 year of unprotected intercourse
infertility TX
reproductive endocrinology interventions
medications
clomiphene
selective estrogen receptor modulator
ovulation stimulator
stims relase of LH = increased ovarian follicles acts @ hypothalamus
SE: ovarian enlargement, vasomotor flushes, distention, breath discomfort, multiple births
contra: primary ovarian failure, leiomyomas, ab uterine bleeding, thrombophlebitis, liver disease, intracranial lesions
interx: ospemifene (toxic)
X
vaginismus
unknown cuases vaginal tightness causing discomfort burning pain penetrationi problems inability to have intercourse pain with intercourse
vaginismus TX
pelvic floor exercises
psychotherapy if needed
Orgasmic dysfunction
never orgasm, difficulty reaching orgasm, decreased intensity orgasm
primary: never achieved (genetic or trauma)
secondary: hypoactive sexual desire disorder
TX: psychotherapy
dyspareunia
painful intercourse, no specific cause
TX: sex education/position changes, lube, psychotherapy (if needed)
menopause (climacteric)
natural process of aging, permanent cessation of menses
progressive decrease in estrogen secretion by ovaries
s/s: hot flashes, night sweats, irregular menses, bone mass loss
consequences of estrogen loss early, mid, post
E: mood disturbances, depression, irritability, insomnia, hot flashes, irregular menses, HA
M: vaginal atrophy, increased infections, painful intercourse, skin atrophy, stress urinary incontinence, sexual disinterest
P: atherosclerosis, CV disease, osteoporosis, alzheimer’s like dementia, colon cancer
hormone replacement therapy
TX unpleasant symptoms of menopause
prevents long-term consequences of estrogen loss
estrogren-progestin combo risks: MI, stroke, breast cancer, dementia, venous thromboembolism BUT less risk of hip fracture/colorectal cancer
estrogen alone: increased risk of stroke/thromboembolism alone
