Female Reproductive System

Question 1

Period Cramps

Question 2

Mood Swings

Question 3

Ovulation

Question 4

Mastagia

Answer 4

Breast Pain can be cyclic and noncyclic

Cyclic: 2 weeks prior to menses. Relieved once menses start. Usually due to changes in hormones

NonCyclic: can be caused by other issues. Identify the cause and treat accordingly.

Detail hx
Imaging- mammo or US

Question 5

Benign Breast Masses

Question 6

Reproductive Cycle Goals

Answer 6

Release and Egg- Ovulate
Prepare Uterus for fertilized egg

Question 7

Follicular Phase

Answer 7

Day 1-14
starts with the period. Prostaglandins are released when pregnancy does not occur. Cramping in uterus is caused by shedding of the endometrium due to ischemia

Question 8

Luteal Phase

Answer 8

Day 15-28

Question 9

Primary Dysmenorrhea

Answer 9

Caused by excessive or imbalanced amount of prostanoids. These are secreted from the endometrium during menstruation

Question 10

Prastaglandins in the uterus

Answer 10

Act on the muscle to contract and increase the tone. Contractions are believed to cause hypoxia and ischemia of the muscle. Which results in pain

They also stimulate nociceptors in the body which causes increased pain signaling!

Question 11

Treatment for the elevated prostaglandins

Answer 11

NSAID’s do stop the prostaglandin cascade

Question 12

Secondary Dysmenorrhea

Answer 12

Painful periods that are caused by underlying pathology
Example: Endometriosis, adenomyosis, nonhormonal IUD, fibroids, scarring from abdominal surgery or infection

Usually is 2+ years after menarche.

Question 13

Dx of secondary menarche

Answer 13

history, physical examination, pelvic imaging

Painful periods that do not improve with typical treatments and is accompanied with other symptoms, such as dypareunia, heavy menses, postcoital bleeding should raise suspicion for secondary causes

Question 14

Imaging used to dx secondary dymenorrhea

Answer 14

Transvaginal and pelvic ultrasound

Question 15

Tx of dysmenorrhea

Answer 15

Biofeedback, acupuncture, herbal therapy, heat, NSAIDS, Vitamin E and Omega 3

Avoid smoking,imit soda and sugary foods and manage stress levels, physical activity

Question 16

NSAIDS for dysmennorhea

Answer 16

They inhibit cyclooxygenase enzymes, which stop the production of prostaglandins.

Aspirin is less effective than others. Use ibuprofen.

May use acetaminophen, but not as impactful.

Try NSAIDS and then re-access in 2-3 months. Usually only needed for 2-3 days during the period

Question 17

Contraceptives for dysmenorrhea

Answer 17

Suppress ovulation and endometrial growth, this causes decreased prostaglandin production and menses volume.

Can be used for both primary and secondary dysmenorrhea.

May use COC for relief of pain even before the causative pathology is found. However, long term it may exacerbate endometriosis, meaning a change in tx after further diagnostic testing may be needed if endometriosis is found.

Question 18

PMDD- Premenstrual dysphoric disorder

Due to the drop in Progesterone!1-2 weeks before the period starts

Answer 18

severe form of PMS. 5/11 symptoms before period starts and then minimalize when period starts

Symptoms:
Emotional lability
irritability
depressed mood
hopelessness
anxiety
tension
Decreased interest in usual activity
Trouble concentrating
appetite changes
hypersomnia
insomnia
overwhelmed
physical symptoms- pains, bloating

Can be treated with an SSRI!. Intermittent dosing 7 days before the period starts and then can stop when period start

Question 19

Progesterone

Answer 19

Converts to another hormone that Acts to decrease anxiety and depression.

Therefore, drop of this before period can cause the opposite in severe forms

Question 20

PMS

Question 21

Cervical Cancer

Answer 21

Early stages asymptomatic. Develops very slowly

Usually a result of HPV infection

Question 22

Cervical Cancer S/Sx

Answer 22

foul odor
vaginal bleeding after intercourse or between periods
bleeding after menopause
pelvic pain
painful intercourse

Question 23

Cervical Cancer screening

Answer 23

Immune system will fight off most HPV infections on its own!

Pap test Every 3 years between 21-65 years of age

No testing needed before age 21

Question 24

Cervical Cancer Risk Factors

Answer 24

Highest in high sexual risk patterns
smoking

Question 25

HPV vaccine

Answer 25

Protective for cervical CA
Given from 9-26 years old

Question 26

S/sx of Cervical CA

Answer 26

Abnormal vaginal bleeding
dysuria
pain with intercourse

Question 27

Uterine Fibroid

Question 28

Uterine Fibroid

Answer 28

Benign muscle growths of uterus