Female Reproductive System Flashcards
Period Cramps
Mood Swings
Ovulation
Mastagia
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
Benign Breast Masses
Reproductive Cycle Goals
Release and Egg- Ovulate
Prepare Uterus for fertilized egg
Follicular Phase
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
Luteal Phase
Day 15-28
Primary Dysmenorrhea
Caused by excessive or imbalanced amount of prostanoids. These are secreted from the endometrium during menstruation
Prastaglandins in the uterus
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!
Treatment for the elevated prostaglandins
NSAID’s do stop the prostaglandin cascade
Secondary Dysmenorrhea
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.
Dx of secondary menarche
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
Imaging used to dx secondary dymenorrhea
Transvaginal and pelvic ultrasound
Tx of dysmenorrhea
Biofeedback, acupuncture, herbal therapy, heat, NSAIDS, Vitamin E and Omega 3
Avoid smoking,imit soda and sugary foods and manage stress levels, physical activity
NSAIDS for dysmennorhea
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
Contraceptives for dysmenorrhea
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.
PMDD- Premenstrual dysphoric disorder
Due to the drop in Progesterone!1-2 weeks before the period starts
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
Progesterone
Converts to another hormone that Acts to decrease anxiety and depression.
Therefore, drop of this before period can cause the opposite in severe forms
PMS
Cervical Cancer
Early stages asymptomatic. Develops very slowly
Usually a result of HPV infection
Cervical Cancer S/Sx
foul odor
vaginal bleeding after intercourse or between periods
bleeding after menopause
pelvic pain
painful intercourse
Cervical Cancer screening
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
Cervical Cancer Risk Factors
Highest in high sexual risk patterns
smoking
