Lecture 4 Flashcards
what is the main source of relaxin and what does it do
main source is corpus luteum
-prepares body for preg and labour
When does relaxin levels peak in preg
increased up to week 12 (then stays consistent)
Risk associated w decreased relaxant
lower levels early in preg have greater risk of miscarriage, gestational hypertension, preclampsia
What is relaxins role in abnormal uterine bleeding
possible that relaxin could contribute to abnormal uterine bleeding
How is relaxin related to uterine fibroids
Research suggests that uterine fibroids may be sites of relaxin storgage/ activity
What conditions can relaxin be linlked to
endometriosis
gynelogical cancers (role in progression and metastasis)
ACL laxity and relaxin; when does it occur in cycle
There is evidence that their is increased laxity mainly in pre ovulatory phase (4-6x increase of injury)
What is the criteria for mentrual migraine with or without aura
migraine w/wo along with
–Mighraine occurring in perimentrual period (on day -2 to +3 of mentruation in at least 2/3 mentrual cycles)
Mentrual migraine two types and descriptions
- mentrual related migraine- attacks in the mentrual period but can also occur during the cycle
Pure mentrual migraine- attacks confined to perimentrual period only
etiology of mentstrual migraines
associated with estrogen withdrawl
what is the mc of anovulatory infertility
Polycystic ovarian syndrome
What is polycystic ovarian syndrome characterized by
Hyperandrogenism
Ovulatory dysfunction
Polycystic ovarian morphological features
What is features of hyperandrogegism in PCOS
Acne
Excess hair groth on face/body (mc)
Thinning scalp hair
Ancanthosis nigricans
What is ovulatory dysfunction in PCOS
mc fx of PCOS
-Menstrual cycles longer than 35days
Irregular or no menstrual periods
-mc cause of anovulatory infertility
Polycystic ovarian morphological features
-accumulation of enraptured follicles on the periphery of the ovaries (mislabeled cysts)
What is the major change in the cycle in relation to hormones in those with PCOS
In women with PCOS the follicles don’t ovulate such that the surge of progesterone occurs
Imaging modality for PCOS and what will you see
US
-string of pearls sign suggests PCOS morphological features
What are some associated risks with PCOS
- cardiometabolic abnormalities
- high prev of hyperlipidemia
- hypertension
- myocardial infarction
- CVD
- type 2 diabtetes
Increased cancer risks of PCOS
- Endometrial cancer (2.7x higher)
- Uterine cancer
- Breast cancer
- Ovarian cancer
what is a major syndrome associated with 33% of women with PCOS
metabolic syndrome
3 main criteria for PCOS dx
- hyperandrogegism
- Ovulatory dysfunction (menes <21 days or >35)
- Polycystic ovarian morphological fx
What are the 2 pharm tx for PCOS
- Birth control= surpasses GnRH and ovarian androgen prod
- decrease risk of endometrial cancer
- possivble increase in CVD tho - Metformin- decreases hyperinsulemia and lowers serum test
- helps slow abnormal hair
- may help ovulation continue
What is the conservative tx to PCOS
Weight loss via low glycemic diet
-5-10% can reduce cardiometabolic risk factors
increase exercise (>1hr day)
What is endometriosis- age, %
Painful disorder that generates just before or during mentruation (often confused w primary dysmenorrhea)
- 6-10% of reproductive women
- most between 25-35
pathology of endrometriosis
increased systemic and local pro inflammatory cytokines and growth factor
-leads to peripheral sensitization characterized by hyperalgesic state, central sensitization and myofascial pain
Most common clinical pres of endometriosis
- Adnexal masses
- infertility
- dysmenorrhea
- backpain
- painfull intercourse
- pain during bowel mvmt
Things that put you at increased risk of endrometriosis
- menarche (early, short, heavy)
- Nulluparity
- low BMI
- alchol
- family
4 theories of endometriosis
- Retrograde flow (endometrial tissue is deposited in unusual loc such as fallopian times etc)
- Embryonic seeding (areas lining the pelvic organ processes primitive cells that are able to grow and differentiate into endometrial cells outside lining)
- Lymphatic spread (direct transfer of endometrial tissue during surgery)
- Altered immune response
pharm tx of endometriosis
pain meds (NSAIDS)
- hormone therapy
- GNRH antagonist
- Surgery (gold standard)