Metodi contraccettivi Flashcards

Question 1

Q

what is contaception?

Answer

A

methods or devices used to prevent pregnancy

Contraception means clustering prevention of conception or the impediment of fertilization between 
egg and sperm (in fact, if this occurred, it is called abortion methods)

Question 2

Q

Characteristics of the ideal contraceptive method

Answer

A

<ul>
<li>Effectiveness: itself with the Pearl Index (IP): number of pregnancy occurred in 100 women in 12 months x 1200 (12 months x 100 women): number of months of use of the method. Place in certain period of use, the Pearl index will proportionally vary the number of unwanted pregnancies: Therefore, it will be inversely proportional the effectiveness of the method</li>
<li>Reversibility: we must, in fact, differentiate: 
-Reversible contraceptive methods 
-Methods irreversible - sterilization: Male ( Vasectomy and other methods of occlusion of the vas deferens) ; Female: tubal resection</li>
<li>harmlessness</li>
<li>agreeable, pleasant</li>
<li>low cost</li>
</ul>

Question 3

Q

Factors Involved in the choice of contraceptive method

Answer

A

<ul>
<li>Age</li>
<li>frequency of reports (manyčiau lytinių santykių dažnis)</li>
<li>cycle regulation</li>
<li>Desire of pregnancy</li>
<li>Any concomitant (susijusios) diseases</li>
<li>costs</li>
<li>socio-psychological aspect</li>
</ul>

Question 4

Q

Methods of contraception

Answer

A

<ul>
<li>Natural: are the most common, but are also Those with the highest failure rate. Are based abstention from intercourse During the fertile period of women</li>
<li>Artificial:</li>
</ul>

<ol>
<li>Barrier: you put a barrier between sperm and oocyte</li>
<li>Hormonal: block ovulation: oral contraceptives</li>
<li>Intrauterine device (IUD)</li>
</ol>

Question 5

Q

Natural methods of contraception (5)

Answer

A

<ul>
<li>Interrupted sexual intercourse(coitus): Widely used, is the interruption of relationship before ejaculation.Not very effective (IP: 7-15) and unwelcome. Furthermore, it is possible to issue nemaspermi before ejaculation or persistence of the same in the urethra with additional risk in the event of repeated coitus</li>
<li>Ogino-Knaus is an empirical method That Identifies the time of ovulation according to Functional the menstrual rhythm, staring around the 14th day and Prohibiting full sex in 4-5d. before and after ovulation. The IP is very high (15-45), making it a methodical unsatisfactory and outdated</li>
<li>Method Billings or cervical mucus: is based on the characteristics That the cervical mucus to assume touch in the ovulatory period. For action of estrogen: the mucus increases and becomes piu filante(aromatingos-racy), transparent and elastic ("to egg white") -->feeling wet, slippery,lubricated until the day of ovulation peak. Then progesterone: mucus-->drier and rare until the next period->making it impossible to migrate and sperm penetration. Sexual relations are allowed for the whole period "dry" from the end of menstruation until appearance of mucus and, then, by the fourth day after the death of the mucus up to next menstruation</li>
<li> Basal temperature method: 2 days before and after temperature's increase (an index of ovulation)</li>
<li>Method person: a small computer, evaluating the levels of LH, Allows you to determinates what is time of ovulation (when LH rises may not occur relationships). The sticks are made with urine (green light to high levels of LH)</li>
</ul>

Question 6

Q

Limits of natural methods

Answer

A

<ul>
<li>15% of women have irregolar menstrual cycle•</li>
<li>Technical errors: for example in the temperature measurement</li>
<li>Interference of other causes, for example, Increase the temperature</li>
<li>Presence of ovulations supernumerary (per daug) 
 </li>
</ul>

Question 7

Q

What barrier methods do you know?

Answer

A

<ul>
<li>condoms</li>
<li>diaphragm</li>
<li>substances spermicide</li>
<li>intrauterine devices (IUDs)</li>
</ul>

Question 8

Q

What is condoms? How do they work?

Answer

A

Condom (condoms) is a cylindrical sheath(apvalkalas) of thin rubber(guma) or latex, Which AIMS(siekia) not only to prevent pregnancy, but also diprevenire the transmission of sexual diseases. Has an IP 3-10

Question 9

Q

What is diaphragm?

Answer

A

is a rubber device, of different types (including the most common is to "dome"(kupolas) withConsisting of base metal ring), tailor-made, filled with spermicidal cream and added tovagina 2-3 hours before intercourse, in order to perfectly cover the cervix and the upperportionof the vagina (the diameter must Correspond to the distance between the posterior vaginal fornix and angleretropubic So THAT it can cover the arches).It must be kept in situ for 7-8 hours 
So THAT Subsequent sperm Has time to act.The IP, However, is quite high (20): thepercentages of positioning errors and extraction, in fact, are quite high

Diaphragms prevent pregnancy by keeping sperm from joining with an egg. In order to be as effective as possible, the diaphragm must be used withspermicidecream, gel,or jelly.

Diaphragms work in two ways:

The diaphragm blocks the opening to theuterus. 
The spermicide stops sperm from moving.

Question 10

Q

How are spermicide substances constituted?

Answer

A

Substances spermicide: Their use alone is not recommended, are constituted by:

<ul>
<li>Electrolytes</li>
<li>Enzyme inhibitors</li>
<li>acids</li>
<li>Surfactants</li>
</ul>

Question 11

Q

what is intrauterine devices (IUDs)?

Answer

A

Intrauterine devices (IUDs) are devices of various shapes with a plastic supportinert, Which is wound on a copperwire-viela (copper spirals-vario spirales) or connected to a tank containingProgesterone 
<img></img>

IP: good, 0.4-2

Question 12

Q

Types of IUD's

Answer

A

<ul>
<li>Spiral copper: copper ions release for 3-5 years, with effects on: </li>
</ul>

<ol>
<li>Sperm: block motility and direct toxic action</li>
<li>endometrial mucosa: chronic inflammation: this makes it unsuitable plant</li>
</ol>

<ul>
<li>Spiral progesterone: releases progesterone for 3-5 years, with effects on:</li>
</ul>

<ol>
<li>Cervical mucus: Becomes dense and difficult to penetrate by sperm</li>
<li>Endometrium: Becomes unsuitable Nesting (lizdas)</li>
</ol>

Question 13

Q

IUDs insertion technique

Answer

A

Insertion technique is usually you inserted During the menstrual cycle, is to be That is a sure that woman is not pregnent, to create less discomfort to the patient, in a 
period in cui the cervical canal is physiologically patulous?

Question 14

Q

IUDs contraindications

Answer

A

Uterine inflammation

Uterine malformations 
Polyps, fibroids or uterine tumors 
Menometrorragia 
Hypersensitivity to copper and Wilson's disease 
Treatment with Anticoagulants 
Hematologic

Question 15

Q

side effects of IUDs

Answer

A

Slight 
• Spotting (kas tas?), mild metrorrhagia, menorrhagia 
• pelvic Algie 
Serious 
• Unwanted pregnancy 
--> for inadvertent ejection device 
--> to ectopic implantation 
• Infertility 
• Serious infections (pelvic inflammatory disease by Actynomices)

Question 16

Q

what is hormonal contraceptive methods? How consists? How administer?

Answer

A

Hormonal contraceptives consist of female sex steroids, estrogen and progestin in association, or progestin alone, administered orally, parenterally, or transvaginal intrauterine, subcutaneous (plants) or transdermal (patch). The preparations are used monophasic oral estroprogestiniche combinations (where hormonal dosage is the same for all days of employment) or multiphasic (two- or three-phase, containing varying doses of Progestogens). The IP is very low (0:07), as well as the risk of complications

Question 17

Q

Components of the contraceptive pill?

Answer

A

<ul>
<li>Estrogen: etilenestradiolo (alternatively, estradiol valerate)</li>
<li>progestins: Progesterone as longer available can not be used for rapid hepatic catabolism and, consequently, its derivatives are used, since:</li>
</ul>

<ol>
<li>19-nortestosterone: levongestrel, gestodene</li>
<li>17-hydroxyprogesterone </li>
<li>Spironolactone: drospirone: is a synthetic progestin, can counteract the estrogen-induced stimulation on renin angiotensin-aldosterone</li>
</ol>

Question 18

Q

Mechanism of horm0nal pill action?

Answer

A

<ul>
<li>block ovulation: Effected is a block away synergistic (estrogen-progestagen) of 
gonadotrophic secretion of hypothalamic and pituitary, with inhibition of the LH surge and 
tonic secretion of FSH and LH</li>
<li>modification of tubal motility and secretion</li>
<li>abnormalities of the cervical mucus: progesterone makes rare, viscous and hypercellular. The content of proteins, enzymes and electrolytes it is changed, Resulting in inhibition penetration of the sperm and a bacterial protection</li>
<li>non-physiological endometrial Impregnation: is manifested by a reduction of the normal 
endometrial proliferation (fail to come true cyclical changes endometrial) and an early and accelerated secretory activity, Followed by modifications 
-like decidual stroma with regressive glandular (endometio "secretory irregular " 
 </li>
</ul>

Question 19

Q

Other benefits of horm pill?

Answer

A

<ul>
<li> improvement of the menstrual cycle, with reduction of bleeding and dysmenorrhea menstrual</li>
<li>Reduced risk of ectopic pregnancy</li>
<li>reduction in the risk of ovarian cancer, endometrial cancer and cancer colorectal</li>
<li>Prevention of youth osteoporosis</li>
<li>prevention of sexual infections</li>
<li>positive changes in the lipid (HDL Increase and decrease LDL)</li>
</ul>

Question 20

Q

Side effects of Horm pill?

Answer

A

<ul>
<li>Minor</li>
</ul>

Spotting (especially in the first period) 
Breast tenderness 
Nausea 
Mood disorders (nervousness, depression) and psychotic 
Water retention with weight gain 
Skin discoloration (attention to the sun!) 
Decreased libido

<ul>
<li>Major:</li>
</ul>

Migraine 
Visual disorders 
Metrorrhagias 
Cardiovascular: thromboembolism, thrombophlebitis 
Cervical cancer: it was, in fact, Demonstrated an association between cancer 
squamous and adenocarcinoma and use of Progestogen

Benign tumors of liver (hepatocellular adenoma)

Question 21

Q

New (piu recente) naujausi Horm contraceptikai?

Answer

A

<ul>
<li>Evra is a patch That puts Progestogens</li>
<li>Nuvaring is an intravaginal ring ricopero of Progestogens with wide release vaginal. The advantage is That Are avoided metabolism in the liver and the possible side effects (by Increasing the concentration to decreased At catabolism): this is Particularly important in patients with liver disease. Also, Ensure lower doses than oral. Are positioned after the menstrual phase and are maintained in place for 21 days</li>
</ul>

Question 22

Q

Emergency contraception

Answer

A

<ul>
<li> "mini-pill" contains only progestin and is Especially useful in lactating women. 
In fact, theoretically being lactation prolactin and oxytocin Should prevent 
ovulation, but this does not always occur</li>
<li>postcoital levonorgestrel (Within 72 hours) 
 </li>
</ul>

Question 23

Q

What is RU486?

Answer

A

RU486 is based mifepristone and Allows chemical abortion in the first two months of pregnancy 
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
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Page 101

101 
  
Chap. 15: Sexually Transmitted Diseases (STDs) 
  
Par. I: General 
Introduction 
STDs are a group of emerging infectious diseases, not only in developing countries, but 
even in Industrialized ones, including Italy. Include in heterogeneous group of clinical, 
Caused by over 25 different etiologic agents of bacterial, viral, and parasitic protozoan, Whose 
Transmission may occur by vaginal, oral or anal (Therefore, for Both heterosexual and homosexual relationships) 
Affecting and the reproductive system. 
According to data provided by the WHO, about 400 million people including the band età15-45 years 
sick of STDs each year. 
Compared to the last century, a when predominated syphilis and gonorrhea, today the most common STDs in Italy are 
diseases Chlamydia, mycoplasma, herpes and HPV; However, the trend could change further Top 
Both for the change of sexual habits (sexual promiscuity, drug addiction), and for 
the import of other pathogens from tropical regions (immigration, but anche sex tourism). 
Moreover, patients suffering from MST, presenting solutions continuously at the level of the genital mucosa, not 
blackberries are only exposed to HIV infection, but also, if HIV 
\+ 
, Sources of infection of the virus, creating a 
"Epidemiological synergy". Furthermore, the immunosuppression by HIV can determinates a state of 
That immunosuppression predisposes to other infections, including genital. 
Other general features That are important: 
• In two thirds of cases are to get sick people under the age of 25 years 
• Once you hit the external genitalia, can climb upwards, Affecting the internal genitalia 
• Even antibiotics not targeted and not Necessary Contributed have not only to the emergence 
new infecting organisms, but the Increase in the incidence of the same MST 
  
In Additions, You Should Consider: 
• Risk factors 
or conditions predisposing biological 
Age: a young age, Increasing the number of sexual partners and, 
Increases the risk 
Females: for the Particular vaginal habitat, but anche For Reasons 
anatomical (shorter length of the urethra) 
or behavioral conditions predisposing 
Drug addiction and alcoholism: especially for the distortion of the defenses 
immune 
High number of sexual partners (ie, occasional reports) 
Unprotected sex 
Coinfection or previous infection with HIV 
Previous history of STDs 
Low socio-cultural 
• Mode of infection 
or Transversal: hetero- or homosexual relationships 
or Vertical: mother to child 
In utero 
At delivery 
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Page 102

102 
  
• General characteristics of diagnosis 
or TORCH: INFORMS about the presence of Toxoplasma, CMV and HSV 
or serological tests for syphilis: VDRL, TPHA 
or Search for HIV 
or analysis of markers of hepatitis 
  
Clinical and diagnostic 
• Symptoms 
or the woman 
Vaginal discharge (leukorrhea): can be of different color and odor (Often 
However smelly). For example, in the case of Candida infections, the loss is 
"Cottage cheese" for the formation of a series of granulations; in other cases, However, 
Recognize air bubbles 
Burning pain and vaginal 
Genital ulcers 
Abdominal pain conspicuous 
or humans 
Pain and burning 
Losses urethral 
Genital ulcers 
• Diagnosis 
or serological tests 
or search of the microorganism in the secretions: for example, Trichomonas is well visible in 
cool while you search with Candida vaginal swabs / urethral 
or viral DNA Research 
  
  
Par. II: Microorganisms responsible for MST 
Bacteria 
• Neisseria gonorrhoeae: is the most common STDs, Particularly common in poor countries, for 
unhygienic conditions and socio-economic 
or Etiopathogenesis: the adhesion of bacterial cells to the mucosal surfaces, decisive for the 
development of the disease, OCCURS at the level of the cylindrical epithelia, predisposing to infection 
ascending (PID: pelvic inflammatory desease). It is Transmitted by vaginal, anal, oral or 
ocular (especially for poor hygiene in the latter case) 
or Clinic 
In women 
• Cervicitis with losses (whites) greenish-yellow (Which may suggest 
the Trichomonas) 
• endometritis 
• Irritations vulvar 
In humans 
• Urethritis 
• disorders of urination (also from prostatitis) 
In Both Sexes 
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• Anorettite 
• pharyngitis 
In the newborn from infected mother: conjunctivitis 
or complications 
Lifts 
• In men: urethritis That You back from the front, and then prostatitis 
epididymitis 
• In women: endocerviciti or endometritis dating back to give salpingitis 
and PID 
Systemic: hematogenous dissemination (endocarditis, meningitis, etc.) 
• Chkamydia trachomatis: CT infection is asymptomatic in 2/3 of the cases and, Moreover, is somewhat 
difficult to diagnose. Can cause two pictures: 
or lymphogranuloma venereum: is caratterizzata by ulcerative lesion Often fleeting and 
subject to multiple chronic adenopathy fistolizzazioni 
or genital infection: 
In women: the cervix is the first site of infection; the Resulting 
endocervicitis presents: 
• Symptoms: abdominal pain, dysuria, blood loss, conditions 
general malaise, nausea and vomiting 
• Complications 
or Chronic Pain 
or Salpingitis: no longer Allows the passage of the egg through the 
fallopian tubes, causing infertility or ectopic pregnancies 
or PID 
• Diagnosis 
or search spontaneous secretions from the urethra 
or Colposcopy 
In humans: urethritis Which may involve the epididymis and prostate 
• Treponema pallidum: causes syphilis, Which OCCURS with a typical symptoms cutaneo- 
mucosa and internal organ involvement 
or Transmission 
Cross street 
Via vertical (transplacental) 
or Clinic 
Primary syphilis chancre caratterizzata is accompanied by satellite adenopathy 
Secondary syphilis is caratterizzata by the appearance of roseole and papules, lesions 
mucous and papular, until you get to destructive lesions (tires luetic) 
Tertiary syphilis: you have skin lesions and mucous localized and persistent, with 
frequent CNS involvement 
or Diagnosis 
Clinic 
Microscopic observation 
Serological tests 
• VDRL: antibodies anticardiolipinici 
• TPHA: antibodies antitreponema 
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Page 104

104 
  
Virus 
• HPV is the most common viral causes of STDs, as well as the causes of frequent blackberries in MST 
Western countries. Approximately 30-40% of the adult persons is the bearer of HPV, but only 1% of them 
is suffering from an STD 
or Subtypes 
High risk: 16, 18, 31, 33: have a high risk of malignancy of 
cervix 
Low risk: 6, 11: determinates at risk of benign 
or Transmission 
Sex 
Fomito: is the presence of biological fluid contaminated That can be Transmitted for 
unsanitary conditions in the absence of reports sesuali: 
• Environments and unclean clothes 
• Surgical gloves, biopsy forceps, fumes generated by laser CO 
2 
  
or Pathogenesis: HPV penetrates the regions most susceptible to microtrauma During intercourse 
sexual, goes in the basal layer of the squamous epithelium, where the viral genome Reaches 
nucleus of the cell, and here he settled in episomal form. 
or Locations: labia, vestibule, urethral meatus, anal canal, perineum 
or types infezionu 
Clinic: evidential ispettivamente 
• condylomata acuminata 
• Warts dishes 
Subclinical: detectable with acetic acid at 3-5% and to colposcopy. They can 
anche occur with only itching. However, colposcopy Should be Noted: 
• Injuries macular: macules are just detected, tending to merge into 
large areas 
• Injuries micropapulari: macules are microscopic 
Latent: detectable with molecular biology techniques (HPV-DNA in tissue 
clinically healthy) 
or Diagnostic procedures 
Inspection of the external genitalia 
PAP-test: the koilocytosis Indicates HPV infection 
Viral typing: is the search of the viral DNA to identify the subtype and then the 
prognosis 
or vaccine subtypes 16-18-31-33 
• Genital herpes: the infection is Caused in 90% of cases by HSV-2 and is Often asymptomatic. In 
Alternatively, you can appreciate the fleeting appearance of vesicles genitals. It is noteworthy the repute 
the infection remains latent 
  
  
  
  
  
  
  
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Page 105

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Protozoa 
• Trichomonas vaginalis is a unicellular parasite, present in Both men and women. In 
this, OFTEN OCCURS in latent form, but can cause a vulvo-vaginitis caratterizzata by 
vaginal irritation, malodorous discharge and itching. 
It has a very easy to identify macroscopic conformation to cool; Furthermore, it is 
the characteristic repute, by adding a potassium hydroxide determines a smell of "fish 
rotten " 
  
Mushrooms 
• Candida albicans: 
or Pathogenesis: live guest in our body and passes from the latent and asymptomatic at 
clinical form, very troublesome in cases of favoring conditions: such as: 
Hyperglycemia: then, Candida infection is typical of diabetic patients 
Anaerobic conditions: in fact, Affects the toenails, If These are little 
aerated (athlete's foot) 
Immunosuppression 
Pharmacological alteration of the normal vaginal flora 
or Clinic 
Uncontrollable itching 
Loss ricottosa: white is a loss, partly liquid and partly solid, in cultured 
poor, sometimes very abundant 
Contamination of the external genitalia, in the region Is that vulvar perianal, with 
appearance of red patches 
  
  
  
Par. III: Pelvic inflammatory disease (PID) 
Main Features 
It is an inflammation of the upper genital tract, with involvement of the endometrium, fallopian tubes, ovaries and cervix: is the 
first cause of irreversible tubal damage, Resulting Therefore Involved in a large number of cases of 
primary infertility (the damage to the mucus and tubal ciliary structure Prevents the passage of the egg 
uterus). In some cases, the inflammation may be so as to Affect Extensive splenic capsule, Appendix 
and liver surface (see below). 
Usually follows a MST (PID primary: sharing, Therefore, the bacterial etiology view for 
MST), but may result from other conditions anche of contamination extragenital as surgical trauma 
(PID secondary). 
It is appropriate to Consider: such as oral contraceptives, reducing the production of cervical mucus, reduce 
the risk of PID. 
Risk factors are: 
• A number of sexual partners 
• Previous PID 
• Presence of a bacterial vaginosis or a MST 
• Use of IUDs 
• nulliparity 
• Recent invasive procedures to load the uterus (eg, revision cavitary instrumental) 
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• Failure antibiotic prophylaxis or no post-surgical 
  
Clinical diagnostic aspects 
• Symptoms: ranges from mild tenderness to severe complications 
or located on the lower abdominal pain: Becomes Progressively severe with blackberries 
the occurrence of contractions of defense 
or nausea and vomiting 
or fever and leukocytosis: especially In These cases, the picture is similar to That of appendicitis 
or losses cervical mucus-purulent 
or irregular bleeding 
or vaginosis with whites 
or Tenderness bounce and movement of the neck of the uterus and adnexal regions 
• Complications 
or Sterility 
or Chronic Pelvic Pain 
or dyspareunia: pain During sexual intercourse 
or tubo-ovarian abscess: Develops in about 15% of cases and suddenly with OCCURS 
the worsening of pain in the lower abdomen and the onset of nausea, vomiting, 
signs of peritonitis and septic shock 
or Piosalpinge: One or Both fallopian tubes are filled with pus. The liquid can be sterile, but 
filling of leukocytes 
or hydrosalpinx is the obstruction of the fimbria with distension of the tube by liquid 
purulent, Which Develops in the case of late or incomplete treatment. Usually 
asymptomatic, it can still cause a compression pelvic pelvic pain croncio 
or dyspareunia 
or Syndrome Fitz-Hugh-Curtis: It can be a complication of gonococcal salpingitis or 
Chlamydia and is caratterizzata by pain in the right upper quadrant 
association with an acute salpingitis, Which Indicates the presence of a perihepatitis 
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
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Chap. 16: Endometriosis 
  
Par. I: General 
Definition, epidemiology and classification 
Endometriosis is a condition caratterizzata by the dissemination and growth of tissue 
Endometrial in abnormal locations (heterotopia), with features stromal, epithelial and glandular-like 
the normal endometrium (in this sense could be Considered a "metastasis" endometrial). 
It is a benign disease, but a progressive character, since the ectopic lesions reserved respond in a 
consensual to hormonal changes typical of the menstrual cycle, including menstrual flow, Which 
accumulates in nonwoven provided with natural drainage. 
  
It is a disease on the rise, multifactorial etiology, Which can cause reduced fertility. Respect 
etiology (see below for details of Which), Has premise as the predominant role in the onset 
endometriosis (EM) of estrogen, as supported by the Following observations: 
• There is no EM before menarche and after menopause: in the latter case, However, may 
Following occur the use of hormone replacement therapy designed to treat the symptoms of 
menopause. 
• The ectopic endometrial cells are ormonoregolate as endometrial cells eutopiche 
• The therapeutic aspect is the most important pregnancy: in this period, in fact, the excess of 
estrogen and progesterone causes a down-regulation of receptors Resulting block 
Hormone 
• Hormone treatments are most effective 
  
Epidemiological data are significant: 
• Peak incidence: 35 years. It is very important to point out the Increase in the average age of first 
pregnancy resulted in an increased At incidence of endometriosis (and a worsening of 
prognosis): in fact, while endometriosis is mild to 20-25 years, asymptomatic and readily 
reversible with pregnancy, in 35 years it is symptomatic and severe (that Has Already formed 
adhesions, reversible only surgically, and infertility may be compromised Already) 
• frequency in the general population: 12% 
• frequency in women with pelvic pain and / or infertility: 20-90% 
• Frequent diagnostic delay: in fact, the symptoms usually you appear in Conjunction with the 
menstruation and, Therefore, macaws is brought back to this 
  
Stand out: 
• External Endometriosis (ectopic): 
or intrapelvic 
Intraperitoneal 
• Ovary 
• Tube 
• Uterine ligaments 
• Pelvic Peritoneum 
Extraperitoneal 
• Vaginal 
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• Bladder (suggested by the presence of hemoglobin in the urine of patients, However, 
asymptomatic) 
• Rretto-sigmoidaria (as you can to complete intestinal obstruction) 
or extrapelvic: Can Affect other organs,: such as lung, skin, sciatic nerve, 
pancreas, appendix 
• Endometriosis internal or adenomyosis: is to develop in the myometrium 
  
Risk factors and etiology 
• Risk factors 
or Familiarity 
or nulliparity 
or Iperpolimenorrea and menorrhagia: In These cases, the stimulus is greater on the endometrium and 
the higher the probability of formation of endometrial material, That, During The 
scaling of a menstrual cycle, However, blackberries abundant, can migrate to other parts of 
body 
or anatomical defects: Some birth defects,: such as imperforate hymen, vaginal septum 
transverse uterine horn and not communicating, prepare, Because of failure 
drainage material endometrial onset of endometriosis 
or alterations of COX 
2 
\: Determine an Increase of PGE 
2 
, Which induces an Increase 
aromatase, estrogen and then, in the ectopic cells. The Increase of PG would be 
very important not only for the onset of endometriosis itself, but for anche 
the onset of infertility for: 
Interference on tubal motility, ovulation and steroidogenesis of the luteal phase 
Syndrome lack luteinized follicular rupture, with retention 
oocyte 
• Theories etiopathogenetic: 
or plant and peritoneal metastatic spread: after retrograde menstruation 
transtubarica (tubal reflux), endometrial cells would reach the surface 
peritoneal impiantandovisi and proliferating in the presence of a stimulus adequate hormone. 
This hypothesis, next to That of the diffusion vascular (blood or lymphatic), may 
explain not only ovarian endometriosis, but anche That extrapelvic and iatrogenic 
or Dissemination blood-lymphatic 
or surgical Dissemination: in case of caesarean section, for example, the transition may occur 
of endometrial cells elsewhere 
or Transformation coelomic (coelomic metaplasia of Meyer): based on totipotentiality 
of the peritoneal mesothelium, Considered as a secondary Müllerian system, Which 
Under Certain stimuli can become sense endometrial (metaplasia endometriosis) 
or Immune tolerance: endometriosis derivates, according to Functional this theory, by a reduced 
peritoneal clearance of endometrial cells from menstrual flow 
for retrograde alteration of cell-mediated: 
Decrease in cell-mediated cytotoxicity against endometrial cells 
Functional deficiency of NK lymphocytes normally delegated to lysis 
of abnormal cells 
Alteration of the monocyte / macrophage: 
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• Increased growth factors stimulate cell growth 
endometrial 
• Increased cytokines: they are Involved in the progression 
endometriosis 
• Increased angiogenic factors: create a microvasculature 
peritoneal essential for the persistence and progression of 
disease 
or hormonal dependence (see back for the role of estrogen) 
or role of environmental toxins 
Dioxin and other dioxin-like compounds: activate the steroid receptors and, as 
result, promote 'the Increase of aromatase. In this way, These Substances 
stimulate the formation of endometriosis and block the activity of progesterone 
That does not induces regression blackberries 
DEMP: is a substance used to make the soft platic, Which, also, 
binds to estrogen receptors with similar effects to dioxin 
Bisphenol A and B: is in plastic bottles and in resins for fillings 
Gives dental and similar effects 
  
  
  
Par. II: Considerations clinical-diagnostic 
  
Pathological anatomy 
The epithelium ectopic Maintains the characteristics of the fabric eutopic (also the sensitivity to hormonal phases 
of the cycle, However, can occur typical characteristics for the individual affected organs: 
• Ovarian Endometriosis: the ovary is the organ most affected by endometriosis and is larger for 
presence of endometrial cysts. Endometriosis Ovarian includes localizations ovarian 
superficial punctate, the so-called "chocolate cysts". These cysts, so called for the efflux 
blackish liquid, are adherent to the peritoneum and are formed as secondary to ovarian endometriosis 
at the level of peritoneal endometriosis ovarian dimple. In fact, it determines adhesion between 
peritoneum and ovary, Which peritoneal folds on the plant: in a place longer available, Subsequent 
ovulations causes the distension of the parenchyma of the impossibility of evacuation of the liquid 
follicular and blood material. Moreover, since These cells are normally Subjected to 
cyclical hormonal stimuli, the ectopic endometrium will give rise, cyclically, to menstrual discharge, Which, 
not being Able to escape, will determinates the collection of cysts ("pseudomestruazione" 
Within the cyst). 
From a clinical point of view, In These cases the cyst will be asymptomatic up to 2-3 cm, to then be 
symptomatic: in Particular, there is a painful symptoms by compression (see also later). 
• Peritoneal Endometriosis: causes pelvic pain, but, unlike the EM (causing pelvic pain for 
compression), it leads to a direct nerve stimulation, with nervous symptoms 
consequent 
• Endometriosis Extragenital: 
or SIGMO-rectal: determines phenomena of intestinal obstruction 
or Urinary (especially bladder detrusor) 
or on scars: eg umbilical or by Caesarean section Following 
or Appendix 
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or utero-sacral ligament 
• Syndrome adhesions: if in charge of ovary or tube determines infertility. The adhesion is determined 
by chronic inflammation and the Resulting fibrosis 
  
Staging 
Especially it is important to evaluate the spread: 
• Stage I: Minimum: presence of isolated systems; not present significant adhesions. 
• STAGE II: mild: the presence of surface facilities (total length 
peritoneum; adhesions significant not present. 
• Stage III: Moderate: presence of multiple systems, Both superficial and infiltrating; presence of 
periannessiali adhesions. 
• STAGE IV: severe: the presence of multiple systems, Both superficial and deep, including endometriomas; 
presence of thick and tenacious adhesions 
  
Symptomatology 
• General (in order of frequency): it is appropriate to note That in 25-30% of cases, endometriosis is 
asymptomatic and detected incidentally in the course of laparoscopic or laporotomici, the carried out for 
looking for causes of infertility or other Reasons 
or Dysmenorrhea: painful menstruation 
or Chronic pelvic pain: pain out of menstruation 
or fatigue and asthenia 
or nausea, vomiting, dizziness and headache 
or Reduced resistance to infections 
or Infertility 
• For home 
or peritoneal adhesions: acute or chronic pelvic pain 
or Involvement of the pouch of Douglas (and pars posterior vaginal): 
dyspareunia 
or Rectum-sigma (cul de sac posterior peritoneum): tenesmus, dischezia 
or Bladder (cul de sac anterior peritoneum): hematuria, dysuria 
or Intestine: sub-ileus 
or Lung: hemoptysis 
or ureters: hydronephrosis (two to the interest of the uterine artery) 
or sciatic nerve: sciatica 
• Symptoms dell'adenomiosi 
or dysmenorrhea and pelvic pain 
or Enlarged uterus 
or Menorrhagia 
  
Diagnostic procedures 
• gynecological speculum 
• pelvic and transvaginal ultrasound (or transrectal): These methods Showed ovarian cysts 
as cystic echostructure mostly liquid, with echoes of low amplitude, Which 
bordering areas heterogeneous echogenic (cysts corpuscular ground glass) 
• RM 
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• Dosage of serum CA125: This source coelomic epithelium, increased At in 
patients with endometriosis. Given ITS low specificity, is most useful as a marker of the evolution of 
disease 
• Laparoscopy: is the method most used 
• Cystoscopy-urography: in the event of Suspected involvement of the urinary 
• Colonoscopy and barium matte: in the event of Suspected involvement of the intestine 
  
Therapy 
• Medical: is a second-line Compared to surgery and AIMS to decrease the stimulation 
Estrogen: 
or GnRH analogs: decrease the release of gonadotropins 
or intrauterine progestins 
or Danazol suppresses the secretion of LH, Resulting in a condition of anovulation, and 
Occupies the progesterone and androgen receptor sites, causing hypoestrogenism and 
hyperandrogenism 
or Gestrinone 
or Progestogens: second choice 
or dell'aromatosi inhibitors and COX 
2 
\: In trial 
• Surgical 
or Conservative: in stage I and II and in patients desiring pregnancy 
Fenestration and ovary removal of the cyst 
Ablation of peritoneal implants 
Uterine artery embolization 
or demolishing: in Stage III or IV, and in patients who no longer desire pregnancy: 
Hysterectomy 
Annessectomia 
Bowel resection 
Resection of bladder 
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
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Chap. 17: Screening in gynecological oncology 
  
Par. I: General 
Prevention 
First, as a preliminary observation, it Should be remembered as the evolution of a tumor 
can stand out in five phases: 
• Debut biological 
• Initial phase or not invasive 
• Phase invasive localized 
• Phase invasive locoregional 
• Phase invasive remote 
  
  
Prevention is the set of Measures to: 
• Avoid the onset of the disease: primary prevention 
or Target (T): elimination of the causes 
or conditions for the application (CA): known causes and avoidable 
• Recognize in asymptomatic phase: secondary prevention 
or T: discovery of the disease in asymptomatic phase through the administration of tests 
laboratory and / or instrumental (PAP-test, mammography): 
Pre-clinical diagnosis: do before the onset of clinical disease and Identifies the 
ITS early onset of disease in biological 
Early diagnosis (see later) is to Recognize the disease in phase 
initial (or phase noninvasive) 
or CA: This must be a stage a when the disease is asymptomatic, and alterations 
functional and / or structural detectable with common diagnostic tests 
• Treat with the aim to reduce complications (gynecology in the concept of complication goes 
extended to recurrence and metachronous tumors): Tertiary prevention 
or T: prevention of complications 
or CA: must be available therapy can reduce the number and extent of 
complications 
  
Any prevention policy rests on two pillars: 
• About habits (lifestyle, eating habits), risk factors and screening methods or 
early diagnosis 
• Systematic Application of These methods in the population (screening) or individuals 
(Early diagnosis): 
or Screening: procedures organized in the territory, enabling identification of a disease or to 
specific condition in apparently healthy individuals 
or Early diagnosis: procedures performed on asymptomatic individuals who go 
at health centers for medical checks 
  
  
  
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Par. II: Prevention of cervical cancer 
  
Main Features 
The introduction of the PAP test Has led to a significant decrease in the incidence and mortality of 
invasive carcinoma. 
Risk factors for ITS occurrence are: 
• Early Sexual Activity 
• High number of sexual partners 
• multiparity 
• Before pregnancy and childbirth at an early age 
• Tobacco smoke 
• Infection with HPV aggressive (16, 18, 31, 33) 
• Failure to control: the screening is to not make a major risk factor, 
Whereas in the early stages the symptoms are absent 
  
Screening methods 
• Pap test: is the examination of the first level, to be made to coincide with the onset of sexual intercourse or 
but no later than 25 years. The test Involves taking exfoliated skin cells and is based 
That principle on the cancer cells lose the Cohesion between them for the destruction of 
desmosomes and exfoliate blackberries abundantly: 
or Execution 
Place the patient in gynecological position 
It Introduces a speculum into the vagina, the cervix highlighting 
We carry two samples 
• In correspondence dell'esocervice (as close as possible to the junction 
squamocolumnar) with a wooden spatula (Ayre spatula) 
• At endocervix by citobrush with cottono fiock 
They crawl exfoliated epithelial cells on a slide, in cui are fixed with 
alcohol or with a mixture of alcohol-ether (in the absence of fixation would be altered and 
could no longer be read) 
Is colored with Papanicolaou smear staining 
It is prepared Observed the optical microscope 
or Who runs it: being very simple, can be performed not only by the specialist, but 
anche by a midwife or GP to competent 
or Features: 
Rapidity 
Easiness 
Absence of pain 
Low cost 
or classifications 
Papanicolaou (cutting easier, but almost completely outdated) 
• I: smear Clearly benign (normal) 
• II: smear with minimal cellular abnormalities (inflammatory) 
• III: smear with cellular abnormalities, but not neoplastic (atypical) 
• IV: smear probably neoplastic 
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• V: smear frankly malignant (positive for cancer) 
Bethesda 
• Normal 
• Normal with reactive changes (inflammatory) 
• SIL (squamous intraepithelial lesion) Low grade: CIN (neoplasia 
cervical intraepithelial) 1 or mild dysplasia (Affects the lower 1/3 
epithelium) 
• high-grade SIL 
or CIN 2 or moderate dysplasia: Affects less than 2/3 
or severe dysplasia or CIN 3: Affects the full thickness epithelium, but 
without exceeding the basement membrane (carcinoma in situ) 
• Squamous cell carcinoma: the cells are of squamous simple 
• Adenocarcinoma: the cells of glandular type (cylindrical) 
• ASCUS: atypical squamous cells of undetermined significance 
• AGCUS: atypical glandular cells of undetermined significance: in about 2/3 
cases, the repeat testing after 2-3 months ASCUS and not AGCUS 
are no longer present; in the remaining third of the cases evolve to SIL or 
carcinomas 
• Colposcopy is the examination of the cervix and vagina with a speculum Particular 
(Colposcope), Which Provides excellent lighting, a three-dimensional view and a 
magnification up to 40 times. For carcinoma of the cervix is an examination of the second level 
or Execution 
It puts the woman in gynecological position 
It Introduces the speculum 
First time of investigation: examination of the cervix to "panoramic magnification" 
(Ie 6-12 times). Also, remove any excess mucus and cleansed the 
cervix with saline, we study the epithelial angioarchitettura. It is good 
notice how the speculum might be Introduced until the initial part endocervix: 
Therefore, a major limitation of colposcopy is PRECISELY Given by the impossibility of 
explore the cervical canal and to explore lesions partially or totally 
endocervical. 
Second Half survey: observation of the cervix after application of a 
solution of acetic acid at 3-5%: this determines the swelling of the tissues, and 
Particularly the papillae of the glandular mucosa endocervix (Which 
take on a papillary villous "in grape"), Allowing you to 
highlight the squamous columnar junction. The acetic acid, in fact, acts on epithelia, 
making them swollen and ITS changing color (pink in the case of normal mucosa, 
pearly-white for thickened mucosa) and is more active on abnormal epithelia and thickened. 
The effect of acetic acid depends on the amount of nuclear proteins present: 
Therefore, the abnormal epithelium, for ITS higher nuclear density and for the 
greatest concentration of nuclear proteins, meets at most 
clumping, assuming them to more or less colorful background. If atypia Involves 
crypts pseudoghiandolari cervical canal, you will notice whitish circles 
around the orifices of the pseudoghiandole 
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Third time survey: observation cervica after application of solution 
Lugol's iodine (Schiller test): while the normal squamous epithelium is rich 
That glycogen binds to the iodine solution, coloring itself in dark brown, 
the endocervical columnar epithelium and the abnormal, lacking glycogen, 
REMAIN unstained 
or Purpose: is to evaluate the location and extent of cervical lesions and allow 
a biopsy accurate, That may be associated with: 
Curettage (scraping endocervical) 
Cone biopsy (removal of an Entire cone of tissue from the cervix) is 
performs in the event of: 
• Whole area of transformation is not Clearly visible to the colposcope 
• Ascent of the colposcopic atypical in the cervical canal beyond the limits of 
vision 
• Area colposcopic atypical widespread 
• Evidence of microinvasion 
• Evidence of malignant characteristics in endocervical curettage but not 
colposcopic observation 
• Probes DNA of biopsies for the diagnosis of cervical infection with HPV types are defined 
Virus 
  
  
  
Par. III: Screening of endometrial cancer 
Main Features 
Predominantly Affects postmenopausal women, with a peak incidence around 65 years of age. 
Presents: 
• Risk factors 
or Obesity 
or Hypertension 
or DM 
or nulliparity 
• Pathology: Develops cylindrical epithelium lining the lumen of the uterine body and is, 
in 90% of cases, Represented dall'adenocarcinoma. Is classified according to Functional the degree of 
differentiation and proliferation of glandular: 
or G1: well-differentiated 
or G2: moderately differentiated areas with partially solid 
or G3: undifferentiated with predominance of solid areas 
• Considerations hormonal 
or The pill is Considered a protective factor, as it Prevents the 
endometrial proliferation 
or hormone replacement therapy in menopause does not Increase the risk: in fact, the progestin 
induces the collapse of the endometrium and Hinders Growth 
or the use of tamoxifen in breast cancer Increases the risk of cancer 
endometrium: in fact, These antiestrogenic Has a role in the antiproliferative level 
breast, but a role in stimulating the proliferation in the endometrium 
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Screening 
• Limits 
or Clinical: remains asymptomatic for a long time. The most common manifestation of onset, 
ie uterine bleeding in menopause, in fact, OCCURS a when the cancer is Already in 
advanced placement 
or Di health policy: adequate screening would be very expensive 
• Methods 
or diagnostic endometrial curettage (or other types of endometrial cytology: aspiration, 
washing) 
or hysteroscopy with biopsy 
or transvaginal ultrasound 
or Ecoflussimetria-Doppler transvaginal 
  
  
  
Par. IV: Ovarian 
Main Features 
It is prevalent in Industrialized countries, with a peak incidence in menopausal age; anche in this case 
there is no effective screening program. 
Risk factors are: 
• nulliparity or low parity 
• Infertility 
• Familiarity: especially for mutations of BRCA 1 or 2 
  
Screening 
Does not target the general population, but only one at risk (see above) and uses: 
• Gynaecological examination: findings striking is the presence of palpable menopausal ovaries (in conditions 
physiological arent Because They are atrophic) 
• pelvic and transvaginal ultrasound: Locate ovarian lesions at risk. The blackberries the 
lesion is solid, the greater is the risk of malignancy. Further sign of malignancy is the strong 
angiogenesis, Recognized by Echo-Doppler 
• Dosage of CA125 is a tumor marker, Which Increases in the case of ovarian cancer, but That 
However, little is specific: 
or Other causes of increase 
Benign diseases 
• Pregnancy 
• Endometriosis 
• PID and peritonitis 
• pancreatic and liver disorders 
Malignancies 
• Tumors tubal 
• Breast Neoplasms 
• Endometrial Cancer 
• pancreatic neoplasms, liver and intestinal 
or Features 
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Specificity: very poor 
Sensibility 
• Stage I: 50% 
• Stage II and III: 90%: Therefore, it is not useful for screening, but to follow 
the evolution of the pathology 
• Laparoscopy 
  
  
  
Par. V: Breast cancer 
Main Features 
Over the past 2 years Has seen an Increase in the number of cases to be Attributed to the improvement of 
diagnostic techniques, but anche to a reduction of mortality of breast cancer, by 
Attributed to a recognition in the earliest stages. 
Risk factors are: 
• Strongly correlated 
or Genetic alterations: 
BRCA 1 and 2 
P53: Li-Fraumeni syndrome 
PTEN: Cowden syndrome 
STK11 / LKB1: Peutz-Jeghers 
or lobular carcinoma in situ 
or ductal carcinoma in situ 
or atypical hyperplasia 
• Moderately Related 
or age of first pregnancy blackberries than 35 years 
or familiarity of First Instance 
or Radiation Exposure 
or Previous history of breast cancer 
• Poorly Related 
or early menarche 
or late menopause 
or nulliparity 
or benign breast pathology 
or Obesity 
or Alcohol Abuse 
  
Screening 
• Visit senologica: recommended for all women over the age of 50 years 
• breast self-examination 
• Mammography: is performed annually since 50th year and is caratterizzata by: 
or diagnostic Reliability 
80% for cancers of diameter> 1 cm still not palpable 
90% a when performed in Conjunction with an ultrasound breast 
or Absence of carcinogenicity to the skin for the background radiation dose delivered 
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or Paintings of malignancy found: radiated masses, irregular margins, with distortion dela 
trabecular structure, fibrosis and breast microcalcifications 
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
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Chap. 18: Menopause 
  
Par. I: General 
Definitions 
It Should be distinguished: 
• Climacteric: it is a stage of life That places women between 45 and 55 years, During Which 
Verifies the progressive loss of reproductive capacity exhaustion heritage follicular 
(Follicular atresia: However, the ovary may be still present in Certain proportion of follicles, 
However, to the primitive stages or primary), accompanied by a progressive insensitivity 
ovary to gonadotropins 
• Menopause is the permanent cessation of menstrual flow, peak and a clear sign of the decline 
endocrine production, with general effects of trophic character, metabolic and sexual. 
The main feature of menopause is, Therefore, ovarian failure That determines not only 
an inability reproductive (for the non-ovulation), but anche a series of symptoms referable to 
deficit hormonal (estrogen, progesterone but anche). In Additions to the time of 
menopause, are Considered: 
or Premenopausal: is the period before the last menstrual period, accompanied by changes 
features 
or Post-menopause is the last menstrual period Following the period (after age 65 does not 
speaks more of post-menopausal, but aging, And These changes are Attributable blackberries 
purely geriatric) 
or artificial menopause: can be induced by radio- or chemotherapy or Surgery 
  
General considerations on menopause are: 
• Average age of menopause: 50-52 years: the age of menopause is extended with improved 
living conditions. Therefore, In These conditions, you not only have a late menopause (accompanied 
Often by an early menarche), but, for the new social habits, the number of children, and Therefore 
anovulatory periods, is Considerably decreased. Therefore, the number of ovulations fatto che 
context is increased At Largely, as well as the average concentration of estrogen exposure 
in this period, thus Resulting in increased At an incidence of estrogen-related conditions,: such as 
endometriosis and ovarian and endometrial 
• Duration of premenopausal: varies widely. In fact, some women in this period lasts 
several years and is presented with the whole procession of symptoms That will be Analyzed later; in the other, 
Instead, the condition, until the time of the last menstrual period, is normo-ovulatory and normo- 
menstrual 
• To define a menopause need to be gone a year since the last menstruation 
  
Hormonal changes 
• Premenopausal: decreased At secretion of inhibin (Which, remember, is produced by cells of the 
grainy and of the corpus luteum from Those and PRECISELY Has the task of inhibiting the secretion of FSH) 
Involves Increasing the production of FSH During the cycle. While FSH Increases, there are 
still near normal levels of estrogen, progesterone and LH. In this period, the production of 
Increases estrogen (hyperestrogenism related) Compared to That of progesterone (the latter, 
in fact, is produced after the outbreak of the follicle: if the follicle does not burst, it does not occur). 
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However, the production of estrogen soon Becomes insufficient and only rarely determines the 
LH peak, and then ovulation. The cycles become Thus blackberries and more frequently anovulatory. 
Moreover, the production of estrogen, albeit declining, it turns out, rather than cyclical, continuous: 
A first Consequence Is that the endometrium is exposed in an irregular manner, the stimulation 
Continuous estrogen, Which causes an Increase in vascularization is not controlled, up to the 
breaking of the vessels (irregular menstruation absolutely). A second Consequence Is that 
the relative hyperestrogenism raises the risk of hyperplasia, endometrial polyps or cancer, 
as well as uterine leiomyomas and breast tumors (These cases of relative hyperestrogenism 
Should be treated with progesterone to make bring the balance estrogen / progesterone). 
In These cases premenopausal, can be determined two Circumstances: 
or amenorrhea: begin to appear long periods (even 6-7 months) anovulatory: risk, 
These Times, Is that the focus on contraception decreases In These periods, with 
Resulting in unwanted pregnancies 
or menstrual Irregularities: polimenorrea or menometrorrhagia: are associated with a high risk 
anemia (and, Therefore, Should be treated) 
• Post-menopausal women: there are no longer menstruating Because estrogen is too low. Yes 
Remember That menstruation is the epiphenomenon of hormonal activity, Particularly ovarian fact, 
the uterus Retains the capacity, if properly stimulated, reserved respond to it adequately to 
hormones. So, in case of absence of the ovary determines menopause (also early). Vice versa, 
in case of absence of the uterus and the ovarian cycle a continue not arrive, if not physiologically, to 
menopause. However, the reduced production of estrogen determines the absence of the feedback 
pituitary negative, with increased At release of FSH. The Increase in FSH, However, is in relation with the 
decreased At ovarian sensitivity. In conclusion, postmenopausal measurement 
FSH concentration, Which is increased At (> 30 pg / mL), and estradiol, Which is decreased At (< 
25 pg / mL), is decisive (condition hypergonadotropic hypogonadism). 
In location addition, the decrease in ovarian estradiol production is accompanied by an Increase 
production extraovarica (adrenal, subcutaneous fat and perivisceral) of estrone. 
  
  
Par. II: Symptoms 
Neurodegenerative diseases 
Usually occur in premenopausal, are indexed According Kupperman (for each disorder is Given 
a score from 1 to 3 and Becomes the sum). Their pathogenesis would be Attributable, rather than a 
decrease in estrogen, the abrupt change in concentration of estrogen (high> low> high). 
In fact, in post-menopause, a when estrogen levels have stabilized, the symptomatology 
autonomic regresses. 
They are Represented by: 
• Hot flashes: have a sudden feeling of extreme heat, with increased At 
vasodilation, and are accompanied by: 
or Sweating 
or Chills 
• Sleep disorders, mood (irritability, depression), attention and memory 
• Palpitations 
• Fatigue 
• Headache 
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• Paresthesias 
• Dizziness 
  
Menopausal disorders 
• In the short term: neurodegenerative diseases 
• In the medium term: 
or amenorrhea: Remember That, in the event of amenorrhea, to understand the adequacy levels 
estrogenic do the test to progesterone (in addition pcs, you do an ultrasound check: if 
adequate estrogen levels, the endometrium is, unlike what happens in the case of 
Low levels of estrogen, yet well Represented). Progesterone Has, in fact, the capacity 
to induce menstruation in women with adequate levels of estrogen, then: 
If the woman mestrua: estrogen levels Has still good and is not in menopause 
If the woman does not mestrua: or is in menopause (with hepatic estrogen) or 
pregnancy 
or atrophy of the skin, mucous membranes and respiratory glandular breast 
or atrophy of the genitourinary: OCCURS on the embryogenesis of this stretch (third 
the distal end of the vagina, urethra, bladder trigone), Which makes it sensitive to estrogens, and 
manifested by: 
Vaginal dryness: causes difficulty During intercourse (dyspareunia 
surface: that is, at the moment of penetration; endometriosis, However, was 
deep) 
Increased incidence of vaginitis is Caused by: 
• Inadequate vaginal tropism 
• Changes in vaginal flora 
Most of the periurethral tissue laxity: exacerbation of pathologies 
dysfunctional or anatomical, leading to urgent (even with nocturia) and 
Urinary incontinence (typical of post-menopausal) 
or weight gain 
or arthralgias 
or decreased At libido 
• In the long term 
or increased At cardiovascular risk: the decrease in estrogen levels change is 
the lipid is the vascular system: 
Changes in the lipid 
• Increased LDL 
• Decreased HDL 
• Increased lipoprotein A 
Changes of the vascular system 
• Increased vasoconstriction 
• Increased deposition of atheromatous plaque 
• Decreased production of prostacyclin 
• Increase of the factors procaoagulativi 
or Osteoporosis is Caused by a loss of bone, age-dependent Generally, During The 
bone remodeling, in cui intrinsic and extrinsic factors they act, Which, exaggerating the 
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process, Determining an increased At resorption. One of these factors is the 
decrease in estrogen 
or neoplastic risk: especially cancers of the endometrium, breast and ovarian 
(Important methods of screening) 
  
  
  
Par. III: Therapy 
Hormone replacement therapy (HRT) 
It is based on the assumption That, Given That menopausal disorders result from a reduction of the 
estrogen, administration of estrogen is protective against These disorders. However, 
improperly administering estrogen in menopause, Has disproportionately increased At the 
Number of carcinomas of the endometrium. Then, it is Introduced the additional use of progesterone: However, the 
risk of endometrial cancer was not Significantly reduced. Later, it was shown That 
Also the risk of breast cancer increases. 
So, currently, in TOS is indicato only for short-term disorders (ie Those neurodegenerative) or 
early menopause. 
However, administering estrogen (etilenestradiolo, 17-β-estradiol, estradiol valerate) and progestin 
oral, transdermal, vaginal or intravascular. 
The association between estrogen and progestin can be either sequential (estrogens and progestins mimic 
the cyclical physiological) or continuous type: the principle is the same as the contraceptive pill, but the results are 
very minor. 
Tibolone, However, That is a Particular estrogen has no effects on the endometrium and does not require Therefore 
the association of a progestin. 
Also, the use of androgens is Particularly suitable to combat decreased At libido. 
Finally, a note on phytoestrogens: These Are food supplements, contained Mainly in soybeans, 
That have estrogenic-like properties 
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
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Chap. 19: Pathology of the corpus uteri 
  
Par. I: Pathology benign 
Endometrial polyps 
Polyps are growths exophytic size, shape, number and appearance variables. Polyps 
endometrial, in Particular, are growths of the mucosa of the corpus uteri, the location of Which can 
be anywhere in the endometrium (anche but at the endocervix). 
Regarding the dimensions, may be a few mm or several cm, Occupying, in this second case, 
much of the uterine cavity and escaping from the external genitalia. 
Regards the number may be single or multiple. 
Considering the role exerted by estrogen stimulation on Their formation, the frequency is 
greater in the age group between 30 and 50 years (Generally, if encountered in menopause, were Already present). 
Important features are: 
• Pathology: always consist of an axis-vascular connective covered with epithelium 
Endometrial. They have a yellowish-red color and possible neoplastic evolution (Therefore, 
Should always be Eliminated). They can be of different natures Depending on the content of the surface 
pathological: 
or adenomatous: glandular ducts lined by cuboidal epithelium 
or with adenomatous hyperplasia: very crowded glands with epithelial proliferation type 
papillary 
or fibrous: poor content with glandular prevalent fibrous structure 
• Symptoms 
or Menorrhagia: abundant and prolonged menstruation (a normal menstrual period, you 
Recalls, Involves loss of 70-80 mL of blood per day for 4-5 days) 
or Metrorrhagia: bleeding outside the menstrual period (or postmenopausal) 
or Menometrorragia: menstruation abundant and prolonged Throughout the cycle. All These 
un'anemizzazione hemorrhagic conditions can cause slow, progressive and 
worsening (since the need for transfusion) 
or pain two to uterine contraction (to expel the octopus, Recognized As The Body 
stranger) 
• Diagnostic Imaging 
or transvaginal ultrasound Allows you to evaluate the thickness of the endometrial rhyme: a rhyme 
thickened, in fact, Allows to suspect a polyp 
or hysteroscopy: provides for the introduction into the uterine cavity of a hysteroscope, Which, thanks 
the use of a physiological solution, will go to distend the uterine cavity. 
Nell'isteroscopio is an optical camera connected to an external room, Which 
Allows a macroscopic view of the cavity. Hysteroscopy Allows removing (and 
Subsequent evaluation biopsy) 
or curettage diagnostic and therapeutic 
• Therapy (see below) 
  
Endometrial hyperplasia 
It is a common condition in women in perimenopausal period and more rare in the blackberries 
young. It is a result of hormonal imbalances hyperestrogenism caratterizzata by absolute or relative, to two 
anovulation or luteal insufficiency, or secondary to estrogen therapies do not revealed adequately 
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balanced with the progestin: it is as if, under the stimulus of estrogen and / or lack of adequate 
stimulus progestin, endometrial epithelium proliferasse blackberries than they Should (Therefore, the pill, being a 
estrogen-progestagen does not cause endometrial hyperplasia). 
By the term "hyperplasia" is included, then, various morphological aspects of the endometrium, ranging from 
simple glandular crowding, bordering the proliferative endometrium, up hyperplasia 
adenomatous with cytologic atypia, virtually indistinguishable from a well-differentiated carcinoma. 
Important aspects are: 
• Pathology: 
or Types 
Simple: increased At number of glands, but no branching glandular 
Cystic: is a variant of the previous one, in cui there is expansion and modification 
morphological glands 
Complex or adenomatous: polymorphism with buttressing of glandular 
glands (look "back to back"), and the reduction of glandular ramifications 
stromal component 
or atypia: the above types may arise or less with atypia: the presence of atypia is very 
important Because it does veer toward a benign lesion preneoplastic 
• Symptoms 
or polimenorrea: menstruation That lasts for several days 
or Main-, metr- or menometroragie 
• Diagnostic Imaging 
or transvaginal ultrasound 
or hysteroscopy 
  
Treatment of polyps and hyperplasia 
• Polyps: Eliminated are always the risk of evolution 
• Hyperplasia 
or Typical: hormonal treatment with progestins 
or Atypical: should be treated aggressively blackberries: 
Adolescent: progesterone or Progestogens 
In women of reproductive age: as above (curettage in cases where the therapy 
hormone is not possible) 
In women with blackberries than 40 years 
• Danazol 
• GnRH Analogs: allow a state of hypoestrogenism only 
transitional and, Therefore, are shown only in view of a treatment 
surgical 
• Endometrial ablation transuterina 
In menopause: 
• Hysterectomy with annessectomia 
• Ablation is more conservative and its use is supplanting what 
hysterectomy 
  
  
  
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Leiomyomas 
Uterine growths are benign and of various volume (even weigh a few kilograms); 
are the most common benign neoplasm of the female genitalia (especially between 40 and 
50 years) and are constituted by bundles of smooth muscle cells and connective tissue intertwined in 
varying proportions. Therefore, they are distinguished, according to Functional the ratio of the muscular component and 
Connective: myomas, fibroids and fibroids. 
The location can be single or multiple (but always with distinct nodules). For uterus is fibromatous 
intends, However, in the womb in cui the fibrous component Has taken precedence over That muscle: It has, 
Therefore, an invasion fibrous uterus in full (and not as in nodular fibroids). 
Important features are: 
• Localization of nodules (Which may be pedunculated or sessile): 
or subserosal: nodules develop under the perimetrium, extend into the abdominal cavity 
and, being furthest from the uterine cavity, rarely give symptoms 
or Intramural: develop in the thickness of the myometrium 
or submucosa: protrude into the uterine cavity and are Clearly visible in hysteroscopy. Those Ones 
pedunculated with long stalk can leak from the cervix. However, the 
Generally subserosal Are Those That give blackberries challenges, changing the stairs 
menstruation and going to alter the phenomena of local hemostasis 
or Intralegamentare: you go to locate the margins in the wall of the uterus, Within the 
broad ligament, in the vicinity of the vessels 
or "in transit": a few nodules, for example, depart from outside (subserosal) and reach the 
uterus (intramural and submucosal then) 
• Pathogenesis 
or hormonal factors: hyperestrogenism (notable is the Increase in the first weeks of 
pregnancy, in cui estrogen is high) 
or Genetic factors: familiarity 
• Symptoms: Considered to be, first of all, as in Un certain slice of the patients (20%) and 
asymptomatic. In These cases, it is the incidental finding of an Increase in the uterus That could be indicative 
in leiomyoma. The symptoms are related to the location, the size and number of nodules: 
or menstrual disorders: are mainly two to the submucosal and may lead to 
anemia 
or pelvic pain (with possible dysmenorrhea and dyspareunia) 
or symptoms of compression: 
Vases: varices 
Ureter: hydronephrosis 
Spinal roots: sciatica 
Bladder: urinary frequency, urgency, and urinary incontinence 
Intestine: constipation 
or alteration of fertility and pregnancy 
Plant endometrial allowed 
Tubal occlusion for locating the corners tubal: passage of the egg in 
uterus Prevented 
Abortion and threatened abortion: the system is abnormal and fails to mature 
Correctly 
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Placenta previa and placenta untimely: leiomyoma hampers 
proper placental development (implantation of the placenta in SI: placenta previa; 
abnormal uterine contraction During childbirth: Placental abruption) 
Abnormalities of childbirth: leiomyoma, as Mentioned, alters uterine contractility 
• Pathology 
or Increase the volume of the uterus 
or irregular contours 
or increased At

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