Other Gyn Problems Flashcards
What happens if no ovulation occurs?
Estrogen continues to be produced and the endometrium continues to proliferate so that periods will not occur normally until the endometrial architecture cannot be sustained any longer leading to sporadic breakthrough bleeding or menorrhagia
NOTE: Oral birth control can help normalize periods!
What is another possible consequence of not ovulating?
endometrial proliferation can turn neoplastic due to unopposed estrogen
How common is dysmenorrhea?
About 50% of menstruating women have dysmenorrhea and 10% require treatment, and is most common between the ages of 20-24
The likelihood of having serious symptoms related to dysmenorrhea is like most common within 2 yrs of menarche
What causes dysmenorrhea?
This is primarily related to levels of prostaglandins, with women who experience dysmenorrhea with menstruation having higher levels of PGF2a and PGE2 (Infusions of PG have been known to cause uterine contractions and pain).
T or F. Women who do not ovulate have no dysmenorrhea and low levels of PGs
T
Note about suggested natural initator of labor
Progesterone levels are high throughout pregnancy and typically progesterone suppresses prostaglandin receptors and the arachadonic acid cascade. When labor nears, progesterone levels drop and prostaglandins can promote muscle contraction and labor
So why would pain occur with menses and not other times of the menstrual cycle?
During the luteal phase progesterone levels are very high and suppress prostaglandin action, but when progesterone levels drop due to the degeneration of the corpus luteum, prostaglandins can act can cause pain
What is primary dysmenorrhea?
No known cause- i.e. most likely due to the hormonal rises and drops of progesterone
How would primary dysmenorrhea be treated?
NSAIDs- want to start taking NSAIDs as soon as progesterone levels begin to fall (i.e. when you feel like your period is about a day away from starting) OR
Hormonal contraceptive agents because they prevent ovulation due to a steady state of progesterone
What are some causes of secondary dysmenorrhea?
pelvic inflammatory disease
Endometriosis
Ovarian cysts
Tx: Treat cause
Notes about Endometriosis
This is a benign condition that is often found incidentally but can cause symptoms, and typically becomes clinically apparent in the 30’s
What is endometriosis?
Endometrial tissue found outside the endometrial cavity that still responds to estrogen and progesterone and thus can cause cyclic symptoms of even chronic symptoms
This is most often found on the ovary or fallopian tubes
How does endometriosis occur?
These are just theories:
1) Retrograde menses (Support: pts. with imperforate hyman often get endometriosis)
2) Totipotential cells differentiate into endometrial tissue (Support: Can see endometrial tissue in the lung)
3) Heme spread
What are the symptoms of endometriosis?
Dysmenorrhea BUT pain typically begins a couple days BEFORE menses and is some better on Day 1 or 2
Can also give a continuous GnRH agonist that essentially places a women in a menopausal state (but long term use is assoicated with bone density loss- may want to add some estrogen)
