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BMS250 > Pathophysiology of Uterus, Vagina, and Adnexa (Week 3) > Flashcards

Pathophysiology of Uterus, Vagina, and Adnexa (Week 3) Flashcards

1
Q

What are common medical conditions affecting the ovaries, uterus, and vagina?

A
  • Abnormal uterine bleeding
  • Dysmenorrhea
  • Amenorrhea
  • Endometriosis
  • Endometrial hyperplasia
  • Fibroids
  • Uterine myoma
  • Pelvic organ prolapse
  • Ovarian cysts
  • Cervical dysplasia
  • Vaginitis
  • Major cancers

These conditions have significant impacts on reproductive health and fertility.

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2
Q

What hormonal processes are relevant to reproductive conditions?

A
  • Oogenesis
  • Ovulation
  • Menstruation

Hormonal regulation of the ovarian-based sexual and reproductive systems is crucial to understanding these conditions.

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3
Q

True or False: There is a higher incidence of cancers in the late reproductive or menopausal years

A

True

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4
Q

What are typical manifestations of disorders in the female reproductive system?

A
  • Altered menstruation
  • Pelvic pain
  • Infertility

Disorders often present with these symptoms, indicating underlying issues.

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5
Q

What systemic CAUSES can lead to reproductive disorders?

A
  • Brain
  • Hypothalamus
  • Pituitary
  • Thyroid
  • Adrenals
  • Kidneys
  • Liver

Dysfunction in these areas can have systemic effects on reproductive health.

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6
Q

What are the systemic EFFECTS of reproductive disorders?

A
  • Osteoporosis
  • Atrophic vaginitis (estrogen deprivation)
  • Cardiovascular risks (atherogenesis, altered vascular compliance)
  • Cancer risk (e.g., endometrial carcinoma from estrogen excess AND progesterone deficiency)
  • pregnancy-related disorders (e.g., gestatioanl diabetes, pre-eclampsia-eclampsia – 5% of pregnancies)

Dysfunction of ovarian hormones can lead to these systemic health issues.

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7
Q

True or False: Early detection in the ovaries and fallopian tubes is difficult due to their deep location (difficult to palpate) and due to the few sensory nerves in the location (thus often asymptomatic)

A

True

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8
Q

True or False: Cervical cancer is easily accessible for screening.

A

True

Effective screening programs like Pap smears have reduced mortality from cervical cancer.

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9
Q

What are the categories of disorders of the female reproductive tract?

A
  • Central (Pituitary, hypothalamus, or brain centers influencing the hypothalamus)
  • Ovarian
  • End-organ (uterine, fallopian tube, or vaginal dysfunction)

Disorders can be categorized based on dysfunction at different levels of the neuroendocrine axis.

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10
Q

What is the effect of changes in GnRH secretion?

A

GnRH dysregulation → altered gonadotropin secretion

Pituitary dysfunction → disordered ovarian function (e.g., anovulation)

End-organ effects → menstrual irregularities, endometrial atrophy

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11
Q

What are the key components of ovarian function?

A
  • Responsiveness to gonadotropins
  • Follicular viability
  • Paracrine signaling within follicles
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12
Q

What characterizes Polycystic Ovary Syndrome (PCOS)?

A
  • Anovulation
  • Hirsutism
  • Infertility
  • Dyslipidemia
  • Abnormal uterine bleeding or amenorrhea

PCOS involves a self-perpetuating feedback disruption affecting ovarian function.

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13
Q

What are common causes of uterine disorders?

A
  • Hormonal dysfunction
  • Fibroids (myomas)
  • Endometrial cancer

Key symptoms include abnormal vaginal bleeding.

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14
Q

What are the causes of pelvic infections?

A
  • Gonorrhea
  • Chlamydia
  • Anaerobic bacteria

These infections can lead to serious complications like infertility and tubo-ovarian abscesses, which may require surgical drainage

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15
Q

What are the steps in the initial diagnostic approach for amenorrhea?

A

Step 1: Rule out pregnancy
Step 2: Assess thyroid function (serum TSH) and assess pituitary function (serum prolactin)
Step 3: Further investigation based on clinical history and physical exam.

Then we want to rule in/out conditions of the uterus and conditions of the ovary

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16
Q

What is primary ovarian insufficiency (POI)?

A

Premature loss of ovarian follicles leading to ovarian failure

Premature ovarian failure due to accelerated follicle atresia in women <40 years.

Leads to estrogen deficiency and symptoms similar to menopause

Causes include genetic disorders (e.g., Turner syndrome), autoimmune disorders (e.g., lymphocytic oophoritis), metabolic conditions (e.g., galactosemia) and exogenous insults (e.g., chemotherapy, toxins, radiation)

Note: this naturally happens around menopause, but it is not called primary ovarian insufficency at that point because it is not premature anymore

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17
Q

What are the clinical features of Primary Ovarian Insufficiency (POI)?

A
  • Amenorrhea or irregular cycles
  • Symptoms of estrogen deficiency (hot flashes, night sweats, vaginal atrophy & dryness)
  • Decreased bone density –> osteoporosis risk

POI can result in significant health issues and infertility.

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18
Q

What hormonal profile is associated with Primary Ovarian Insufficiency (POI)?

A
  • ↑ FSH & LH
  • ↓ Estrogen

This profile indicates loss of ovarian feedback.

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19
Q

What is chronic anovulation?

A

Condition where follicles are present but fail to mature and ovulate

This can lead to irregular bleeding or amenorrhea with intermittent bleeding, and increased endometrial hyperplasia and cancer risk

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20
Q

What are the common causes of chronic anovulation?

A
  • Thyroid dysfunction
  • Hyperprolactinemia
  • PCOS
    *Pituitary and hypothalmic disorders
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21
Q

What is the role of lifestyle modifications in treating hypothalamic amenorrhea?

A

Reversible with weight restoration and stress reduction

Addressing lifestyle factors can restore normal menstrual function.

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22
Q

What is the purpose of measuring lactin levels?

A

To rule out hyperprolactinemia

Hyperprolactinemia can disrupt menstrual cycles and affect fertility.

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23
Q

What hormones are evaluated to assess for hypothyroidism?

A

TSH and Free T4

These hormones help determine thyroid function.

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24
Q

What imaging technique is used to evaluate pituitary tumors?

A

MRI of the brain

MRI can help visualize abnormalities in the pituitary gland.

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25
Q

What lifestyle interventions can help manage chronic anovulation?

A

Weight gain, stress reduction, moderate exercise

These changes can improve ovarian function.

26
Q

What is the treatment for hypothyroidism?

A

Levothyroxine

Levothyroxine is a synthetic thyroid hormone.

27
Q

How is hyperprolactinemia managed?

A

Dopamine agonists (cabergoline, bromocriptine)

These medications help lower prolactin levels.

28
Q

What is ovulation induction?

A

Pulsatile GnRH therapy or gonadotropins if pregnancy is desired

These therapies stimulate ovarian function.

29
Q

What hormone replacement therapy is used for estrogen deficiency?

A

Hormone replacement therapy (HRT)

HRT helps alleviate symptoms related to low estrogen levels.

30
Q

What is the most common complication of amenorrhea in nonpregnant patients?

A

Infertility

Amenorrhea often indicates underlying reproductive issues.

31
Q

What are long-term effects of estrogen deficiency?

A
  • Osteoporosis
  • Atrophic vaginitis
  • Cardiovascular risks

These effects can significantly impact women’s health.

32
Q

What risks are associated with progesterone deficiency?

A

Endometrial hyperplasia & cancer risk

Unopposed estrogen can lead to abnormal growth of the endometrium.

33
Q

What does FSH and LH testing evaluate?

A

Ovarian function

These hormones are crucial for normal ovarian activity.

34
Q

What does a pelvic ultrasound assess?

A

Uterus, ovaries, and outflow tract

Ultrasound is a non-invasive method to visualize reproductive organs.

35
Q

What is primary amenorrhea?

A

Lack of menses due to abnormal ovarian function

Primary amenorrhea often indicates developmental or genetic issues.

36
Q

What is dysmenorrhea?

A

Painful menstruation in the absence of structural abnormalities

This condition is often linked to excessive prostaglandin production.

37
Q

What is endometriosis?

A

Presence of endometrial tissue outside of the uterine lining

Endometriosis can cause significant pain and fertility issues.

38
Q

What is pelvic inflammatory disease (PID)?

A

Acute infection of the upper genital tract

PID can lead to chronic pelvic pain and infertility if untreated.

39
Q

What are the common non-neoplastic ovarian masses?

A

Cysts

Most ovarian masses are benign and related to normal ovulatory cycles.

40
Q

What is abnormal uterine bleeding (AUB)?

A

More common consequence of uterine conditions

AUB can result from various benign and malignant causes.

41
Q

What do endometrial polyps represent?

A

Outgrowths of endometrial (glandular) tissue into the lumen of the uterus

Polyps can cause intermenstrual bleeding.

42
Q

What is endometrial hyperplasia?

A

Increased gland:stroma ratio due to excessive estrogen stimulation

This condition can predispose to endometrial carcinoma.

43
Q

What are risk factors for cervical dysplasia?

A
  • HPV infection
  • Tobacco use
  • Immunosuppression
  • Multiple sexual partners

High-risk HPV strains are particularly concerning.

44
Q

What is the function of the Pap test?

A

Early detection of cervical atypia and dysplasia

Regular Pap tests can prevent cervical cancer.

45
Q

What are common symptoms of vaginitis?

A
  • Pain
  • Pruritus
  • Burning
  • Erythema

Symptoms vary based on the underlying cause of inflammation.

46
Q

What is one method of contraception that is non-hormonal?

A

Non-hormonal IUD

IUDs provide effective contraception through uterine irritation.

47
Q

What is a significant risk associated with hormonal contraceptives?

A

Increased risk of thromboembolism

Hormonal methods can affect coagulation pathways.

48
Q

What is essential to remember about contraception effectiveness?

A

Nothing is 100% effective

There is often a gap between ideal and actual use.

49
Q

What makes it difficult for early detection of tumours in the breast?

A

large amounts of adipose tissue

50
Q

What factors can influence GnRH secretion?

A
  • Central: Stress, emotional factors
  • Peripheral: Body fat, energy balance
51
Q

True or False: A common presentation of GnRH dysfunction is amenorrhea (e.g., athletic young women)

A

True

52
Q

How does a pelvic infection typically present?

A
  • Abdominal & pelvic pain
  • Fever & elevated white blood cell count
  • Positive endocervical culture

Importance of early treatment: Aggressive screening & antibiotics prevent permanent damage

53
Q

Please review the following conditions that may cause amenorrhea

A
54
Q

What are some causes of uterine disorders?

A
  • Postpartum endometritis.
  • Curettage complications.
  • Chronic infection or inflammation.
55
Q

How would you diagnose a uterine disorder?

A
  • Clinical history of curettage or infection.
  • Ultrasound findings: Thin endometrial lining (<5 mm)
56
Q

Treatment for uterine disorders

A
  • goal is to establish a functional endometrium
  • hormonal therapy may include: progesterone alone or sequential estrogen and progesterone

Note: Renewed vaginal bleeding after stopping hormonal therapy suggests an intact endometrium (successful treatment)

57
Q

difference between endometrial vs. endocrine causes of uterine disorders

A

ENDOMETRIAL CAUSE:
- Failure to regenerate endometrium.
- No withdrawal bleeding after hormonal therapy

ENDOCRINE CAUSE:
- insufficient cyclic estrogen/progesterone stimulation.
- Withdrawal bleeding indicates that the amenorrhea is due to an endocrine defect.

58
Q

What is secondary ovarian insufficiency?

A

Ovaries are normal, but lack gonadotropin stimulation from the brain

59
Q

What hormonal profile is associated with Secondary Ovarian Insufficiency?

A

low estrogen and progesterone production

Causes include: hypothalamic dysfunction (stress, excessive exercise, weight loss), pituitary disorders (tumors, Sheehan’s syndrome)

60
Q

Diagnosing POI

A

Hormonal testing:
* ↑ FSH & LH → ovarian failure.
* ↓ Estrogen → estrogen deficiency symptoms.

Karyotyping:
* Essential in any amenorrheic woman <30 years with high FSH/LH
* Detects Turner syndrome, mosaicism, or Y chromosome presence

Autoimmune screening:
* If suspected, check for thyroid, adrenal, and pancreatic autoantibodies

61
Q

Management/Treatment of POI

A
  • Hormone Replacement Therapy (HRT) Prevents complications of estrogen deficiency (bone loss, cardiovascular risk).
  • Fertility Considerations: Most patients require assisted reproduction (IVF with donor eggs).
  • Rare cases of spontaneous ovarian activity (5–10%).
  • Monitoring for Autoimmune Disorders: Regular screening for associated endocrine conditions.

BMS250 (15 decks)

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