Reproduction Flashcards
What does “ectopic” mean?
“Ectopic” refers to a normal process occurring in an abnormal location.
What is an ectopic pregnancy?
An ectopic pregnancy is a pregnancy that occurs outside the uterus.
Where do most ectopic pregnancies occur?
About 95% of ectopic pregnancies occur in the fallopian tubes.
Why is an ectopic pregnancy dangerous?
If the fertilized egg attaches to a blood vessel in the tube wall, the pregnancy may continue, but the fallopian tube will rupture when the fetus is 6-9 weeks. This can lead to life-threatening hemorrhage because the tube wall is highly vascular.
What increases the risk of an ectopic pregnancy?
Anything that can cause fallopian tube stenosis, meaning sperm can pass through but a fertilized egg is too large and gets stuck.
What are the common risk factors for fallopian tube stenosis?
• History of pelvic inflammatory disease (PID)
• Ruptured appendix (infection affecting the fallopian tube)
• Endometriosis
• Tubal ligation reversal
• Damage from surgical procedures
• Trauma
What are the signs and symptoms of a ruptured ectopic pregnancy?
• Acute onset of intense, sharp pain in a lower abdominal quadrant
• Abdominal distension becomes apparent
• Signs of shock that progress quickly
• Possibly vaginal bleeding, but it is not a reliable indicator
Why is a ruptured ectopic pregnancy a medical emergency?
The fallopian tube is highly vascular, meaning rupture can cause severe hemorrhage, which can be life-threatening.
What should a massage therapist be aware of regarding ectopic pregnancy?
Massage therapists should maintain awareness of patients with a higher risk of ectopic pregnancy, especially those with the listed risk factors.
What is Pelvic Inflammatory Disease (PID)?
PID is a disseminated infection in the pelvoabdominal cavity. It is typically bacterial, but can occasionally be fungal.
Who can develop PID?
PID is most commonly associated with women due to the reproductive tract being the usual entry point for infection. However, it can occur in either gender in some instances, such as:
• Infected penetrating wounds
• Abdominal surgery infections
• Internally generated infections (e.g., ruptured appendix)
What are the most common sources of infection for PID in women?
• IUDs (intrauterine devices)
• Complications from childbirth, miscarriage, or abortion
• Gynecological surgeries
• Gonorrhea
How does PID typically progress in the female reproductive tract?
The infecting organism usually enters via the vagina or uterus, where symptoms may be minimal due to local immune responses.
What marks the beginning of a more dangerous phase of PID?
Fallopian tube infection (salpingitis).
Why is salpingitis dangerous?
• The fallopian tubes provide an ideal environment for bacterial growth.
• Their narrow passageways can become blocked, making it harder for immune cells to fight the infection.
• Bacteria can cause erosion or rupture of the tube walls.
• Bacteria can spread into the pelvic basin, where the pelvoabdominal structures provide warmth and vascularization, allowing rapid bacterial proliferation.
What makes PID particularly serious?
If bacteria enter the peritoneum, peritonitis can develop, leading to rapid infection spread throughout the abdominal cavity.
What are the general signs and symptoms of PID?
• Often very few symptoms at first, sometimes none
• Green, creamy (pus-like) vaginal discharge
• Localized pain if salpingitis causes wall damage
• Slow onset of fever and malaise
• Abdominal pain and cramping
• Constant fatigue
• Dysmenorrhea (painful menstruation)
• Dyspareunia (deep, achy pelvic pain after intercourse, especially in females)
Do men experience the same symptoms as women?
Men will have symptoms that are not specific to the female reproductive system (e.g., fever, malaise, abdominal pain).
What are the potential complications of PID?
• Ectopic pregnancy (due to fallopian tube scarring/stenosis)
• Reduced fertility or infertility (due to fallopian tube blockage)
• Abscess formation in visceral organs
• Intestinal stenosis, increasing risk of obstruction
• Abdominal cavity adhesions
• Severe cases can lead to septicemia (systemic infection in the blood)
How is PID treated?
• Antibiotics or antifungal medications, often in a prolonged course
• Lifestyle modifications (e.g., improving diet, sleep, relaxation)
What are the massage considerations for active PID?
- Most abdominal massage is contraindicated.
- Relaxing reflexive techniques may be used to reduce pain and tension.
- Cool/cold abdominal hydrotherapy can help reduce pain and inflammation while promoting deep blood flow into the pelvoabdominal structures.
- Avoid manual manipulation, as it may spread the infection.
- Massage should be avoided if the patient has a high fever or is too ill.
- If septicemia risk is high, massage is contraindicated.
- The goal of massage should be to relax the patient and support immune resilience without overtaxing their system.
What are the massage considerations for a patient with a history of PID?
- Pelvoabdominal structures may be adhered, requiring a cautious, light approach.
- Deep specific techniques like frictions should be avoided, as they may damage visceral structures.
- PID may cause permanent weakening of visceral structures, requiring a gentler approach to abdominal work.
- Massage therapists should remain alert for signs of ectopic pregnancy or rapid-onset abdominal problems.
What is endometriosis?
Endometriosis is characterized by the presence of ectopic endometrium, meaning endometrial tissue and its blood/mucus product exist outside the uterus.
What are the most common locations for ectopic endometrial tissue?
Ovaries, fallopian tubes, uterine ligaments, and the pouch of Douglas (fold of peritoneum between the uterus and rectum).
Can endometriosis spread beyond the pelvic area?
Yes, it can disseminate in the pelvoabdominal cavity and, in rare cases, reach distant sites like the brain, lungs, and muscle tissue.
What are the known causes of endometriosis?
Most cases are idiopathic, but known causes include:
• Uterine surgery complications, torn uterus from childbirth, injury, or IUD use.
• Strong menstrual cramping pushing endometrial tissue out through the fallopian tubes.
At what age does endometriosis typically onset?
• Dysmenorrhea (painful menstruation)
• Hypermenorrhea (excess menstrual flow)
• Polymenorrhea (abnormal menstrual frequency)
• Pain with ovulation
• Dyspareunia (deep pelvic pain after intercourse)
• Intestinal irritation (cramping, fluctuating diarrhea/constipation)
What is the congenital theory of endometriosis?
Some cases may originate from endometrial precursor tissue that was misplaced during fetal development.
What lifestyle factor may contribute to endometriosis?
A high-stress lifestyle may be a factor.
How does ectopic endometrial tissue behave in response to hormones?
It responds to monthly hormonal stimulation by producing endometrium, which accumulates around the ectopic membranes without an exit route.
How does ectopic endometrial tissue affect its surrounding structures?
It attaches to neighboring tissues’ blood supply and causes:
- Pain, inflammation, and tissue damage from blood product irritation.
- Organ damage (e.g., thick “chocolate cysts” in ovaries/kidneys).
- Spread of endometrial tissue, leading to adhesions, stenosis, and torsion.
Do all endometriosis sufferers have symptoms?
No, symptoms vary from none to severe chronic pain.
What are typical pelvoabdominal symptoms of endometriosis?
How does the progression of pain typically occur in endometriosis?
Initially, dysmenorrhea is the primary symptom, but over time, constant pain from intestinal and visceral irritation may develop.
Why do some women with severe endometriosis require multiple surgeries?
They may need surgeries to correct intestinal stenoses, erosions, blockages, or to remove damaged organs (e.g., ovaries).
What are the potential complications of endometriosis?
• Ectopic pregnancy (due to fallopian tube scarring/stenosis)
• Reduced fertility or infertility (fallopian tube blockage, ovary damage)
• Intestinal stenosis and risk of obstruction
• Abdominal adhesions
• Permanent damage to affected structures
• Chronic pain complications (depression, painkiller addiction)
What is considered the best response to an endometriosis diagnosis?
Getting pregnant, as pregnancy suppresses endometrial stimulation and may cause ectopic tissue to die off.
What are the first-line drug therapies for endometriosis?
• Continuous birth control pills (simulate pregnancy for 1 year)
• Estrogen-suppressing drugs (e.g., Danazol)
• Testosterone therapy (suppresses estrogen effects)
Why might drug therapy be discontinued?
Many women cannot tolerate the side effects of hormonal treatments.
What are the surgical treatment options for endometriosis?
• Endoscopic investigation with laser destruction of ectopic tissue (effective if all tissue is detected).
• Hysterectomy (removal of uterus), but results are mixed and controversial.
What ultimately stops endometriosis activity?
Menopause, as it ends hormonal stimulation.
What types of massage should be avoided for endometriosis patients?
Deep manual work, as it may disseminate endometrial tissue and damage stressed structures.
What considerations should an RMT have regarding surgical history?
Be prepared to work appropriately with patients who have had recent or prior surgeries.
How might medications affect RMT treatment planning?
Many endometriosis patients take analgesics and anti-inflammatories, while hormonal therapies may cause physical and emotional changes.
Why is drug addiction a concern in endometriosis patients?
Endometriosis is one of the most painful chronic conditions, leading some sufferers to overuse analgesics, prescription drugs, or recreational drugs.
How can an RMT support a patient emotionally?
By providing a supportive listening role, in addition to the physical benefits of massage therapy.
How can endometriosis support groups help?
They offer valuable emotional and informational support—RMTs should be aware of local groups.
What are uterine fibroids (leiomyomas)?
Uterine fibroids are benign tumors of the muscular layer of the uterus (myometrium).
How common are uterine fibroids?
They are very common, and most women are believed to have some fibroid formation, though many are asymptomatic.
What factors influence the development of uterine fibroids?
The exact cause is unclear, but fibroids are estrogen-consuming tumors, and inheritance plays a role. Some families have a tendency for large fibroid development.
Which ethnic group is more likely to develop large problematic fibroids?
Black women are significantly more likely to develop large fibroids than women of other ethnic backgrounds.
What are the three main categories of symptoms associated with uterine fibroids?
- Compression Symptoms
- Signs of ↓ Estrogen
- Bleeding
What compression symptoms can large fibroids cause?
Large fibroids can compress structures like the bladder, sacrum, rectum, and local nerves. Compression symptoms may only occur in specific positions.
Why might some fibroids not cause significant compression symptoms?
Fibroids that project upward into the abdomen can be quite large without causing significant compression.
How can fibroids lead to estrogen deficiency symptoms?
Since fibroids consume estrogen, a significant tumor load can reduce available estrogen, leading to diminished or lost menstruation and other perimenopausal symptoms.
How do fibroids cause bleeding?
• Smaller fibroids can disrupt the endometrium, stressing or breaking through the uterine lining.
• The uterus is highly vascular, and strong contractions during menstruation can lead to heavy bleeding.
• Some women experience anemia due to excessive menstrual bleeding.
• Bleeding between menstrual cycles may also occur.
How do uterine fibroids behave during pregnancy?
How do uterine fibroids behave during pregnancy?
What happens to fibroids after menopause?
They are expected to shrink or disappear.
What is the physical consistency of fibroids?
Fibroids are dense, firm structures.
Are fibroids painful or fragile to palpation?
No, they are not painful or fragile to palpation.
How are fibroids typically detected?
They are often palpable via the abdomen, especially if located superiorly.
What are the main medical treatments for fibroids?
- Surgical treatment: Hysterectomy or myomectomy.
- Drug therapy: Estrogen-suppressing drugs to shrink fibroids.
- Experimental treatment: Local infarction (blocking arterial branches to fibroids).
What is an ovarian cyst (cystadenoma)?
An ovarian cyst is a growth that develops from unruptured graafian follicles or corpus luteum follicles.
How do ovarian cysts form?
During the female cycle, a group of eggs matures, and one fully developed egg is ejected during ovulation. If the follicle does not rupture properly, it can develop into a cyst.
What is the corpus luteum?
After ovulation, the emptied follicle becomes the corpus luteum, which produces hormones for the remainder of the cycle.
What factors may contribute to ovarian cyst formation?
The exact cause is unclear, but hormonal factors are presumed to play a role.
What are ovarian cysts composed of?
They consist of cystic chambers that can be filled with:
• Serous fluid
• Mucus
• Tissue debris
• Blood (in some cases)
How large can ovarian cysts grow?
They can grow to be quite large.
Are ovarian cysts typically symptomatic?
They are often asymptomatic, but pain can occur with ovulation.
How do ovarian cysts feel upon palpation?
They are soft, spongy, and not precisely palpable. However, they may become more palpable if they shift the placement of other organs.
Why are ovarian cysts considered unstable?
Because ovaries are highly vascular, if an ovarian cyst (cystadenoma) tears or ruptures, there is a risk of serious hemorrhage.
What increases the risk of cyst rupture?
The risk increases with size—cysts larger than 3-5 cm are carefully monitored.
What precautions should massage therapists take regarding ovarian cysts?
• Never apply direct pressure over the ovaries.
• Since many women are unaware of having ovarian cysts, universal precaution is appropriate.
• If a client is known to have an ovarian cyst, avoid local direct massage techniques, considering the size and position of the cyst.
What is another name for Polycystic Ovarian Syndrome (PCOS)?
Stein-Levanthal Syndrome.
Who is primarily affected by PCOS?
Young women.
What characterizes the ovaries in PCOS?
Both ovaries tend to be multicystic.
What causes PCOS?
It appears to be a dysfunction of the hypothalamus cycling center, preventing ovulation.
What are the main symptoms of PCOS?
• Obesity
• Infertility
• Hirsutism (excessive hair growth)
• Greater risk of breast and uterine cancer due to a high estrogen state
What is cervical cancer?
Cancer of the cervix, which was once the most common female cancer and a leading cause of female death before PAP smear testing.
How has cervical cancer treatment improved?
The PAP smear allows for early detection, enabling effective treatment in pre-cancer or cancer-in-situ stages, leading to a very good prognosis.
What is the primary cause of cervical cancer?
The majority of cases are believed to be caused by the human papilloma virus (HPV).
What are the risk factors for cervical cancer?
• Young cervical trauma or early PAP smear (highest risk: ages 12-16)
• 5+ vaginal births
• Chronic irritations, infections, STDs, venereal warts
• Numerous sexual partners
• Poor sexual partner/sex toy hygiene
• Smoking
What are the early signs of cervical cancer?
• Typically none
• Leucorrhea (abnormal vaginal discharge)
• Spotting, especially after sexual activity
How can cervical cancer be prevented?
• Delay first sexual activity/PAP smear until after 19
• Good sexual hygiene practices
• Use barrier methods of birth control
• Avoid penetrating sexual practices during menstruation
• Regular PAP smears
• Avoid smoking
• HPV vaccination
What is the leading cause of gynecological cancer death?
Ovarian cancer
What age group is most affected by ovarian cancer?
Women over 55; younger onset is typically linked to genetics.
What is the most common type of ovarian cancer?
Cystadenocarcinomas, originating in ovarian follicles.
What are the risk factors for ovarian cancer?
• Family history of ovarian cancer
• Personal or strong family history of uterine, colon/rectal, or breast cancer (especially young onset)
• Use of hormone replacement therapy (HRT), especially for 10+ years or estrogen-only type
• Nulliparity (no pregnancies)
• Endometriosis (may contribute some risk)
• More common in industrialized nations (except Japan)
• Many idiopathic factors (unknown causes)
Why is ovarian cancer difficult to diagnose early?
Early symptoms are nonspecific and mimic common digestive and bladder issues. Symptoms are often persistent and gradually worsen rather than fluctuating like typical digestive disorders.
What are the early symptoms of ovarian cancer?
• Abdominal pressure, fullness, swelling, or bloating (tight-fitting clothes)
• Vague, non-specific abdominal pain
• Pelvic discomfort or achiness
• Low back pain, possibly radiating down the legs
What are additional signs and symptoms of ovarian cancer?
• Persistent indigestion, gas, or nausea
• Urinary urgency or frequency
• Unexplained changes in bowel habits (diarrhea or constipation)
• Loss of appetite
• Unexplained weight loss or gain
• Lower half of body feels thick or heavy
• Dyspareunia (pain during sex)
• Persistent fatigue, lack of energy
• Less common: abnormally heavy period, postmenopausal vaginal bleeding
When should a person take action regarding symptoms of ovarian cancer?
If symptoms last more than 2-3 weeks.
Why is ovarian cancer dangerous in terms of metastasis?
The ovary is the most common metastatic site for abdominal/pelvic cancers.
Can ovarian cancer be detected through palpation?
• Cystadenocarcinomas tend to be soft and not reliably palpable.
• Other solid ovarian tumors may be more easily palpable.
What is the most common gynecological cancer today?
Uterine cancer
What is the typical site of uterine cancer development?
It develops in endometrial tissues and is often linked to endometrial hyperplasia.
When is endometrial hyperplasia most common?
Toward the end of the menstrual years, as the estrogen/progesterone balance shifts.
What age group is most affected by uterine cancer?
• Typically over 50
• Very rare under 40
• Most cases occur in menopausal or postmenopausal women
• Caucasian predominance
What are the risk factors for uterine cancer?
• Prolonged estrogen replacement therapy
• Tamoxifen use
• High estrogen conditions (e.g., Stein-Levanthal Syndrome / PCOS)
• Personal or strong family history of high estrogen cancers (ovarian, breast types) or colorectal cancer
• Obesity (fat tissue forms estrogen)
• Obesity-related conditions (diabetes, hypertension)
• Nulliparity (no pregnancies)
What is the most common early symptom of uterine cancer?
Vaginal bleeding
What are other early symptoms of uterine cancer?
• Hypermenorrhea (excessive menstrual bleeding)
• Polymenorrhea (frequent menstrual cycles)
• Postmenopausal bleeding
• Leucorrhea (abnormal vaginal discharge)
• Difficult or painful urination
• Dyspareunia (pain during sex)
• Pain in the pelvic region
