Reproductive disorders part 2. lecture 8 Flashcards
What is PCOS?
The association of hyperandrogenism with chronic an ovulation in women without underlying diseases of the adrenal or pituitary glands.
What is PCOS characterised by?
Raised LH and Testosterone levels due to hypothalamic-pituitary-ovarian axis dysfunction
What may PCOS present with?
Hirsutism (male like hair growth), acne and obesity.
What is the american and european guideline for PCOS diagnosis?
America, must have
- Polycystic ovaries
- Androgen excess
- Anovulation
Europe only requires 2/3 of those symptoms.
How many women have polycystic ovaries and get PCOS?
20% have polycystic ovaries and 5% have PCOS
How does PCOS symptoms develop?
The ovaries are enlarged by a peripheral ring of follicles and stromal hypertrophy.
A fall in SHBG results in excess unbound testosterone as well as excess androgen production from adipose tissue.
What are some possible pathogenesis of PCOS?
HPA ABNORMALITIES causing excess GnRH and LH, resulting in increase ovarian androgen production.
ENZYMATIC DEFECT of ovarian steroidogenesis favouring excess androgen production.
INSULIN RESISTANCE drives the metabolic and reproductive abnormalities in PCOS.
What is menorrhagia?
Abnormally heavy and prolonged menstrual cycle.
What can menorrhagia lead to?
Social anxiety
If blood loss is greater than iron reserves, may lead to anaemia
Do women with menorrhagia ovulate?
Ovulatory menorrhagia is more common
Non-ovulatory menorrhagia may lead to irregular heavy bleeding and occurs prior to puberty or prior to the onset of regular menstruation or in late 30’s. Also seen in PCOS.
What are the causes of menorrhagia?
Unexplained
Pelvic causes
- Fibroids
- Endometrial hyperplasia
- Adenomyosis
- Incomplete miscarriage
Systemic causes
- Platelet disorder
What is endometriosis?
Characterised by the presence or growth of endometrial cells outside the uterus usually in the peritoneal cavity, perhaps due to retrograde menstruation.
(most commonly on the ovary)
What happens to ectopic endometrium?
It responds to ovarian hormone production and proliferates
Can endometriosis be diagnosed on ultra sound?
No, needs a laparoscopic diagnosis
What are the symptoms of endometriosis?
Painful periods
Adhesions (uterine tube walls touch)
Subfertility
When would endometriosis occur?
Never before puberty, regresses with menopause
How many women have endometriosis?
5% asymptomatic women undergoing sterilisation have endometriosis
20% Women with chronic menstrual pain have endometriosis
20%infertile women have endometriosis
60% of women with endometriosis are infertile or sub fertile.
What is dysmenorrhoea?
Painful periods that are accompanied either by sharp intermittent pain or dull aching pain usually in the pelvis or lower abdomen. Some pain during menstruation is normal but dysmenorrhea refers to pain that is severe enough to limit normal activities or require medication.
What are the classifications of dysmenorrhoea?
Primary: Menstural pain in otherwise healthy women.
Secondary: Menstural pain that is attributed to some underlying disease process or structural abnormality such as PID or Endometriosis.
Whom is dysmenorrhoea common in and whats the cause?
Mostly common in young women and is thought to be caused by a spasm of the myometrium possible in response to prostaglandins.
What is PMS?
Defined as re-occuring psychological and or physical symptoms which occur specifically in the luteal phase and are relieved by menstruation.
Who does PMS occur in?
80% of women have mild symptoms.
Mostly over thirty years
What is a clinical characteristic for PMS diagnosis?
Symptomless week post mensturation
What are the psychological symptoms of PMS?
Irritability Agression Tension Anxiety Depression Inability to concentrate
