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
What are the physical symptoms of PMS?
Abdominal bloating breast tenderness constipation pelvic pain headache
What are the disorders of pregnancy?
Miscarriage
Premature or preterm labour
Ectopic Pregnancy
Pre-eclampsia
Whats the most common complication of pregnancy?
Miscarriage
Define miscarriage:
Miscarriage/spontaneous abortion is the natural or spontaneous end of pregnancy at a stage where the embryo or the foetus is incapable of surviving, generally defined at a gestation of prior to 20 weeks.
Define preterm birth:
Labour resulting in live birth before 37 weeks.
What is a still birth?
A foetus that dies in the uterus after 20 weeks of pregnancy
What is the fait of 100 fertilised eggs.?
31 fail to implant
69 implant of which 14 are miscarriages, 0.7 stillborn, 55 new borns
of the 55 newborns, 1 will have major congenital birth defects, 6 with minor congenital defects and 48 will be healthy.
What are the classifications of miscarriage?
First trimester (75%+) Second trimester
What are the causes of miscarriage in the first trimester?
- Chromosome abnormalities (found in 50% of miscarriages in the first 13 weeks)
- Genetic problems = 95% chance of miscarriage (older parents)
- Progesterone deficiency
- Problems with the placenta.
What are the causes of miscarriage in the second trimester?
Due to uterine malformation, growths in the uterus (fibroids) or cervical problems
Umbilical cord issues
Problems with the placenta
How many babies are born prematurely?
1 in 10
What risks are used by preterm births?
Greater risk of:
- Death
- Cerebral palsy
- Chronic lung disease
- GI problems
- Mental retardation
- Vision and hearing loss
What can cause preterm births?
- Previous history of preterm births or miscarriages
- Multiple pregnancies
- Uterine or cervical abnormalities
- Stress
- Preeclampsia
- Inadequate nutrition during pregnancy
What is an ectopic pregnancy?
When the fertilised ovum is implanted in any tissue other than the uterine wall. i.e tubal pregnancies (most common)
Where else can ectopic pregnancies occur?
2% in the ovary, cervix and intraabdominal.
What are risk factors for ectopic pregnancies?
- Smoking
- Age
- Prior tubal damage
- Previous ectopic pregnancies
What is pre-eclampsia?
Pregnancy induced hypertension- associated with high protein levels in the urine.
What is the cause of pre-eclampsia?
Unclear, but may be due to substances from the placenta causing endothelial dysfunction in maternal blood vessels
How many pregnancies are affected by pre-eclampsia?
6-8%
What parts of the female reproductive tract can develop gynaecological neoplasms?
Ovarian
Uterine/endometrial
Cervical
Vuvla
What type of gynaecological cancer is most lethal?
Ovarian as often found at late stage malignancy
What are the types of tumors in the ovaries?
- Benign tumors
- Borderline/low malignant potential tutors
Both of which turn into: - Malignant tumors (can start off here too)
What is the theory behind ovarian tutors?
Incessant ovulation hypothesis.
What is the incessant ovulation hypothesis?
Suggests that ovarian epithelial cells undergo several rounds of division and proliferative growth to heal the wound in the surface due to ovulation, thereby increasing the chance of genetic error occurring during the repair process.
What halves your chance of ovarian cancer.
Being on the pill
What are benign tumors of the uterus?
Fibroids are local overgrowths of smooth muscle cells in the uterine wall.
Whats the incidence of fibroids?
Common: 20% women, rarely become cancerous
What are the affects of fibroids?
Interfere with menstrual functions or may be asymptomatic
Oestrogen dependant and regress at menopause
Can become very large
What causes cervical cancer?
HPV infection
50% of women will have HPV at some point though not necessarily cancer.
What are some male reproductive disorders?
Intersex disorders Chromosome abnormalities (klinefelters) Cryptochordism Precocious or delayed puberty Erectile dysfunction Andropause Prostate cancer
What is cryptochordism?
Failure of testis to descend during fetal development from an abdominal position, through the inguinal canal and into the scrotum.
Whats the incidence of cryptochordism?
1% truly.
3% full term, 30% preterm however most testis descend during the first year of life.
What problems do cryptochrodism create?
- reduced fertility
- increased risk of testicular cancer
- psychological problems
Can be corrected with surgery
What is erectile dysfunction?
ED is the inability to achieve or sustain an erection for satisfactory sexual activity.
Varies in severity
What are the causes of ED?
Nonphysical:
- Psychological problems, stress, anxiety, depression, fatigue
Physical
- Diabetic neuropathy
- CV disease affecting pelvic blood supply
- MS
- hormonal disorders
- Smoking
- Prostate operations
What is andropause?
The male equivalent of menopause created by drug companies
Could truly happen in rare instances so low t levels would result.
