Reproductive pathologies Flashcards
Amenorrhoea
- Absence of menstruation
Causes:
* Primary; mostly caused by congenital defects – failure of ovarian follicles to develop (Turner’s syndrome)
* Secondary; Pituitary tumour, PCOS, hypothyroidism, stress, anorexia excessive exercise (endorphins inhibit GnRH), uterine obstruction, medications (i.e. antipsychotics)
Signs and symptoms:
* Primary = failure of menses to occur by expected onset (16, 17 years)
* Secondary = lack of menstruation for three months in previously menstrual women
Dysmenorrhoea
- Painful periods
Causes:
Primary
* Excessive release of uterine prostaglandins during menstruation causing the myometrium to contract
* Usually occurs shortly (6-12 months) after menarche
* No association with identifiable pelvic disease
Secondary
* Associated with specific pelvic or systemic pathologies such as endometriosis, fibroids, pelvic inflammatory disease
Allopathic treatment:
* Contraceptive pill (inhibits ovulation), NSAIDs
Alternative treatment:
* Treat cause; e.g. hormone balancing, anti-inflammatory diet; seed cycling, magnesium, B vitamins, omega-3/6, address iron deficiency anaemia if heavy bleeding
Other:
* Raised prostaglandins may be due to low progesterone before mensus
Premenstrual Syndrome
(PMS)
- Cyclical, physiological, psychological and behavioral changes during the luteal phase (second half of cycle)
Causes:
* Definitive cause unknown - variable
* Hormone imbalance; rapid shifts in levels of oestrogen and progesterone, which influence neurotransmitters
* Drop in progesterone in the luteal phase of the cycle and an increased production of prostaglandins
* A serotonin deficiency is thought to be a key neurotransmitter relationship
Signs and symptoms:
Over 150 symptoms have been attributed to PMS; Tension, anxiety, reduced concentration, aggression, depression, listelessness, confusion, fatigue, insomnia, headache (migraines), bloating, oedema, backache, pelvic pain, aching legs, ovarian pain, sweating, hot flushes, bladder problems, constipation, weight gain, fluid retention, low blood sugar, cravings, pica, increased appetite, thirst, breast tenderness, greasy skin & hair, pimples, palpitations
Allopathic treatment:
* Oral contraceptive pill
* Counselling
Alternative treatment:
* Support hormone and blood sugar dysregulation (low GL diet), Vitamin B6
* Exercise (decreases anxiety, stress hormones, blood glucose control). Normalise sleeping pattern
* Homeopathy, acupuncture, herbal medicine (e.g. Agnus Castus, St John’s Wort)
Pelvic Inflammatory Disease (PID)
- An infectious & inflammatory disorder of the upper female genital tract including the uterus, fallopian tubes & ovaries
Causes:
* Infection typically results from spread of microorganisms (bacteria) ascending from the cervix
* Sexually transmitted infective causes include Neisseria gonorrhoea and Chlamydia trachomatis
* Insertion of intra-uterine device (IUD)
* Abortion /delivery under non-sterile conditions
Signs and symptoms:
* Lower abdominal pain (gradual or sudden and severe) – may increase with walking
* Deep dyspareunia. Purulent discharge
* Occasional dysuria, fever, nausea and vomiting
Allopathic treatment:
* Antibiotics
Alternative treatment:
* Support immune system (nutrition, herbs, acupuncture, homeopathy)
Complications
* Ectopic pregnancy, infertility, peritonitis, abscesses and septicemia
Endometriosis
- Endometrial tissue found outside uterine cavity
Pathophysiology:
* Commonly affects ovaries, fallopian tubes, utero-sacral ligaments, pelvic cavity, intestines. Rarely more distant places; e.g. lungs, joints
* Affects 1 in 10 women, estimated that 30-4-% of women with infertility are affected.
* Greater risk with family history, women who haven’t given birth, menses <7 days.
* Ectopic endometrial tissue follows the menstrual cycle but there is no exit point for blood that accumulates during menstruation. This leads to irritation, inflammation and pain
Causes:
* Altered immune surveillance in pelvis, affecting the ability of the body to recognise ectopic endometrial tissue
* Oestrogen dominance
* Retrograde menstruation; migration of endometrial tissue back through the fallopian tubes or transplant of tissue during surgery
* Primordial cells lining other body cavities or organs differentiate into endometrial cells
* Transfer of tissue through blood and lymph
(primordial = cell in earliest stage of development)
Signs and symptoms:
* Dysmenorrhoea (painful)
* Menorrhagia (heavy)
* Pelvic pain occurring around menstruation, lessening after
* Dyspareunia
* Bloating, lower back pain
* Bowel changes; e.g. diarrhoea
* Infertility
Diagnosis:
* Ultrasound
* Laparoscopy
Allopathic treatment:
* Combined oral contraceptive pill.
* Surgery to remove ectopic tissue (45% grows back within a year)
Alternative treatment:
* Manage multifactorial influences. Reduce inflammation, encourage oestrogen clearance (cruciferous vegetables, supporting liver, detox (castor oil packs), fibre, no dairy)
* Immune support, gut bacteria
* Herbs, homeopathy, acupuncture
Complications:
* Recurrent inflammation leads to formation of fibrous tissue, which can produce adhesions
* Adhesions can obstruct the uterus or fallopian tubes, which can contribute to infertility
* Chocolate cysts – sac containing old blood
Fibroids
- Benign tumours of the myometrium of the uterus
- Can vary significancy in size and number
- Consist of smooth muscle cells and connective tissue
- More common in reproductive years, tend to subside post-menopause
Causes:
* Develop is linked to the levels of oestrogen and progesterone
* Increased risk with obesity (excess oestrogen), earlier menses, family history and the contraceptive pill
Signs and symptoms:
* 50-80% are asymptomatic
* Menstrual changes; menorrhagia (increased bleeding), prolonged menses, spotting mid cycle bleeding iron deficiency anaemia (fatigue etc.)
* Fibroids can press on bladder / rectum causing urgency, frequent urination, constipation
* Bloating & heaviness in abdomen
* Infertility (2-10% of infertility cases)
Diagnosis:
* Ultrasound
Allopathic treatment:
* NSAIDs
* Hormonal therapies (including OCP), surgery (myomectomy or hysterectomy)
Alternative treatment:
* Hormone balancing support (oestrogen detoxification) – dietary phytoestrogen
* Traditional herb protocols have been used to shrink uterine fibroids (i.e. scutellaria barbata).
* Acupuncture and homeopathy
Complications:
* Large fibroids can occlude their blood supply causing necrosis. They can calcify which causes pain
Ovarian Cysts
- Fluid filled sac within the ovary
Pathophysiology:
* Most common type is a follicular cyst; failure to ovulate and instead fills with fluid
Signs and symptoms:
* Often asymptomatic
* Dull ache or sudden sharp / severe pain if rupture
* Large cysts may affect bladder function
Diagnosis:
* Diagnosis is usually made by ultrasound and/or laparoscopy
Allopathic treatment:
* Surgery (>5cm)
Alternative treatment:
* Hormone balancing using herbs, acupuncture and diet.
* Homeopathy
Polycystic Ovarian Syndrome (PCOS)
An endocrine metabolic condition associated with;
1. Menstrual dysfunction
2. Ovulatory dysfunction
3. Hyperandrogenism
4. Metabolic disturbances; i.e. hyperinsulinaermia
It is important to distinguish between polycystic ovaries and PCOS. Polycystic Ovaries: The presence of many cysts within ovaries. At least one of the following criteria should be present to establish polycystic ovaries: 1) 12 or more follicles, 2) Increased ovarian volume (>10 cm3)
Pathophysiology:
1. Dysfunction of the hypothalamic-pituitary (HPO) axis:
- LH/FSH imbalance; high circulating LH promotes ovarian and androgen formation
2. Insulin resistance:
- Occurs in approx. 40% irrespective of body weight
- Suppresses sex hormone-binding globulin (SHBG) = free circulating androgens
- The excess androgen production will suppress ovulation
Signs and symptoms:
* Amenorrhoea / Oligomenorrhoea
* Lack of ovulation, Infertility, Increased risk of miscarriage
* Hirsutism (60-80%), Acne and oily skin
* Acanthosis nigricans, Alopecia / baldness
* Weight gain & difficulty losing weight
* Anxiety & depression
Diagnostics:
* Blood tests:
- Increased androgens
- Low sex hormone binding globulin (SHBG)
- High LH; Normal or low FSH
- Hyperinsulinemia & elevated blood glucose levels
* Ultrasound
* Laparoscopy
Diagnosis: The following diagnostic criteria must be present for PCOS diagnosis;
1. Oligo / anovulation AND / OR polycystic ovaries
2. Clinical or biochemical signs of hyperandrogenism (hirsutism, acne, elevated testosterone).
3. Exclusion of other causes of hormonal and metabolic dysfunction (androgen-secreting tumours, Cushing’s)
Allopathic treatment:
* Oral contraceptive pill and Metformin
* Anti0androgen topical creams
* ‘Clomiphene’ - stimulates ovulation
Alternative treatment:
* Weight loss and exercise, Low glycemic-load diet
* Nutritional supplements for blood sugar regulation. Spearmint tea ( androgens)
* Vitamin D, Chromian and cinnamon (insulin resistance)
* Hormone balancing using herbs, diet and supplements.
* Acupuncture and homeopathy
Complications:
* Infertility
* Amenorrhoea increase risk of endometrial cancer
* Increased risk of type II diabetes and cardiovascular disease
Ectopic Pregnancy
Fertilised ovum implants outside of the uterine cavity
Causes:
* Increased risk with intra-uterine devices and endometriosis
* May cause spontaneous abortion, haemorrhage and peritonitis
* Initially causing no symptoms but amenorrhea
* Unilateral pelvic pain and vaginal bleeding
* If ruptures: sudden acute abdominal pain
* Generally 6-8 weeks after ovulation
Other:
Can occur in the fallopian tubes (97%), ovary, cervix, abdomen
Ectopic = abnormal location
Infertility
Failure to conceive after one year of unprotected intercourse
Causes:
* Male 40%; low sperm count, poor sperm viability or motility, blocked sperm ducts, undescended testes, metal toxicity, smoking
* Female 40%; PCOS, endometriosis (blocked fallopian tubes), fibroids, PID, menopause, hypothyroid, STI’s
* Both 20%; Toxicity, radiation, malnutrition, body weight, smoking / alcohol, stress
Allopathic treatment:
* Clomiphene (induces ovulation)
* IVF
Alternative treatment:
* Treat cause;
* Weight management can normalize hormone levels.
* Both males & female to be treated
* Detoxification & healthy diet
* Acupuncture and homeopathy
In-Vitro Fertilisation
(IVF)
Artificial fertilsation of the ovum by sperm outside the body – ‘in vitro’
Pathophysiology:
The process involves:
1. The drug clomiphene causes oocytes to develop
2. Eggs retrieved from ovaries, examined and incubated with sperm on a petri dish to allow fertilisation to occur (or sperm injected into egg)
3. The embryo is then transferred to the uterus with the intent to establish a successful pregnancy
Other:
* When other methods of assisted reproductive technology have failed.
* Success rates; 32.3% women under 35, 27.7% aged 35-37, 20.8% aged 38-39, 13.6% aged 40-42
Breast cancer
Most common female cancer
Causes:
* Family history (breast, ovarian cancer) and age
* Genetic mutations in BRCA1 OR BRCA2
* Poor diet and sedentary lifestyle, regular alcohol intake and smoking
* Oestrogen excess
Signs and symptoms:
* Asymptomatic usually
* Painless, unilateral fixed lump
* Overlying skin changes; i.e. dimpling, ‘orange peel’ appearance
* Inverted and discharging nipple
* Enlarged axillary lymph nodes
Diagnosis:
* Mammography (X-rays)
* Thermography (safer and more
effective method of detecting earlier cell changes)
Allopathic treatment:
* Radiotherapy, surgery, tamoxifen (blocks oestrogen receptors)
Alternative treatment:
* Support; plant-based diet, diet high in fruit, vegetables
* Ozone therapy
* Herbs – medicinal mushrooms, Homeopathy and acupuncture
Complications:
* Metastatic spread via lymphatics
Other:
* 80% of breast cancers are oestrogen dominant
Balanitis
Inflammation of the glans penis
Causes:
* Infectious: bacterial or fungal e.g. candida albicans
* Non-infectious: Lichen sclerosus (autoimmune), eczema, psoriasis, inadequate cleaning under foreskin
* Phimosis (foreskin narrowing, preventing retraction)
Signs and symptoms:
* Pain, irritation, dyspareunia
* Chronic infections can result in foreskin fibrosis
Allopathic treatment:
* Antibiotics, surgery, hygiene
Alternative treatment:
* Anti-microbial herbs, support immunity with herbs and supplements, homeopathy
Prostatitis
Inflammation of the prostate gland that can be infectious (bacterial) or non-infectious
Causes:
* Can be associated with UTI’s, or STI’s
Signs and symptoms:
* Recurrent UTI’s; increased urinary frequency, urgency, dysuria, nocturia, hesitancy and incomplete voiding
* Painful ejaculation, fever & malaise
Allopathic treatment:
* Antibiotics
* Painkillers
Alternative treatment:
* Immune supporting nutrients and herbs, quercetin, zinc, selenium
* Homeopathy and acupuncture
Other:
* 8% of men have prostatitis at some point in their lives
Undescended Testes
One testicle fails to descend in late foetal development & remains in the abdomen
Causes:
* Unclear; may be hormonal or structural
* Premature birth (affects 30% of premature boys)
Allopathic treatment:
* May descend independently a few months after birth
* hCG injection (acts like LH, increases testosterone)
* Surgery (6-18 months)
Alternative treatment:
* Acupuncture and homeopathy
