Reproductive System Flashcards
Name the 2 types of reproduction
Sexual, and asexual
Which 2 key process does sexual reproduction involve?
Meiosis and fertilisation
Define “reproduction”
The production of new offspring
What is a gamete?
A sex cell
Name an organism that reproduces asexually
Bacteria
What is produced via meiosis?
Male & female sex cells (sperm and ova)
How many chromosomes do gametes have?
23
Are gametes diploid or haploid cells?
Haploid (they contain half the amount of chromosomes)
What is another name for the male gamete?
Sperm
What is another name for the female gamete?
Ova
What is the name of the single cell created by the process of fertilisation?
A zygote
How many chromosomes does a zygote contain?
46 (a full set - 23 from the sperm and 23 from the ova)
What ensures genetic variability?
The mix of genes inherited by an offspring from each parent, via the process of meiosis and the fusing of the male and female gametes.
List 3 key functions of the female reproductive system.
- Formation of ova (female gametes)
- Reception of spermatozoa (male gametes)
- Provide a suitable environment for fertilisation/foetus
- Parturition (childbirth)
- Lactation
What is ‘parturition’?
Childbirth
Does the male or female reproductive system have more functions?
The female reproductive system has more functions
List 2 key functions of the male reproductive system
- Production of spermatozoa (male gametes)
2. Transmission of sperm to the female
Why do sperm have lots of mitochondria?
To give them lots of energy to swim
Name the accessory glands to the female reproductive system
The breasts
What are the mammary glands?
Exocrine glands that specialise in the production and ejection of milk.
They are essentially modified sweat glands that produce milk.
How do the mammary glands develop?
Gradually through pregnancy, where they get bigger and bigger under the influence of oestrogen.
Which hormone is responsible for the development and maturation of the mammary glands?
Oestrogen
Within the body, oestrogen is always promoting ______.
Growth
Which hormone causes the endometrium and myometrium (in the womb) to grow?
Oestrogen
Describe the lobes of the mammary glands
Each mammary gland consists of 15-20 lobes, separated by adipose tissue.
The lobes contain small grape-like clusters of glands called alveoli.
How many lobes does each mammary gland consist of?
15-20
Other than in the lungs, where else would you find ‘alveoli’ in the body?
In the mammary glands (within the lobes)
Which hormone stimulates lactation?
Oxytocin
What are the breasts supported by?
Suspensory ligaments
What supports the breast between the skin and the underlying fascia, keeping it in shape?
Suspensory ligaments
In regards to the breast, what is ‘dimpling’ and what can it be caused by?
Small, focused indentation in the breast. It can be caused by damage to the suspensory ligaments by a breast tumour.
What function does the male breast tissue have?
None. Male breast tissue is rudimentary.
What is growth of male breast tissue an indicator of?
Excess oestrogen (potentially caused by liver problems - not deactivating oestrogen as it should be doing)
What is lactation?
Milk secretion
Which cells, surrounding alveoli in the mammary glands, contract to help propel milk into lactiferous ducts?
Myoepithelial cells
Which hormone is stimulated by suckling, causing milk ejection?
Oxytocin
After birth, which hormone stimulates lactation?
Prolactin
Name the structure in the breast where milk is stored.
Lactiferous sinuses
Where is prolactin produced/released from?
The anterior pituitary gland
Where is oxytocin produced/released from?
The posterior pituitary gland
Which 2 hormones together result in lactation?
Oxytocin and prolactin
Which part of the female reproductive system contracts to initiate labour?
Uterus
List 3 functions of the uterus.
- Pathway for sperm
- Site of zygote implantation
- Location of foetal development
Name the 3 layers of tissue that make up the uterine wall.
- Perimetrium (outer layer)
- Myometrium (3 smooth muscle layers)
- Endometrium (inner layer)
Which layer of the uterine wall is highly vascular?
Endometrium
Name the 2 layers of the endometrium
Stratum Functionalis & Stratum Basalis
Which layer of the endometrium sloughs off during menses?
The stratum functionalis
How many smooth muscle layers does the uterus have?
3 - in the myometrium layer
Describe the uterus
The size and shape of a pear that has been inverted
What does ‘stratum’ mean?
Layer
What is the bleeding associated with the menstrual cycle caused by?
The breakdown of the stratum functionalis within the endometrium of the uterus.
What is endometriosis?
A condition where endometrial tissue leaves the uterus and deposits somewhere else (i.e, in the ovary, fallopian tube, or pelvis).
The uterus consists of 3 key anatomical areas. Name them.
The fundus, body and cervix
What is the fundus?
The top of the uterus
Which structure separates the body of the uterus from the vagina?
The cervix
Which hormone can sperm secrete to enable them to travel through the muscle of the cervix?
Relaxin
Where in the female reproductive system will most fertilisation take place?
The fallopian tube
What is the uterus held in place by?
Ligaments
Name one of the ligaments that hold the uterus in place
The broad ligament
Which organs sit anterior and posterior to the uterus?
Bladder (anterior)
Rectum (posterior)
What is the name given to a fertilised ova?
Zygote
What is the endometrium?
The highly vascular, inner layer of the uterus.
Which hormone maintains the endometrium for the second half of the menstrual cycle?
Progesterone
Which hormone builds the endometrium and which hormone maintains it?
Oestrogen builds it, progesterone maintains it.
What is the name given to a zygote, during its first 8 weeks of development?
Embyro
What does an embryo become after 8 weeks, until birth?
A foetus
What is the main role of the placenta?
To maintain the pregnancy. It is the site of nutrient and waste exchange between the mother and foetus, and produces hormones necessary for the pregnancy and labour.
What is the placenta directly attached to?
The endometrium
Once fully formed, how many distinct regions is the placenta divided into?
2 - the maternal side and the foetal side
Why is there a membrane separating the maternal and foetal sides of the placenta?
Because the baby’s circulation and the mother’s circulation are separate from each other. This is to prevent the sharing of substances that could be very harmful (protective barrier).
Which structure connects the embryo/foetus with the placenta?
The umbilical cord
How long is the umbilical cord?
50 - 60cms
At what point in the pregnancy is the placenta fully formed?
At 12 weeks, but it is fully functioning in it’s duties from 8 weeks.
What does the umbilical cord do?
Brings oxygen and nutrients to the foetus and removes wastes and carbon dioxide (the foetus doesn’t itself breathe, eat or eliminate whilst in the womb).
Give 4 examples of diseases/microorganisms/substances that can pass through the placenta during pregnancy.
- Measles
- Chickenpox
- HIV
- Polio
- Alcohol
- Many drugs
- Viral infections
- Stress hormones
Blood cells cannot cross the placenta. True or false?
True.
Give one reason why it’s important that blood cells cannot cross the placental membrane between mother and child.
They may have different, opposing blood groups.
List the hormones produced by the placenta.
Oestrogen Progesterone hCG (human Chorionic Gonadotrophin) hPL (Human Placental Lactogen) Relaxin CRH (corticotropin releasing hormone)
Why is it important that the placenta produces progesterone during pregnancy?
Because progesterone maintains the stratum functionalis layer of the endometrium, which sustains and nourishes the foetus.
What would be the result of a lack of progesterone during pregnancy?
Miscarriage
Why is it important that the placenta produces oestrogen during pregnancy?
Because oestrogen promotes growth of breast tissue and myometrium.
Which structure in the female reproductive system produces progesterone and oestrogen for the first 8 weeks of pregnancy?
Corpus luteum, in the ovary
Which of the placental hormones is only found in the body during pregnancy (pathologies aside), and therefore is detected for the purposes of pregnancy tests?
hCG - Human Chorionic Gonadotropin
Which hormone is associated with morning sickness?
hCG - Human Chorionic Gonadotropin
Which of the placental hormones can occasionally be found in men and can indicate testicular cancer?
hCG - Human Chorionic Gonadotropin
If a male did a pregnancy test and it was positive, which pathology could this indicate?
Testicular cancer (hCG is a testicular cancer marker)
What can the acupressure point PC6 (between the ligaments in the wrist) help with in pregnancy?
Relieving morning sickness and nausea
What is the role of the placental hormone Human Placental Lactogen (hPL)
Increasing the amount of glucose and fats in the maternal blood (to nourish the foetus)
Which body structures does the hormone Relaxin specifically work on?
Ligaments
Which placental hormone helps to increase pelvic space and pliability during childbirth?
Relaxin
What does CRH (Corticotropin Releasing Hormone) do?
Triggers release of cortisol from the adrenals.
What is the relevance of the hormone CRH in pregnancy?
It prevents rejection of the foetus and placenta by the mother (it slightly suppresses the immune system)
Which placental hormone stops the mother’s body rejecting a foetus?
Corticotropin Releasing Hormone (CRH)
Why do a lot of autoimmune conditions spontaneously resolve during pregnancy / for a few months afterwards?
Due to the slight suppression of the immune system by cortisol, released by the kidneys as a result of the placental hormone CRH.
What is placenta praevia?
A placental complication whereby the placenta attaches to the lower part of the placental wall, potentially blocking the opening of the cervix.
Why is the risk of placenta praevia higher with multiple births (twins/triplets)?
Because there are more placentas in the uterus.
Why is placenta praevia a problem in the 2nd or 3rd trimester of pregnancy?
Because the risk of detachment from the cervix and haemorrhage is high.
What can painless ante-partum vaginal bleeding in the 2nd or 3rd trimester of pregnancy indicate?
Haemorrhaged placenta praevia
What is the preferred form of delivery in a pregnancy with placenta praevia?
C-section
What is Placenta Accreta?
A placental complication whereby there is an abnormally deep attachment of the placenta through the endometrium, into the myometrium.
Name and explain the 2 types of Placenta Accreta
- Placenta Increta = The placenta invades the myometrium
2. Placenta Percreta = The placenta grows through the uterine wall into the surrounding viscera (i.e, the bladder)
What is the normal cause of Placenta Accreta?
The endometrium (stratum basalis layer) is too thin for the placenta to attach properly, so the placenta has to ‘dig in deeper’ when implanting.
Name 3 medical procedures that can make Placenta Accreta more likely in a future pregnancy.
- Previous C-Section
- Curettage (scraping procedure)
- Fibroid removal
What is the main risk posed by Placenta Accreta?
A post partum haemorrhage
What is a Placental Abruption?
Rupture of the blood vessels that adhere the placenta to the uterine wall.
Leads to separation of the placenta from the uterus.
List 2 risk factors for placental abruption.
Smoking Maternal hypertension (pre-eclampsia)
What does ante-partum mean?
Before birth
What are the 2 main signs of placental abruption?
Abdominal pain and ante-partum bleeding
What is pre-eclampsia?
Increase of the mother’s blood pressure during pregnancy
What is one of the main risks of pre-eclampsia?
Placental abruption
A placental abruption after 20 weeks of pregnancy is an obstetric emergency. Why is this?
Because the developing foetus is then starved of nutrients from the mother and wastes cannot be adequately removed.
What are monozygotic twins?
Identical twins (same genetic information)
What are dizygotic twins?
Non-identical twins
What type of siblings that result from the same pregnancy originate from a single fertilised ovum and share a single placenta?
Monozygotic (identical) twins
Are more twins monozygotic or dizygotic?
Dizygotic (non-identical) = 70%
Monozygotic (identical) = 30%
What is the role of the fallopian tubes?
- Provide a route for sperm to meet the ova.
2. Provide a route for the ova to reach the uterus
What is the name given to the finger-like projections that surround the ovary and sweep the ova into the fallopian tube?
Fimbriae
The fallopian tubes have 2 features that make them suitable for their role in carrying an ova from the ovary to the uterus. What are these features?
- Ciliated epithelial layer ‘sweeps’ the ova along.
2. Smooth muscle layer performs peristalsis to move the ova along.
What are the ovaries?
The female gonads, which exist as paired glands.
What do the ovaries look like?
Almonds!
What do the ovaries do?
- Produce female gametes
2. Secrete sex hormones oestrogen and progesterone
Which 2 hormones are created by the ovaries?
Oestrogen and progesterone
How many immature sex cells (gametes - eggs) are females born with and when do they mature?
Between 20,000 and 2 million
They mature at puberty
What are oocytes?
Ova / eggs
What is oogenesis?
The formation of female gametes (ova) in the ovaries
At what stage of life does oogenesis / the production of primary oocytes occur?
During foetal development. Women are born with a set amount of ova for life and will not produce any more after birth.
What is a secondary oocyte?
The fully-formed, mature form of an ova, which is suitable for fertilisation.
At what stage of a woman’s life do her primary oocytes become secondary oocytes?
Puberty
When in life does spermatogenesis begin?
Puberty
What is the significance of the layer of follicular cells that surround each primary oocyte?
Without this layer of follicular cells, the primary oocyte cannot mature into a secondary oocyte
What is a primordial follicle?
A primary oocyte surrounded by a layer of follicular cells.
Which hormone drives the process of sex cell development (primary oocyte –> secondary oocyte) in the female?
FSH (Follicle Stimulating Hormone)
What does FSH in the male body do?
Drive the development of sperm
What does FSH in the female body do?
Drives the maturation of primordial follicles, which in turn drives the development of primary oocytes into secondary oocytes and the production of mature follicles (ova)
A surge of which hormone triggers ovulation?
Luteinising Hormone (LH)
What is ovulation?
Release of a secondary oocyte
The follicular cells surrounding it get left behind and become the ‘corpus luteum’
What is the corpus luteum?
The follicular cells that remain after a secondary oocyte is released from the ovary (ovulation)
What is the significance of the corpus luteum?
It releases progesterone, and some oestrogen
Which structure is progesterone released from in the first 8 weeks of pregnancy?
The corpus luteum
List the 4 phases of the menstrual cycle and the key hormone involved in each phase.
- Menstrual phase - FSH
- Pre-ovulatory phase - Oestrogen
- Ovulation - LH
- Post-ovulatory phase - Progesterone
What is the average length of the menstrual cycle?
28 days, but there is a lot of variability
How long is the ovulation phase of the menstrual cycle?
1 day
In which phase of the menstrual cycle is the stratum functionalis shed?
Phase 1 - Menstrual phase
In which phase of the menstrual cycle is the corpus luteum essential in establishing and maintaining pregnancy?
Phase 4 - Post ovulatory phase
At what phase in the menstrual cycle does the hormone Inhibin kick in, and what does it do?
Phase 2 - Pre ovulatory phase
Inhibin decreases the production of FSH and stops other follicles (other than the one ‘chosen’ that month) developing.
Which gland secretes Luteinising Hormone (LH)?
Anterior pituitary
During the ovulation phase of the menstrual cycle, what does LH do in the ovaries?
LH causes rupture of the mature follicle and expulsion of the egg (ovulation)
Which 2 hormones control the action of the ovaries and which 2 hormones control the action of the uterus?
Ovaries = FSH & LH Uterus = Oestrogen & Progesterone
Which hormone, produced by the embryo, maintains and stimulates the corpus luteum to produce oestrogen and progesterone?
hCG - Human Chorionic Gonadotropin
Which hormone stops the corpus luteum from degenerating into the corpus albicans?
hCG - Human Chorionic Gonadotropin
Define ‘puberty’.
The period when the potential for sexual reproduction is reached.
At what age does puberty occur in females?
Between 10 - 14 years old
Pulses of LH and FSH, each triggered by bursts of GnRH (Gonadotrophin Releasing Hormone) from the hypothalamus, signify the onset of what?
Puberty in females
Define ‘menarche’
The first period / menses
At which defined points do the female reproductive lifetime start and finish?
Menarche = the start Menopause = the finish
Define ‘menopause’.
The permanent cessation of menstruation for 12 consecutive months.
A physiological process, NOT a pathology!
What is the average age of a woman going through menopause?
51 yrs
At what age does the menopause normally occur?
45 - 55 yrs
What causes menopause?
Ovarian ageing and depletion of oocytes.
Follicles are depleted, and subsequently progesterone and oestrogen levels decrease.
Which 2 female hormones rise in pre-menopause?
FSH & LH
What is the period leading up to the menopause called?
Perimenopause
List 5 signs & symptoms associated with the menopause
- Hot flushes & increased sweating
- Vaginal dryness
- Atrophy of mucosal lining
- Painful intercourse
- Mood changes, irritability, anxiety
- Dry mouth (xerostomia)
- Increased risk of UTI’s
- Decreased libido
- Sleep disturbances
- Breast shrinkage
- Osteoporosis
Where is sperm stored before ejaculation?
In the epididymis
Name the 2 basic parts of the penis.
The root and body
Where would you find the root of the penis?
Internally, within the pelvic cavity
How many cylindrical masses of erectile tissue are in the body of the penis?
3
In which 2 situations does the erectile tissue of the body of the penis fill with blood?
- During sexual arousal
2. During REM sleep
What is the name of the enlarged end of the penis?
The glans penis
Which gas, which causes vasodilation, is involved in gaining an erection?
Nitric Oxide
Why might arginine be a suitable supplement for someone with erectile dysfunction?
Because arginine is the amino acid that the body uses to create nitric oxide, which is the essential gas involved in the vasodilation that leads to getting an erection.
The process of getting an erection is controlled by which nervous system - the parasympathetic NS or sympathetic NS?
Parasympathetic nervous system
Why is stress often a cause of erectile dysfunction?
Because stress causes the sympathetic nervous system to kick in and vasoconstriction in the penis.
Vasodilation and the parasympathetic NS are needed for erection.
The testes develop in the pelvic cavity but at what point do they descend into the scrotum, via the inguinal canals?
7-9 months utero
What is the term given to the formation of sperm?
Spermatogenesis
Where does spermatogenesis take place?
In the testes (in the seminiferous tubules)
Which hormone is produced in the Leydig cells in the testes?
Testosterone
How long does the production of sperm take?
Around 70 days
What helps to propel sperm from the testes into the epididymis for maturation and storage?
Muscle in the testes (in the seminiferous tubules)
How many sperm are produced each day by spermatogenesis?
Around 300 million
Spermatogenesis occurs best at what temperature?
3 degrees below body temperature
Where is the nucleus found in a sperm?
In the head
How many chromosomes are contained within the nucleus in the head of a sperm?
23
What is the name of the vesicle covering the head of the sperm, which contains lysosomal enzymes to penetrate the egg?
The acrosome
Which structures are contained within the body of the sperm, and why are they important?
Mitochondria.
They create lots of energy to fuel the tail
Spermatozoa are expelled from the epididymis through the ____ ______ and into the _____ duct.
Vas deferens
Ejaculatory duct
What is significant about the ejaculatory duct?
Here the seminal fluid is secreted and mixed with the sperm.
Which 2 glands produce seminal fluid?
- Seminal Vesicles (behind the bladder)
2. Prostate Gland
Why are sperm mixed with alkaline fluid (ejaculate/seminal fluid)?
To give them some protection from the acid environment in the vagina
Why is ejaculate rich in nutrients (e.g fructose)?
To allow the sperm continued energy to swim.
What does the prostate gland do?
It secretes a thin, nutrient-rich, milky fluid that makes up 30% of semen.
This fluid also contains anti-coagulants to ensure that ejaculate is not too thick, and enzymes.
What can blood in the ejaculate indicate?
Prostate issues (including prostate cancer)
What is Prostate Specific Antigen (PSA)?
An enzyme that can be picked up on blood tests and used to assess the function of the prostate.
What is released in big amounts by a hyper-functioning prostate?
Prostate Specific Antigen (PSA)
Is seminal fluid acidic or alkaline?
Alkaline
What percentage of semen is comprised of sperm?
Only 10%
What is the role of the vas deferens?
Transporting sperm from the testicle to the urethra
Where would you find the Cowpers Glands in the male reproductive system?
At the base of the penis (internally)
What is the role of the the Cowpers Glands in the male reproductive system?
They secrete an alkaline mucous fluid that neutralises urinary acids in the urethra and lubricates the penis prior to ejaculation.
What does pre-ejaculate consist of?
The secretion from the Cowpers Glands.
Does pre-ejaculate contain sperm?
No
Acne in a female patient might be an indication of too much of which hormone?
Testosterone
What is metorrhagia?
Mid-cycle bleeding
What is menorrhagia?
Increased menstrual bleeding
What is amenorrhea?
Absence of periods
What is dysmenorrhea?
Painful, heavy periods
What is polymenorrhea?
Short menstrual cycle, frequent periods
What is ogliomenorrhea?
Infrequent menstrual cycles
What is dyspareunia?
Painful intercourse (female)
What is gynaecomastia?
Enlarged breast tissue in a male
What is galactorrhea?
Lactation in the absence of pregnancy
An indicator of high prolactin levels
Which pathology is dyspareunia (pain on intercourse) often a symptom of?
Endometriosis
Name the 2 types of amenorrhea
Primary and Secondary
What is the difference between primary and secondary amenorrhea?
Primary is failure of menses to occur by the predicted onset age (16 - 17 years)
Secondary is lack of menstruation for 3 months in previously menstrual women.
What is the main cause of primary amenorrhea?
Congenital defect - a failure in the development of ovarian follicles
List 3 possible causes of secondary amenorrhea
- Pituitary tumour
- PCOS
- Hypothyroidism
- Stress
- Anorexia
- Excessive exercise
- Medications (anti-psychotics)
- Pregnancy
Name the 2 types of dysmenorrhea
Primary and Secondary
What is the difference between primary and secondary dysmenorrhea?
Primary dysmenorrhea is not associated with any underlying pelvic pathology/disease, whereas secondary is.
List 3 possible causes of secondary dysmenorrhea
- Endometriosis
- Fibroids
- Pelvic inflammatory Disease
Dysmenorrhea is associated with an excessive release of ______ _______ , causing the myometrium to contract.
Uterine prostaglandins
What are prostaglandins?
Chemicals that are pro-inflammatory
Suggest one way in which a patient can help turn inflammatory prostaglandins into anti-inflammatory / more beneficial prostaglandins, to help ease dysmenorrhea.
Increased intake of Omega 3’s.
Natural painkillers include turmeric and boswellia
Increase magnesium & magnesium rich foods (natural painkiller and anti-spasmodic).
What is Pre-Menstrual Syndrome (PMS) characterised by?
Cyclic physiological, psychological and behaviour changes during the luteal phase (the second half of the menstrual cycle)
Which additional hormone can be affected by a drop in progesterone associated with PMS?
Serotonin
How many symptoms have been attributed to PMS?
More than 150.
Which vitamin might you suggest a client with PMS to take and why?
Vitamin B6. Because it increases progesterone and lower oestrogen in the mid-luteal phase. It can help with hormone metabolism.
Which herb is well known for it’s ability to re-establish hormonal balance and is particularly good for both male & female sex hormone balance
Agnus Castus
Which gender is affected by Pelvic Inflammatory Disease?
Females
Describe Pelvic Inflammatory Disease
An infectious and inflammatory disorder of the upper female genital tract, including the uterus, ovaries and fallopian tubes
What is the most common cause of Pelvic Inflammatory Disease?
Bacteria that has ascended up from the cervix (most commonly chlamydia or gonorrhoea - both sexually transmitted diseases)
List 4 potential causes of Pelvic Inflammatory Disease
- Bacteria ascended from cervix
- Sexually transmitted diseases (chlamydia and gonorrhea)
- IUD insertion
- Abortion or delivery under non-sterile conditions
List 3 signs or symptoms of pelvic inflammatory disease
- Lower abdominal pain - can be worse with walking.
- Pain during sex
- Vaginal discharge - purulent with odour
- Fever
- General malaise
List 3 complications of Pelvic Inflammatory Disease
- Ectopic pregnancy
- Infertility
- Peritonitis
- Abcesses & Septicaemia
What is an ectopic pregnancy?
Where a pregnancy has formed outside of the uterus.
What is the allopathic treatment for Pelvic Inflammatory Disease?
Antibiotics
Define Endometriosis
The deposition of endometrial tissue outside of the uterus
List 3 areas of the body commonly affected by endometriosis
- Ovaries
- Fallopian tubes
- Pelvic cavity
- Intestines
- Utero-sacral ligaments
What % of women are estimated to have endometriosis?
25%
But 30 - 40% of women with infertility
Explain the pathological process in endometriosis, which leads to pain.
Ectopic endometrial tissue follows the menstrual cycle but there is no exit point for the blood that accumulates from that tissue in the affected areas during menstruation.
This leads to irritation, inflammation and pain.
List 3 possible causes of endometriosis
- Oestrogen dominance
- Altered immune surveillance in pelvis
- Retrograde menstruation (??)
- Primordial cells lining other cavities/organs differentiating into endometrial cells.
- Transfer of tissue through blood/lymph
Which dietary factor is one of the biggest contributors to oestrogen dominance.
Dairy
How does endometriosis clinically present?
- Dysmenorrhea (very heavy, painful periods)
- Menorrhagia
- Anaemia
- Lower back pain
- Dyspareunia
- Bloating, lower back pain
- Diahorrhea and bowel changes
- Infertility
How is endometriosis diagnosed?
Ultrasound
Laparoscopy
List 3 complications of endometriosis
- Adhesions (of the uterus to other structures)
- Infertility
- Chocolate cysts (sacs containing old blood)
What is the allopathic treatment for endometriosis?
Contraceptive pill
Surgery to remove ectopic tissue (but 45% grows back within a year)
What are uterine fibroids?
Benign tumours of the myometrium of the uterus
What type of tissue are uterine fibroids made up of?
Smooth muscle cells and connective tissue
List 3 causes of uterine fibroids
- Unbalanced oestrogen & progesterone levels
- Obesity (more adipose tissue)
- Contraceptive pill use
- Earlier menses
- Family history
List 5 signs/symptoms of uterine fibroids
- Most are assymptomatic
- Menorrhagia
- Prolonged menses
- Spotting / mid-cycle bleeding
- Fatigue & iron deficiency anaemia
- Bloating and abdominal heaviness
- Frequent and/or urgent urination
- Constipation
Explain 1 potential complication associated with uterine fibroids
Large fibroids can occlude their blood supply, causing calcification and necrosis, which causes pain.
What is the allopathic treatment for uterine fibroids?
Surgery
Hysterectomy
NSAID’s
Contraceptive pill
How are uterine fibroids diagnosed?
Via ultrasound
What is an ovarian cyst?
Fluid filled sac within the ovary
What is the most common type of ovarian cyst, and what causes it?
A follicular cyst
When there has been a failure to ovulate and there is a collection of fluid instead.
How are ovarian cysts diagnosed?
Via ultrasound or laparoscopy
Most ovarian cysts are harmless and asymptomatic. But when might they become a problem?
- If they rupture.
This causes sudden, sharp and intense pain. similar to appendicitis - If they push on the bladder
What is the allopathic treatment for ovarian cysts?
Nothing if asymptomatic and small.
Surgery if >5cms
The presence of how many ovarian cysts leads to a diagnosis of ‘Polycystic’ ovaries
More than 12 cysts = polycystic
What is the difference between polycystic ovaries and Polycystic Ovarian Syndrome (PCOS)?
Polycystic Ovaries = the presence of many cysts within the ovaries.
PCOS = An endocrine metabolic condition
Define PCOS
An endocrine metabolic condition associated with:
- Menstrual dysfunction
- Ovulatory dysfunction
- Hyperandrogenism
- Metabolic disturbances (ie, hyperinsulinaemia)
Why can the name PCOS be misleading when it comes to the pathology?
Because you don’t necessarily have to have actual cysts on your ovaries to have PCOS. It is not required for the diagnosis.
Does PCOS usually present with an absence of menstruation, or heavy periods?
Usually an absence of menstruation
Amenorrhea or Oligorrhea
If a female presents to you with increased/male pattern hair growth, what pathology might you suspect?
PCOS
Which reproductive pathology, which is an endocrine abnormality, tends to begin soon after menarche?
PCOS
Which lifestyle-related risk factor is closely associated with PCOS?
Obesity. However, many women who have PCOS are not obese.
Describe 2 of the factors involved in the pathophysiology of PCOS
- High levels of LH, with normal or low FSH level
2. Insulin resistance (occurs in 40%)
Very high levels of LH can cause the ovaries to start pushing out which other kind of hormones?
In which reproductive pathology might we see this?
Androgens (male hormones)
PCOS
How might the presence of high androgens associated with PCOS present in the patient?
- Absent periods (androgens generally suppress the menstrual cycle and ovulation)
- Acne
- Male pattern hair growth
What percentage of women with PCOS are believed to have some level of insulin resistance?
Around 40% - irrespective of body weight.
High levels of insulin (insulin resistance) suppress which protein?
SHBG - Sex hormone binding globulin
Results in the release of more androgens (especially testosterone)
What is hirsutism?
Male pattern hair growth
Name 2 hormones that can drive the production of acne in PCOS.
Testosterone and insulin
Acanthosis Nigricans - a skin condition associated with rough, dry & thickened, dark skin (often around the neck, elbows and knuckles) is often associated with which reproductive pathology?
What is it actually a sign of?
PCOS
Insulin resistance
Which diagnostic tests can be used to diagnose PCOS?
- Blood Tests
2.
Why is blood testing a good diagnostic test for PCOS?
Because PCOS is an endocrine disorder, and hormone imbalances show in the blood.
What would a blood test diagnosing PCOS show?
- Increased androgens
- Low SHBG (sex hormone binding globulin)
- High LH: normal or low FSH
- Elevated blood glucose levels (hyperinsulinaemia)
Why might PCOS increase the overall risk of developing Type II Diabetes?
Because insulin resistance (and therefore high blood glucose levels) is very often a factor in PCOS.
Which 3 criteria must be present for a diagnosis of PCOS?
- Lack of, or irregular periods, AND/OR Polycystic ovaries
- Clinical or biochemical signs of hyperandrogenism
- Exclusion of other causes of hormonal & metabolic dysfunction.
Name 2 signs of hyperandrogenism
- Hirsutism
2. Acne
List 3 complications associated with PCOS
- Infertility
- Endometrial cancer
- Type II diabetes
What is the allopathic treatment for PCOS?
- Contraceptive pill
- Metformin (to try & deal with insulin resistance)
- Anti-androgen topical creams
- Drugs to stimulate ovulation
Where can an ectopic pregnancy occur?
- Fallopian tubes (97%)
- Ovaries
- Cervix
- Abdomen
List 3 risk factors for ectopic pregnancy
- IUD
- Pelvic Inflammatory Disease
- Endometriosis
List 3 signs/symptoms of an ectopic pregnancy
- Pelvic pain
- Vaginal bleeding
- Amenorrhea
Define infertility
Failure to conceive after 1 year of unprotected intercourse
What is the allopathic treatment for infertility?
Clomiphene - induces ovulation
IVF
What is the average overall success rate of IVF?
27%
What is the most common female cancer?
Breast Cancer
List 3 risk factors associated with breast cancer
- Family history
- BRCA1 and BRCA2 gene mutations
- Poor diet and lifestyle
- Oestrogen excess
- Regular alcohol and smoking
List 3 signs/symptoms of breast cancer
- Unilateral lump on/in breast (fixed, hard and painless)
- Skin redness / dimpling / orange peel appearance
- Inverted and discharging nipple
- Enlarged accessory lymph nodes
What are the 2 main methods of breast cancer diagnosis?
Mammography (X-ray)
Thermography
What % of breast cancers are driven by oestrogen?
80%
What are the allopathic treatments for breast cancer?
Surgery, radiotherapy, chemotherapy, Tamoxifen (blocks oestrogen)
What is balanitis?
Inflammation of the glans penis
List 3 causes of balanitis
- Infection (fungal or bacterial)
- Lichen sclerosis (autoimmune)
- Inadequate cleaning/hygiene
- Phimosis (foreskin narrowing)
What is the main fungal microbe associated with balanitis?
Candida albicans
What are the allopathic treatments for balanitis?
- Steroids
- Antibiotics
List 3 signs/symptoms of balanitis
- Pain
- Irritation
- Dyspareunia
Describe undescended testes
Where one testicle fails to descend in late foetal development and remains in the abdomen
Why is infertility a complication of undescended testes?
Because sperm doesn’t like being in warm environments (i.e, up in the pelvic cavity).
What is the most common cancer affecting young men?
Testicular cancer
List 2 risk factors for testicular cancer
- Family history
2. Undescended testes
List 3 signs/symptoms of testicular cancer
- Hard, fixed, painless, unilateral mass in testicle
- Dragging sensation
- Dull ache
What is prostatitis?
Inflammation of the prostate gland
There are 2 types of prostatitis. Name them.
Infectious (bacterial) or non-infectious
What are the 2 most common causes of Prostatitis?
Urinary Tract Infection, or STI
List 3 signs/symptoms of prostatitis
- Painful ejaculation
- Nocturia (urination at night)
- Recurrent UTI’s
Define Benign Prostatic Hyperplasia (BPH)
Enlargement of the prostate tissue leading to compression of the urethra.
(Benign enlargement of the prostate)
What is hyperplasia?
Increase in the number of cells
Which reproductive pathology is common in older men (esp. 60yrs +)?
Benign Prostatic Hyperplasia (BPH)
List 3 risk factors for Benign Prostatic Hyperplasia (BPH)
- Abdominal obesity
- Sedentary lifestyle
- Genetics
- Pesticides and herbicides
- Nutritional deficiencies (i.e, zinc)
Which supplement can act as a 5-alpha-reductase inhibitor, reducing the ability for excess testosterone to negatively affect the prostate gland?
Zinc
List 4 signs/symptoms of Benign Prostatic Hyperplasia
- Obstructed / poor urine flow
- Dribbling urine
- Nocturia (multiple times in the night)
- Increased urinary frequency
- Reduced sexual function
Which type of test would usually diagnose Benign Prostatic Hyperplasia?
- Blood test - raised PSA
(Prostatic Specific Antigen) - Digital rectal exam
- Ultrasound
Which male reproductive pathology may be indicated by raised PSA in the blood?
Benign Prostatic Hyperplasia
Which herb can act as a 5-alpha-reductase inhibitor, reducing the ability for excess testosterone to negatively affect the prostate gland?
Saw Palmetto
Which is the most common cancer in men?
Prostate cancer. Generally 50+ yrs old.
As well as the general symptoms of Benign Prostatic Hyperplasia, which additional symptom could lead to a suspicion of prostate cancer with metastatic (bone) spread?
Lumbar back pain
List 2 symptoms that would indicate prostate cancer rather than benign prostatic hyperplasia
- Haematuria (blood in urine)
2. Blood in ejaculate
If a patient presents with right shoulder pain, which organ might be indicated?
Gallbladder
If a patient presents with left shoulder pain, which organ might be indicated?
Diaphragm and/or heart
Explain the role of DHT in benign prostatic hyperplasia.
DHT causes growth of the prostate
What is PSA
Prostate Specific Antigen
