Reproductive System Flashcards
menstrual cycle - basics and phases
length: 21-38 days
menstrual phase: day 1-7
- FSH begins to rise
proliferative/follicular phase: day 7-14
- estrogen (stimulated by FSH) causes proliferation of endometrium and follicular growth
- estrogen triggers LH surge causing ovulation (day 14)
secretory/progestational/luteal phase: day 14-28
- high levels of progesterone
- progesterone converts thickened endometrium to vascularized tissue (preps to host fertilized egg)
menorrhagia / heavy menstrual bleeding or prolonged bleeding - causes
Von Willebrand’s dz
molar pregnancy
malignant endometrial CA
perimenopause
metrorrhagia / irregular bleeding - causes
bleeding b/t cycles
polyps
cervical CA
OC pills
menometrorrhagia / heavy + irregular bleeding
molar pregnancy
malignant endometrial CA
premenopause
dysfunctional uterine bleeding (aka abnormal uterine bleeding) - causes (reproductive age v. post-menopausal)
bleeding due to an anovulatory cause
Reproductive age:
- pregnancy (and preg complications)
- anovulation/hormone abnormalities
- systemic (PCOS, pituitary, thyroid)
Post-menopausal (think structural vs. non-structural):
- medications (HRT)
- trauma (vaginal atrophy), polyps
- malignancy
abnormal uterine bleeding - approach
- take a good hx
- bleeding history
- PE: growths, masses, trauma
- Labs: preg test (#1), CBC, TSH, TSH/LH
- Imaging: U/S
- endometrial biopsy: over 35 w/ obesity, HTN, DM or anyone after menopause
- progestin trial
- if bleeding stops, think ovulatory problem!
- investigate pituitary and order prolactin and TSH
abnormal uterine bleeding - management
Goals:
- must control bleeding
- consider if women wants to maintain fertility or not (depends on age)
treatment:
- hormonal (OCP - progesterone only) - if not trying to get pregnant
- surgery: D&C (can also consider endometrial ablation or hysterectomy if no desire for future fertility)
amenorrhea - primary and secondary definition
primary:
- no menses by 14 yr and absence of 2ndary sex characteristics
- no menses by 16 yr w/ presense of 2ndary sex characteristics
secondary:
- no menses for 3 mo (previously normal cycle)
- no menses for 6 mo (previous irregular cycle)
primary amenorrhea - causes
Turner’s Syndrome: no ovaries but pituitary pumps out FSH so see high FSH
- manage w/ OCP (estrogen and progestin)
hypothalamic-pituitary insufficiency: see low FSH and LH
- manage w/ OCP (estrogen and progestin)
Androgen insensitivity: see high testosterone (XY genetically)
- remove testes, start estrogen
Imperforate hymen: dx on PE
- surgically open
Anorexia
- tx eating d/o
secondary amenorrhea - causes
PREGNANCY (most common cause
androgen excess disordered: PCOS
secondary amenorrhea - dx
hx and PE: pelvic exam signs of androgen excess
Labs:
- pregnancy test
- TSH and prolactin
- FSH/LH only if TSH and protecting normal
Progestin challenge: Provera 10mg orally for 5 days
- bleed 2-7 days later
- if bleeding: ovulatory issue
- if no bleeding: structural issue
secondary amenorrhea - tx
NOT desiring pregnancy:
- OCP
Desire pregnant: tx varies by cause
- elevated prolactin - dopamine agonist
- surgery
- fertility specialist
primary dysmenorrhea - sxs, cause, PE results, tx
sxs: abd pain and cramps, N/V/D, H/A
- most common w/in 2 yrs of menarche
cause: NO PATHOLOGIC CAUSE
- inc. prostaglandins
- inc. leukotriene levels
PE results
- normal
tx:
- NSAIDS - 1st line
- Cox-2 inhibitor (less GI side-effects)
- OCP
secondary dysmenorrhea - definition/population, sxs, causes, dx, tx
excessive menstrual pain during mid-reproductive yrs
- USUALLY PATHOLOGIC
sxs: pelvic pain related to menstrual cycle
- infertility
- dyspareunia (painful sex)
causes:
- endometriosis
- pelvic adhesions / fibroids (prior surgery)
- polyps
dx:
- pelvic U/S
- laproscopy
tx: depends on cause
premenstrual syndrome (PMS) - definition, dx, tx
physical and emotional sxs that occur during 2nd half of menstrual cycle
- caused by low serotonin levels
dx: clinical (benign PE)
- only occurs during 2nd half of cycle
- accompanied by bloating, H/A, aches, irritability
tx:
- lifestyle modifications: exercise, small, frequent meals
- SSRI for emotional; NSAIDS for aches
endometriosis - definition
endometrial tissue outside uterine cavity
- occurs in women of reproductive age
- no matter where it is, it will “plump up” during proliferative phase
- most common on ovary
endometriosis - classic triad and most common sxs
dysmenorrhea: low sacral backache premenstrually that resolves w/ menstruation
dyspareunia
infertility
most common sx: pelvic pain
endometriosis - PE, dx, tx
PE:
- retroverted uterus w/ uterosacral ligament nodularity (CLASSIC FINDING)
dx: clinical
- laparoscopy is definitive (cannot se on U/S)
tx:
- observation (1st line)
- medicine (all for women not trying to get pregnant): NSAIDS or OCP, continuous progesterone, danazol-testosterone (bad SE: deep voice)
- surgical (for women who want to get pregnant)
pelvic pain - ddx
endometriosis: diffuse
ectopic pregnancy: one-sided
acute appendicitis: RLQ
PID: will also have fever, chills
adhesions: hx of prior surgery or infection
IBS: would also have GI sxs
ovarian cyst
psychologic d/o
uterine leiomyoma (fibroids) - definition, population, most common type
most common benign uterine tumor
- women in 40’s with many babies
- AA women 5x more likely
Types:
- submucous location within the uterine cavity (cause abnormal bleeding)
uterine leiomyoma (fibroids) - sxs, exam, tx
sxs: abnormal menstrual bleeding, pain, pressure, infertility
exam: enlarged uterus, firm, nontender, asymmetric
dx: U/S is best
tx:
- conservative (most do not require tx)
- GnRH agonists help to shrink fibroids
- endometrial ablation (if not planning on future pregnancy)
- surgery: severe sxs and want to keep fertility
endometrial cancer - risk factors, what is protective
MOST common Gyn Cancer
- caused by prolonged estrogen exposure
Risks:
- Prolonged estrogen exposure
- nulliparity (no babies)
- early menarche/late menopause
- chronic unopposed estrogen
- tamoxifen (breast cancer tx) - DM, HTN, obesity
- cancer of breast, colon, ovaries
protective: OCP
endometrial cancer -tumor type, sxs, exam, dx, tx
tumor type: adenocarcinoma (75%)
sxs: post-menopausal bleeding
exam: normal
dx: endometrial biopsy
- curettage is definitive
- stages I-IV
tx:
- total abd hysterectomy and bilateral salpingo-oophorectomy (remove ovary and tubes)
- radiation post-operative (stage I and II)
- radiation, progestins, chemo (stage III and IV)
ovarian cysts - population, characteristics
common in reproductive years
- due to excess estrogen and progesterone
- most benign and resolve spontaneously
Note: considered malignant in post-menopausal women until proven otherwise