week 3, lec 3 BAD Flashcards
typical manifestation of reproductive problems
menstruation, pelvic pain, infertility
main causes of reproductive problems
abnormal hypothalamic or pituitary function
ovarian dysfunction
disorder of uterus or menstrual outflow
hypothalamic changes causing amenorrhea
which hormone?
GnRH pulses altered
which alters progesterone and estrogen cycles then can cause intermittent bleeds
hypothalamic changes causing amenorrhea
what causes?
stress (i.e. food, psychology, over exercise)
hyper/hypothyroid (impacts negative feedback loops of GnRH, LH, FSH, estrogen/progesterone)
hypothalamic amenorrhea
from stress
(physiologic, eg. overtraining/underrecovery, undernutrition; psychologic);
pituitary changes causing amenorrhea
what hormones?
FSH and LH
rarely an adenoma
reduce menses
pituitary changes causing amenorrhea
what causes?
prolactinemia (pituitary adenoma- prolactin suppresses FSH/LH similar to lactation)
post-partum necrosis of pituitary gland (Sheehan syndrome)
head trauma
ovarian changes that cause amenorrhea
PCOS (androgens and insulin)
premature ovarian failure
ovarian dysgenesis
ovarian insufficiency is AKA
and at what age
early menopause
lack of viable follicles prior to 40yoa
what does ovarian insufficiency do to menses and fertility
reduced or cessation of menses
lose fertility
causes of ovarian insufficiencies
autoimmune, diabetes, hypothalamic, exogenous (i.e. radiation)
levels of hormones in ovarian insufficiency
high LH and FSH
low estrogen
ovarian dysgenesis
female a birth (phenotypic female)
genotypes causes deletions in X chromosome
can impact pubertal development and cause primary amenorrhea or early ovarian insufficiency
Y chromosome = high risk of gonadal neoplasia
consequences of amenorrhea
lack of menses
fertility
osteropororis
CVD function
thinning of estrogen dependent epithelia
inadequate progesterone increases risk of endometrail cancer
dygenesis
abnormal or absent development of uterus and vagina from genetic polymorphisms
effects estrogens, androgens, reproductive tissue development
Imperforate hymen or transverse vaginal septum cause
amenorrhea
Sherman syndrome (causes amenorrhea)
Endometrial adhesions and scarring following vigorous curettage (procedure) or uterine tuberculosis
causes of abnormal uterine bleeding
polyp
adenomyosis
lelomyoma
malignancy
iatrogenic (i.e. IUD)
endormtrial
ovulatory
coagulopathy
3 types of benign uterine masses “PAL”
endometrial polyps
adenomyosis
leiomyoma (fibroids)
endometrial polyps
outgrowths of endometrial tissue into lumen of uterus (or in fallopian tubes)
intermenstural bleeding
possible dysplasia
adenomyosis
endometrial glands in myometrium
downward growth of endometrium
heavy and painful bleeds
endometrial polyps vs adenomyosis growth differences
polyps- outward growth
adeno- downward growth
leiomyoma is aka
and pathophysio
AKA fibroids
tumors of muscle mass in myometrium
heavy bleeds, pelvic pressure
endometrial hyperplasia
what happens?
due to?
common in?
increase gland: stroma ratio
due to excessive/unopossed estrogen stimulation (without progesterone) {i.e. chronic anovulation from no corpus luteum, androgen in periphery from obesity, estrogen therapy}
common in peri/post menopause
predisposed to malignancy esp if dysplastic cells
endometrial carincoma is most common in
uterine tract
then progress to endometrial hyperplasia
metastases common
primary dysmenorrhea definition
painful mesnsturation/ cramps without structural abnormalities
why excessive contractions in primary dysmenorrhea
endometrial necrosis stimulates prostaglandins –> myometrial contractions –> muscle hypoxia and irritate pain fibers
prostaglandins în primary dysmenorrhea cause pain but also
excess bleeding
other common things that go with pain in primary dysmenorrhea
stress and anxiety
PMS includes what
non-structural dysmenorrhea plus a range of other potentially endocrine-mediated systemic symptoms
estrogen and progesterone cycling on mood, lymphatic function, mammary tissue, digestive function, metabolism, libido
endometriosis is
Presence of endometrial tissue outside of the uterine lining (“ectopic”)
can be anywhere; myometrium, ovaries (common), pelvic cavity…
endometriosis is due to
a) retrograde menstruation through Fallopian tubes into pelvic cavity, and/or
b) metaplasia of celomic mesenchyme into endometrial tissue, and/or
c) vascular or lymphatic dissemination of endometrial “seeds
the tissue in endometriosis still responds to
estrogen and progesterone cycling
endometriosis sx and pathophysiology
menses has more pain
inflammation and cytokines and angiogenesis cause new blood vessels and pain nerves in endometrial lesions
scarring
obstruct reproductive pathways and bowerls
fertility, endocrine disruption
pain, anxiety, stress in CNS
pelvic inflammatory disease
acute infection of upper genital tract
i.e. mucopurulent secretions (from gonorrhoea), tubo-ovarian abscesses and peritonitis and fever etc
sx in PID
not cyclic
scarring, adhesions, obstruction of reproductive tract leading to chronic sx and infertility
ovarian masses
mostly non-neoplastic i.e. cysts (rupture and cause pain)
can be neoplastic and malignant (usually not painful until advanced, can rupture, bleeding, torsion and then cause pain)
prolapse
Extrusion of the uterus, anterior vaginal wall with/without bladder, posterior vaginal wall with/without rectum, vaginal apex, or the perineum through the pelvic floor or vaginal introitus
what causes prolapse
dysfunction of pelvic floor (esp levator ani)
who’s prolapse most common in and sx
parous (given birth) or older
no pain, but heavy/uncomfortable and incontinence
stages of prolapse is based on
degrees in relation to the plane of the hymen:
1: cervix in the lower third of the vagina
2: cervix protrudes through the introitus
3: “procidentia;” entire uterus protrudes past the hymen with eversion
of the vagina
procidentia
stage 3 of prolapse when entire uterus protrudes past the hymen with eversion
of the vagina
cervicitis is due to
changing vaginal microbiome, with or without frank infection
what can influence the vaginal microbiome to change in cervictiis
cycling homrmone levels can change vaginal pH and flora
what cell is present in cervical atypia and dysplasia
squamous cell
how to detect CERVICAL ATYPIA AND DYSPLASIA
Pap smear; cytologic exam
sx of CERVICAL ATYPIA AND DYSPLASIA
abrnomal bleeding possible
cause of CERVICAL ATYPIA AND DYSPLASIA
high risk HPV infection (16 and 18) but also other factors increase risk (smoking, immunosuppression, large # sex partners)
how HPV infection causes CERVICAL ATYPIA AND DYSPLASIA
HPV hijacks cervical epithelial cells to make viral particles
inactivates tumor suppressor genes
lead to local invasion and metastasis
vaginitis and vulvitis is from
inflamed epithelium:
changes in microbiome (pH, hormones, exogenous like trauma or pathogen) (not necessarily pathological)
effect vaginal discharge
sx of vaginitis and vulvitis
abnormal sx: pain, pruritic, burn, erythema
inflam and ROS
infectious vs non-infectious vaginitis
infectious: bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis
non-infectious: atrophic vaginitis, allergic vaginitis, foreign body, chemical irritation, desquamative vaginitis, lichen planus
atrophy of vagina
thin vaginal epithelium –> irritation, infection and bleeding
pre-pubescent or post-menopausal
vulvo/vaginal malignancy
what type of cell
squamous cell carcinoma
cervical atypia –> dysplasia
vulvar/vaginal intraepithelial neoplasia
types of contraception
surgical sterilization
hormonal: i.e. IUD, cervical ring, pill, implant, patch
barrier: diaphragm, condoms
spermicide: lube, sponge
fertility awareness (temp)
emergency contraception
hromonal contraception affect hormones
progesterone influence to thin endometrium, thicken cervical mucus and negatively impact FSH/LH secretion
fertility awareness is
Body temperature = cervical position and mucus + LH levels + knowledge of cycle
