Women's Reproductive System Flashcards
Asherman’s Syndrome
Uncommon, acquired disorder characterized by changes in the menstrual cycle often d/t severe inflammation of the lining of the uterus (endometriosis) caused by the development of bands of scar tissue that join parts of the walls of the uterus to one another, thus reducing the volume of the uterine cavity (intrauterine adhesions and synechiae).
Etiology: Endometrial scarring and intrauterine adhesions may occur as a result of surgical scraping or cleaning of tissue from the uterine wall (dilatation and curettage [D and C]), infections of the endometrium (e.g., tuberculosis), or other factors.
SXS: reduced menstrual flow, increased cramping and abdominal pain, eventual cessation of menstrual cycles (amenorrhea), infertility.
Menstrual Cycle
Cycle variants
● Normal: 24-35 days
● Menorrhagia: heavy bleeding at normal intervals
● Metrorrhagia: bleeding between cycles
● Menometrorrhagia: irregular intervals with excessive bleeding
● Oligomenorrhea: infrequent cycles >35 days
● Polymenorrhea: frequent cycles <21 days
Dysfunctional Uterine Bleeding
Definition: Abnormal uterine bleeding with no underlying cause
● Can be ovulatory or anovulatory
● Diagnosis of exclusion
● Tx: NSAIDs, hormonal (oral contraceptive pills [OCPs], intrauterine device [IUD]),
ablation/surgery if persistent
Primary Amenorrhea
Definition: the absence of menarche by age 15 yo with normal 2° sexual characteristics
or by age 13 yo without
● Work-up: pregnancy test, prolactin, follicle stimulating hormone (FSH), luteinizing
hormone (LH), thyroid stimulating hormone (TSH)
● Axial points of interruption
o Hypothalamus/pituitary
§ Anorexia nervosa, athletes, chronic illness, tumors
o Ovary
§ Chromosomal abnormalities, premature ovarian failure (POF),
polycystic ovary syndrome (PCOS)
o Outflow tract
§ May require surgery
Secondary Amenorrhea
Definition: cessation of menses of 6 mo with previous normal cycles
● Most common cause: PREGNANCY
● Check hormone levels to help determine if cause is due to interruptions in
hypothalamic-pituitary-ovary axis
● Progestin challenge
● Use ultrasound (U/S) to diagnose uterine injury – e.g. Asherman syndrome
● Tx: determined by cause, hormonal therapy
Dysmenorrhea
● Primary: diagnosis of exclusion, painful menstruation with the absence of
pathologic findings
o Tx: NSAIDs, hormonal (OCPs, IUD)
● Secondary: attributed to pelvic pathology
o Endometriosis, fibroids, pelvic inflammatory disease (PID), adhesions
o Tx: etiology specific
Premenstrual Syndrome
Cyclic cluster of physical & emotional changes
● Must occur 2 weeks prior to menstruation & must have 7 symptom free days at
beginning of cycle
● Must occur for 2 consecutive cycles to be diagnosed
● Sx: physical (bloating, headache, breast pain, bowel changes), emotional
(irritability, depression), behavioral (poor concentration, food cravings)
Premenstrual Dysphoric Disorder (PMDD)
Severe PMS with functional impairment, DSM-5 criteria
● Tx: selective serotonin reuptake inhibitors (SSRIs), OCPs
Menopause
Definition: Cessation of menses >1 yr caused by loss of ovarian function
● Average range in US: 50-52 yo
● Considered premature if <40 yo
● S/S: hot flushes, mood changes, vaginal atrophy, dyspareunia
● Dx: clinical, ± labs (↑ FSH, ↑ LH, ↓ estrogen)
● Tx: hormone replacement therapy (HRT) [weigh risks & benefits], topical estrogen
for dryness, osteoporosis prevention, SSRIs
Adenomyosis
Definition: Ectopic endometrial tissue within myometrium
● Classic presentation: triad of non-cyclical pain + menorrhagia + enlarged uterus
● Uterus is uniformly enlarged, “boggy”
● Dx: MRI, post-total abdominal hysterectomy (TAH) examination of uterus
● Tx: TAH - only effective therapy; NSAIDs & hormones for symptomatic relief
Leiomyoma (AKA: Uterine Fibroids)
Uterine smooth muscle tumor, “Benign Bleeders”
● 5x more common in African Americans
● Pelvic exam: irregular, hard palpable mass(es)
● Dx: U/S
● Tx: hormones, ablation, TAH
● Leiomyosarcoma is rare malignancy
o Incidence (0.1-0.5%)
Endometriosis
Definition: Ectopic endometrial tissue outside of the uterus
● Responds to cyclical hormonal changes
● Onset usually < 35 yo
● Most common cause of infertility >30 yo
● Classic presentation: triad of cyclic premenstrual pelvic pain + dysmenorrhea +
dyspareunia; ± low back pain, dyschezia, spotting
● Dx: laparoscopy
● Tx: hormonal, NSAIDs, ablation, TAH & bilateral salpingo-oophrectomy (BSO)
Endometrial Hyperplasia
Precursor to endometrial adenocarcinoma (type 1) ● Due to unopposed estrogen ● Most common in postmenopausal women ● Presents with menorrhagia, metrorrhagia, postmenopausal bleeding ● Dx: U/S, endometrial biopsy ● Tx: o Hyperplasia without atypia: progestin o Hyperplasia with atypia: TAH
Endometrial Cancer
● 4th most common female cancer (breast>lung>colon)
● Type 1 adenocarcinoma (75%): due to unopposed estrogen, hyperplasia
● Type 2 serous (25%): unrelated to estrogen, p53 mutation in 90%
● Presents with abnormal vaginal bleeding
● Dx: endometrial biopsy
● Tx:
o Child-bearing years: high dose progestin
o Postmenopausal: TAH/BSO, ± radiation/chemotherapy depending upon
staging
● No current screening guidelines for asymptomatic women
Ovarian Cysts
Common in reproductive years, usually unilateral
● Follicular - associated with ovulation
● Corpus luteum - may be hemorrhagic upon rupture
● Dx: U/S, r/o pregnancy
● Tx: NSAIDs, most resolve on their own, repeat U/S, may need surgery if recurrent
● BEWARE: large cysts > 5 cm can lead to ovarian torsion
o Emergent surgical detorsion
