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HCR240-Chapter26DisordersoftheFemaleReproductiveSystem.pptx

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Chapter 26

Disorders of the Female Reproductive Tract

Epidemiology of Female Reproductive Tract Disorders

Common disorders

Dysmenorrhea

Painful menstrual periods

Dysfunctional uterine bleeding (DUB)

Menorrhagia

Excessive uterine blood loss

Premenstrual syndrome (PMS)

Nearly 100% will experience disorder of menstrual cycle during their lifetime

Basic Concepts

Female reproductive organs

Ovaries, uterus, fallopian tubes, vagina, and breasts

Menstrual cycle

Hormonal, uterine, and ovarian changes

Estrogen and progesterone produced by ovaries

Female Reproductive System

Menstrual Cycle

Hypothalamic (GnRH)-pituitary (FSH/LH)-ovarian (estrogen/progesterone) axis

28-day cycle

Follicular phase

FSH stimulates ovarian follicles to produce estrogen

Days 1–14

Ovulation

Positive feedback by estrogen causes surge in FSH/LH

Day 14

Ovum released from ovary

Menstrual Cycle (continued_1)

Luteal phase

Corpus luteum forms and produces progesterone

Days 14–28

Hormones stimulate changes in uterine lining

Estrogen

Stimulates uterine lining growth for implantation

Progesterone

Stabilizes uterine lining for implantation

If fertilization does not occur…

Corpus luteum degenerates, progesterone levels fall, and uterine lining is shed

Menstrual Cycle (continued_2)

Ovarian Cycle

Menstrual Cycle (continued_3)

Menarche

1st episode menstrual bleeding

Menses

Menstrual bleeding

Menopause

Permanent cessation of menstrual cycles

Perimenopause: gradual decline in ovarian function

Atrophic vaginitis, vasomotor instability

Low estrogen, high FSH

Breasts

Thelarche

Development of breast tissue

Occurs at about the same time first menstrual period

Breast contain lobules which drains into lactiferous duct

Lactiferous duct empties into nipple surface

Prolactin: Milk formation

Oxytocin: Milk release

Precocious Puberty

Puberty occurring earlier than in the past

Secondary sex characteristics by 6 or 7 years of age

Two types

Central

Hypothalamus-pituitary involvement

Peripheral

Independent of hypothalamus-pituitary (problems with ovaries, adrenal glands)

Delayed Puberty

Secondary sex characteristics have not appeared by age 13

Most cases are genetic

Constitutional growth delay (CGD)

Other causes

Chronic illness, eating disorders, strenuous exercise

Infertility

10%–15% of couples

Unprotected, frequent intercourse for a year

40%–50% of cases: female infertility

Ovulation disorders account for 25% of infertility issues

Disruption of FSH/LH signal (stress, very low or high body weight, excessive exercise)

Infertility (continued_1)

Polycystic ovarian syndrome (PCOS)

Overproduction of androgens, ovary does not release ovum

Premature ovarian failure (POF)

Body develops antibodies against ovarian tissue

Endometriosis

Uterine tissue outside the uterus

Fallopian tube damage

Ectopic pregnancy, infection, or inflammation

Infertility (continued_2)

Cervical obstruction

Inherited malformation of damage to cervix

Uterine fibroids

Menstrual Disorders

Amenorrhea

Absence of menstrual period

Pregnancy must be ruled out

Primary

Menses does not occur before age 16

Often congenital, unrecognized until puberty

Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH)

Uterus absent and vagina foreshortened, normal ovaries

Secondary Amenorrhea

Period absent 3 to 6 months

Rule out pregnancy

Disruption hypothalamic-pituitary axis

Stress, excessive exercise, weight loss

POI (primary ovarian insufficiency)

Idiopathic, chemotherapy, autoimmune

Hypergonadotropic hypogonadism

High FSH/LH, low estrogen

Turner’s syndrome most common example

Secondary Amenorrhea (continued)

PCOS

Ovulation does not occur monthly

Hyperprolactinemia

Asherman’s syndrome

Damage to uterine lining

Imperforate hymen

Menstrual Disorders (continued_1)

Dysmenorrhea

Painful periods

75% of 15- to 25-year-olds

Prostaglandin release (particularly prostaglandin F) within 48 hours menstruation

Diagnosis

Rule out pelvic pathologies

Treatment

Oral contraceptives

Anti-prostaglandins

Menstrual Disorders (continued_2)

Premenstrual syndrome (PMS)

Physical, emotional, behavior changes prior to menstrual cycle

50% of women have mild to moderate PMS

Abnormal response to neurotransmitters prior to menstruation

Treatment with selective serotonin receptor inhibitors (SSRI’s) have been helpful

Premenstrual dysphoric disorder (PMDD)

More severe form of PMS, interferes with work, school, social activities, and relationships

Menstrual Disorders (continued_3)

Menorrhagia

Excessive menstrual bleeding

Menses lasts greater than 7 days

Metrorrhagia

Excessive uterine bleeding

Both at time of normal menstrual period and more frequency

Oligomenorrhea

Infrequent periods

Prolonged time between periods

Pathologies of Female Reproductive Tract

Uterus

Endometritis

Endometriosis

Endometrial polyps

Leiomyomas

Dysfunctional uterine bleeding

Uterine prolapse

Cystocele, rectocele, enterocele

Cervix

Cervicitis

Vagina, external genitalia

Vulvodynia

Vulvar cancer

Vaginitis

Pathologies of Female Reproductive Tract (continued)

Ovary

Premature ovarian failure

Benign ovarian cyst

Teratoma

Ovarian torsion

Polycystic ovarian syndrome

Ectopic pregnancy

Breast

Fibrocystic breast disease

Fibroadenoma

Mastitis

Galactorrhea

Mammary duct ectasia

Uterus—Endometritis

May occur in conjunction of infection of other tissues

i.e., uterine tubes, ovaries

Usually a mixed infection, often ascending from vagina

Gonococcus, Chlamydia trachomatis, Enterococcus

Symptoms

Vaginal bleeding, uterine tenderness, fever, malodorous discharge

Antibiotic treatment based on causative organism

Uterus—Endometriosis

Growth of endometrial tissue outside of uterus

~15% of women

~80% of women with pelvic pain

Ovaries, uterine ligaments, pelvic peritoneum, myometrium of uterus (adenomyosis) are locations for endometrial growth

Displaced tissue responds to hormonal signals, causing bleeding, pain, infertility

Uterus—Endometriosis (continued)

Definitive diagnosis

Laparoscopy

Treatment

Surgery

NSAID’s

Oral contraceptives

Long-acting GnRH

Endometriosis

Endometriosis Causes—Theories

Regurgitation/implantation

Endometrial tissue forced up through uterine tubes and into pelvic cavity

Metaplastic

During embryological development, endometrial tissue appears in abnormal areas

Vascular or lymphatic

Endometrial tissue metastasized to other areas

Endometriosis Causes—Theories (continued)

Immunological

Displaced endometrial tissue triggers an autoimmune attack

Environmental toxicity

Associated with some chemicals (dioxin)

Disorders of Vagina

Vaginitis

Inflammation of vagina

Discharge, burning, itching

Pain with urination, sexual intercourse

Bacterial causes (40%–45%), vaginal candidiasis (20%–25%), trichomoniasis (15%–20%)

Precise identification of organism is crucial to treatment

Oral medications

Application of medications to vagina

Preventive measures

Proper hygiene, avoidance of feminine deodorants and douches

Polycystic Ovarian Syndrome (PCOS)

Autosomal dominant genetic disorder

Women: puberty to age 30 years

Most common endocrine disturbance in young women, leading cause of infertility in U.S.

Anovulation

Follicular cysts

Hypothalamic-pituitary-ovarian axis dysfunction

Polycystic Ovarian Syndrome (PCOS) (continued)

Androgen excess, anovulation, hyperinsulinemia

38% of women with PCOS are obese

PCOS can be part of metabolic syndrome

Treatment

Suppress excess androgens

Increase insulin sensitivity

Stimulate cyclic menstruation

Fibrocystic Breast Disease

Fibrocystic breast disease

Largely benign

1 in 3 women age 35–50 years of age

Granular breast masses prominent in second half of menstrual cycle

Ultrasound and mammogram to diagnose

MODULE 7

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