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Reproductive System

Part I

menarche average age 12-13
anovulatory cycles (irregular), or post OC termination 6mon - 1 year after menarche
follicular phase FSH = ovarian follicle growth. ovarian follicle produces estrogen. which causes uterine lining to proliferate.
estrogen surge at day 14 causes what to spike? LH, stimulates release of ovum from follicle.
When does luteal phase begin? post release of ovum from follicle. follicle reminants in ovary become corpus luteum and secrete progesterone
what does progesterone do? maintain uterine lining for ovum implant
IF FERTILIZATION OCCURS...developing trophoblast syntehsizes human chorionic gonadotrophin (hCG) and what does this do? maintains corpus luteum until placenta
IF NO FERTILIZATION... corpus luteum degenerates (hCG is not there to sustain Corp Lut) progesterone fall.
endometrial lining sloughs no progesterone
remove estrogen and progesterone... FSH increase (follicular phase)
Dysfunctional bleeding causes? primary menorrhagia from hypothalamic-pituitary gonadal axis = continuous estrogen stimulation, endometrium overgrows, sloughs off at irregular times and varying amounts ( timing near menarche, menopause)
endometrial sampling is the gold standard to determine if ovulation is messed up dx for dysfunctoinal bleeding
tX for dysfunctional bleeds oral contraceptives first line (uncomplicated). excessive bleeds - conjugated estrogens. NSAIDS reduce menstrual blood loss. surgerical: dilate curettage, hysterectomy (refractory)
most common gynecologic cancer in US? endometrial cancer
median age for dx of endometrial cancer? 60
prognostic for endometrial cancer? histological, myometrial invasion, histologic type
DM, Obesity, nulliparity (never giving birth), late menopause, unopposed estrogen therapy, tamoxifen (works as agonist in uterus, but works against breast ca) risk factors for endometriosis
irregular bleeding, prolonged heavy periods, or spotting. normal pelvic exam, endometrial biopsy. pelvic US r/o fibroids, polyps, and hyperplasia endometrial cancer
depends on staging, treatment: sugreical hysterectomy, salpingo-oophorectomy and postoperative radidation therapy endometrial ca
endometrial tissue in ovary, pelvic periotoneum, round ligament, sigmoid colon in women of reproductive age endometriosis
dysmenorrhea, dyspareunia (pain in intercourse), infertile, abnorm bleeding, chronic pelivic pain endometriosis sx
progressive uterosacral nodules, fixed retroverted uterus, (if ovary invovled = tender fixed adnexal mass noted) endometriosis
laparoscopy required for dx to visualize structures of uterus endometriosis
endometriosis treatment supression: OC or medroxyprogesterone supression of FSH/LH = eliminates estrogen: Danazol
dysmenorrhea tx for NSAIDS start onset of menses until sxs abate, or prior to menses if sx severe. max dose 800mg ibuprofen q 8 hours. take with food to minimize GI - OC: suppression of ovulation - decreased prostaglandins
failure to improve with NSAID, OC; onset of sx iwth menarche, pelvic pain outside of menses, worsening sx, hx of STI RED Flags - consider referral to laparoscpy
when to proscribe paragard (copper IUD for contraception and dysmenorrhea) severe pain with menses for year. (missed work, borderline uterine enlarged. Recommend pamprin)
differentiating between primary and secondary dysmenorrhea secondary: pain with age. primary: loss of pain with age (after pregnant)
endometriosis (enlarged uterus, IUD for contra 3 yrs), adenomyosis (lining grows into muscular boarder), leiomyomata, ovarian cyst, pelvic adhesion, chronic PID, cervical stenosis, copper IUD, IBS, inflammtory Bowel dz, interstitial cystitis secondary dysmenorrhea
Dx for causes of pain in menses laparoscopy, hysteroscpy
tx for causes of pain in menses underlying: abx (PID), cautery (implant), hormonal (endometriosis), resection (fibroid), cystectomy ovarian (for cysts), hysterectomy (cancer), drugs for IBD, cystitis
abn Serotonin in luteal phase possible cause PMS
Dx for PMS menstrual hx of sx, general medical hx, TSH, FSH, HcG, prolactin if menses irregular. r/o somatic (r/o mood, premenopause, thyroid, substance abuse
Tx for PMS exercise, stress reduce, SSRI (fluoxetine, OC -= shorten placebo), GnRH (lupron) for refractory.
heavy periods - menorrhagia clinical pearls >80ml, prolonged >7 days, irregular btw menses espcially. anovulatory bleeding, cycle length less than 24 days.
anovulation = menorrhagia or none common in adolescence, perimenopause, PCOS, thyroid dz.
menorrhagia differential endometrial polyp, leiomyomata (submucus), adenomyosis, uterine malignancy
abnormal bleeding hx (easy bruisability), on conraceptives, assoc. pain/discharge/pressure/hot flashes, on IUDs Dx questions for menorrhagia
PE: thyroid, contour of uterus, adnexal mass, pelvic pain, bleeding site PE for excess/irregular bleeding
Labs: hcG, CBC (r/o anemia, thrombocytopenia) cerical cytology (pap smear), STI screening (Gc/Chl), TSH, coag tests (PT, PTT, Factor VIII, vWillebrand) labs for menorrhagia
anovulatory menorrhagia OC cycling, progestin withdrawal bleeds scheduled, IUD (Mirena)
Hysteroscopic resection (endometrial polyps, myoma) OC/IUD (adenomyosis/myoma heavy bleeds), endometrial ablation, hysterectomy Menorrhagia treatment options
if menopause before age... considered premature 40
diminished estrogen leads to increased... FSH, LH (lab tests indicate high FSH for menopausal women - amenorrhea)
lose benefits of estrogen (natural) in menopause lipid profile, vascular endothelium damage, loss of bone resorption (osteopenia)
progesterone with estrogen decreases risk of ... endometrial hyperplasia, cancer
hepatic dysfunction, estrogen neoplasm, DVT, undiagnosed vaginal bleed OC risk factors
Created by: jamieseals