Female reproductive system

reproductive system of female is more complex because of

pregnancy

ovaries (gonads)

produce ova and hormones (estrogen and progesterone)

uterus

muscular organ within which fertilized ovum may implant and develop

cervix

opening in to uterus and neck of the uterus

fallopian tubes (oviducts)

tubes from ovaries to the uterus

-passageway for ovum released by the ovary to travel towards the uterus

Gonadotropin-releasing hormone (GnRH)

Stimulates release of LH and FSH from pituitary.

Follicle-stimulating hormone (FSH)

stimulates growth of ovarian follicles and oogenesis

luteinizing hormone (LH)

causes ovulation and development of corpus luteum

estrogen

primary ovarian hormone, essential for reproduction, metabolism, and normal function of body systems

Progesterone

'pro gestation'- prepares uterus to receive a fertilized ovum and to maintain pregnancy

progesterone is also important throughout cycle in non-pregnant women because it controls:

-smooth muscle relaxation- prevents contractions that would prematurely eject fetus

-increases body temperature before ovulation

mentrual cycle

non-pregnant females experience cyclical changes in the ovaries and uterus

ovarian cycle

changes that occur during and after maturation of the oocyte

-maturation of ovarian follicle, ovulation- rupture of mature follicle

-follicle becomes corpus luteum

What does the corpus luteum secrete?

progesterone

uterine cycle

changes in the endometrium that prepare it for implantation of the developing embryo

-growth and vascularization of endometrium

Menstruation

if implantation does not occur, corpus luteum atrophies, progesterone declines, endometrium degenerates

normal position of uterus

Slightly anteverted and anteflexed

Cervix downward and posterior

retroflexion

body of the uterus is sharply tipped or bent backward towards the rectum

anteflexion

body of the uterus bending sharply forward at the cervix, toward the bladder and the anterior abdominal wall

retrocele

protrusion of the rectum into the posterior wall of the vagina

what does retrocele cause

constipation and pain

cystocele

protrusion of bladder into the anterior wall of the vagina

what does cystocele cause

urinary retention and UTI

uterine prolapse

displacement of the uterus from its normal position and drop into the vagina

first degree prolapse

cervix drops into vagina

second degree prolapse

Cervix lies at opening to the vagina

-Body of uterus is in the vagina

third degree prolapse

uterus and cervix protrude through the vaginal orifice

-advanced stages cause discomfort, infection, and decreased mobility

amenorrhea

absence of menstruation

primary (genetic) amenorrhea

absence of menstruation by age 15

secondary (hormonal) amenorrhea

cessation of menstrual cycle for 3 consecutive cycles

dysmenorrhea

painful menstruation caused by excessive release of prostaglandins resulting in endometrial ischemia

premenstrual syndrome (PMS)

combination of physical and emotional symptoms that occur in luteal phase

PMS characteristics

weight gain, bloating, irritability, emotional liability, sleep disturbances, depression, headache, fatigue

menorrhagia

increased amount and duration of flow during menstrual periods

metrorrhagia

bleeding between cycles

polymenorrhea

short cycles of less than 3 weeks

oligomenorrhea

long cycles of more than 6 weeks

menometrorrhagia

heavy bleeding during and between menstrual periods

endometriosis

endometrial tissue occurs outside the uterus

pelvic inflammatory disease (PID)

infection of the uterus, fallopian tubes, and ovaries

PID usually originates as

an ascending infection from the lower reproductive tract

FIRST symptom of PID

pelvic pain

other symptoms of PID

-abnormal vaginal discharge (purulent, yellow-green)

-systemic symptoms (fever, nausea, leukocytosis)

-potential acute complications (peritonitis, pelvic abscesses, septic shock)

-scarring of tubes

treatment of PID

requires aggressive antibiotic therapy in hospital.

leiomyoma (uterine fibroids)

benign tumor of the myometruim

Leiomyoma clinical features

-classified by location

-usually multiple well defined masses

-asymptomatic until large growth

polycystic ovarian disease (PCOS)

spectrum of hormonal imbalance coupled with predisposition to insulin resistance

PCOS features-

-lack of ovulation

-excess LH- stimulates androgen secretion and androgens interfere with ovulation even more

-excess insulin is result of decreased sensitivity

-ovaries contain many cysts

hirsutism

excessive body and facial hair growth

absence of ovulation

oligomenorrhea or amenorrhea

carcinoma of the breast

most common cancer diagnosed among women

breast carcinoma features

most tumors are unilateral and arise from ductal epithelial cells

breast carcinoma predisposing factors

-first degree relative with the disease

-strong genetic disposition (BRCA1 and BRCA2)

-longer and higher exposure to estrogen

-Nulliparous= no pregnancies or late first pregnancy

mammography is more sensitive in detecting cancer in older women because

their breast tissue is less dense and glandular

initial sign of breast carcinoma

single, small, hard, painless nodule

later sign of breast carcinoma

distortion of breast tissue, dimpled skin, discharge from nipple

metastasis

occurs by the time the tumor is 1-2 cm in diameter

axillary lymph node involvement

-secondary tumors in bone, lung, brain, and liver

breast cancer treatment

surgery, removal of lymph nodes, radiation

carcinoma of the cervix

most cases of cervical cancer linked to HPV infection

routine pap smears of cervical cells are

important in identifying early treatable stages of cervical cancer

carcinoma of cervix pathogenesis

-early dysplasia of cells: abnormal cells showing less differentiation

-In situ tumor= located on the mucosal surface

-invasion to submucosa

-invasion and spread to adjacent organs

-late metastasis

Endometrial carcinoma (cancer of the Uterus)

originates in endometrial lining of the uterus

type 1 endometrial carcinoma

occurs in women in their 40s (perimenopausal)

-80% of cases are associated with estrogen excess

type 2 endometrial carcinoma

occurs in menopausal women, peak age being 55-65

-associated with uterine atrophy

early warning sign in 90% of uterine cancers

abnormal bleeding

does pap smear detect uterine cancer

no!

ovarian cancer

considered a silent tumor- few are diagnosed in early stage

ovarian cancer symptoms:

causes vague GI symptoms= increased abdominal size, indigestion, bloating

transvaginal ultrasound

best method for early detection of ovarian cancer

poor prognosis of ovarian cancer

up to 75% of cases have metastasized by the time they are discovered

-5 year survival

Stage 0 of Gynecologic Cancer

rarely used; preinvasive lesions

Stage 1 of Gynecologic Cancer

cancer is confined to organ it originated in

stage 2 gynecologic cancer

cancer involves some structures surrounding the organ of origination

Stage 3 of Gynecologic Cancer

regional spread of cancer with lymph node involvement

Stage 4 of Gynecologic Cancer

distant spread of cancer with metastasis