Obstetrics and Gynaecological Diseases I

Flashcards covering key definitions, symptoms, pathophysiology, and treatments for PMS, Dysmenorrhea, and Menopause as presented in the OB-GYN Diseases I lecture.

How does the specialization of Obstetrics differ from Gynecology?

Obstetrics deals with childbirth and the care of women giving birth, while Gynecology deals with functions and diseases specific to women, especially the reproductive system.

What is the definition of the menstrual cycle based on the lecture notes?

The cyclic, physiologic changes in hormone levels that cause egg release from the ovary and the thickening of the uterine lining (endometrium) to prepare for a fertilized egg.

What is Pre-menstrual syndrome (PMS)?

Physical or behavioral changes that some women experience before their menstrual periods begin every month, which can range from mild discomfort to major effects on work and family life.

What is the suspected cause of PMS regarding hormone levels?

While levels appear normal, it is believed estrogen and progesterone may act in combination with chemicals in the brain to cause symptoms.

What are the specific risk factors mentioned for PMS?

Increased caffeine intake, stress, and dietary factors.

List four physical signs and four emotional signs of PMS.

Physical: bloating, abdominal discomfort, breast swelling/soreness, headache. Emotional: depression, irritability, mood swings, inability to concentrate.

What are the timing requirements to diagnose a woman with PMS?

Discomfort must occur during the last $3$ to $14$ days before the period, follow a pattern repeated for at least two cycles, and the woman must be symptom-free for at least two weeks a month.

Which medications are listed as treatments for the physical discomfort of PMS?

Vitamins (B6), Mefenanic acid, and hormonal treatments such as low-dose estrogen and progesterone.

What is Dysmenorrhea?

Painful menstruation observed as painful or discomforting "cramps" during or just before a menstrual period.

In the pathophysiology of dysmenorrhea, what does progesterone induce the endometrium to secrete?

Prostaglandins.

Compare the functions of prostacyclin and Prostaglandin F2$\alpha$ ($PGF2\alpha$) in the myometrium.

Prostacyclin is for vasodilation and myometrial relaxation, while $PGF2\alpha$ is for vasostriction and myometrial constriction.

What causes the sensation of a "cramp" during dysmenorrhea?

Production is skewed toward $PGF2\alpha$, causing a strong, painful spasm that temporarily cuts off blood flow and deprives the uterine muscle of oxygen.

Distinguish between Primary and Secondary Dysmenorrhea based on age and cause.

Primary: affects young women ($15$ to $25$ years old), no underlying illness. Secondary: occurs in older women (>30 years old), caused by medical problems like endometriosis or pelvic inflammatory disease (secondary cause)

What is Laparoscopy?

A diagnostic procedure involving the insertion of a tiny, flexible lighted tube through a small incision below the navel to view internal abdominal and pelvic organs.

How do NSAIDs such as aspirin or ibuprofen treat Primary Dysmenorrhea?

They inhibit the synthesis of prostaglandins, which lessens uterine contractions and reduces menstrual flow.

At what age does Menopause typically occur, and is it influenced by body size?

It occurs around ages $50$ to $52$ and is not known to be related to race, body size, or the age of first menstruation.

What characterizes the Perimenopause phase?

Occurring between ages $40$ and $50$, it is a phase where hormone production declines, leading to irregular cycles and unpredictable heavy bleeding.

What two physiological changes lead to decreased estrogen secretion at the start of the menopausal cycle?

$1$. Decrease in the number of ovarian follicles. $2$. Decrease in the number of receptor sites for FSH and LH on each ovarian follicle.

Why do hot flushes occur during menopause?

Decreased estrogen levels confuse the hypothalamus thermostat, leading to intense heat and red blotches on the face and body.

How does menopause affect the risk of Urinary Tract Infections (UTI)?

Thinning of the vaginal mucosa increases the pH, which increases the likelihood of bacterial growth. Due to URINARY INCONTINENCE (structural deterioration and weakening leads to the lack of watertight seal to keep urine in the bladder)

What are the cardiovascular and bone health risks associated with decreased estrogen?

Increased risk of atherosclerosis/cardiovascular diseases (as estrogen has a protective effect) and increased bone resorption leading to osteoporosis.

What are the potential risks identified with Hormone Replacement Therapy (HRT)?

Increased risk of heart attack, stroke, breast cancer, and dementia.

Which specific drugs are mentioned for the treatment of hot flashes?

Synthetic progesterone (Cycrin/Megace), methyldopa (Aldomet), and clonidine (Catapres).

What is the pathophysiology of menopause?

Menopause involves the gradual decline in ovarian function, leading to reduced levels of estrogen and progesterone.

The decrease in estrogen results from a reduction in the number of ovarian follicles and the decline in sensitivity of existing follicles to follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

This causes ovaries to secrete less estrogen disrupting the normal menstrual cycle, leading to irregularities and eventually menopause.

How do we diagnose Menopause?

• Changes/Irregularities in menstrual patterns (at appropriate age)

• Hot Flashes

• Upon Physical Examination of mucus secretion or pap smears of the vagina

• Low estrogen levels or profile in the body.

How can menopause severity be classified?

25% → no symptoms

35% → mild symptoms

40% → severe symptoms