Ch. 26 - Female Reproductive System

Pathophysiology Exam 3

What are the four phases of the menstrual cycle?

Menstrual phase

Follicular (proliferative) phase

Ovulation

Luteal (secretory) phase

What occurs during the menstrual phase?

The functional layer of the endometrium is shed due to a drop in estrogen and progesterone, resulting in menstrual bleeeding

Which hormone stimulates the growth of ovarian follicles?

Follicle-stimulating hormone (FSH)

Which hormone is responsible for stimulating ovulation?

Luteinizing hormone (LH)

What triggers ovulation?

A surge in luteinizing hormone (LH)

What is the primary function of estrogen during the menstrual cycle?

Estrogen stimulates growth and thickening of the endometrium during the follicular (proliferative) phase

What structure forms after ovulation?

The corpus luteum

What hormone is primarily produced by the corpus lute?

Progesterone

What is the primary function of progesterone?

To prepare and maintain the endometrium for implantation of a fertilized egg

What happens to progesterone and estrogen levels if fertilization does not occur?

Both hormone levels fall, causing the endometrium to shed and menstruation to begin

During which phase does the endometrium become thick, vascular, and ready for implantation?

The luteal (secretory) phase

What happens to the corpus lutes if pregnancy does not occur?

It degenerates into the corpus albicans

Which hormone maintains the corpus luteum during early pregnancy?

Human chorionic gonadotropin (hCG)

Which hormone is produced by the anterior pituitary to stimulate follicle development?

Follicle-stimulating hormone (FSH)

Which hormone is produced by the anterior pituitary to stimulate ovulation and corpus luteum formation?

Luteinizing hormone (LH)

How is infertility defined?

The inability to achieve pregnancy after 12 months of regular, unprotected intercourse (or after 6 months if the woman is 35 years or older)

What are common female causes of infertility?

Ovulation disorders (such as PCOS)

Endometriosis

Blocked fallopian tubes

Uterine abnormalities

Advanced maternal age

Hormonal disorders

What are common male causes of infertility?

Low sperm count

Poor sperm motility

Abnormal sperm morphology

Varicocele

Hormonal disorders

Genetic abnormalities

What lifestyle factors increase the risk of infertility?

Smoking

Excessive alcohol use

Obesity

Being underweight

Illicit drug use

Excessive exercise

Exposure to environmental toxins

Which sexually transmitted infections can increase the risk of infertility in women?

Chlamydia and gonorrhea because they can lead to pelvic inflammatory disease (PID)

How does advanced maternal age affect fertility?

Both the number and quality of oocytes decline, making conception more difficult and increasing the risk of miscarriage

Which condition commonly causes infertility by creating adhesions outside the uterus?

Endometriosis

What is the purpose of a pelvic examination?

To evaluate the external genitalia, vagina, cervix, uterus, and ovaries for abnormalities

What is a Pap smear used to detect?

Precancerous and cancerous changes of the cervix caused primarily by HPV

What imaging study is most commonly used to evaluate the uterus and ovaries?

Transvaginal pelvic ultrasound

What is hysteroscopy?

A procedure in which a camera is inserted through the cervix to directly visualize the inside of the uterus

What is an endometrial biopsy?

Removal of a small sample of the uterine lining to evaluate abnormal uterine bleeding or suspected endometrial cancer

What is a laparoscopy?

A minimally invasive surgical procedure used to directly visualize pelvic organs and diagnose conditions such as endometriosis

What is considered the gold standard for diagnosing endometriosis?

Laparoscopy

Which diagnostic test is commonly used first to evaluate abnormal uterine bleeding?

Transvaginal pelvic ultrasound

What are endometrial polyps?

Benign overgrowths of the endometrial lining that project into the uterine cavity

What are the common signs and symptoms of endometrial polyps?

Abnormal uterine bleeding

Intermenstrual bleeding

Postmenopausal bleeding

Heavy menstrual periods

Infertility

How are endometrial polyps diagnosed?

Transvaginal ultrasound

Saline infusion sonohysterography

Hysteroscopy

Endometrial biopsy

What are leiomyomas (uterine fibroids)?

Benign smooth muscle tumors of the uterus that are estrogen-dependent

What are the common signs and symptoms of leiomyomas?

Heavy menstrual bleeding (menorrhagia)

Pelvic pressure or pain

Urinary frequency

Constipation

Enlarged uterus

Infertility in some cases

How are leiomyomas diagnosed?

Primarily with transvaginal pelvic ultrasound

MRI may be used for complex cases or surgical planning

What is dysfunctional uterine bleeding (abnormal uterine bleeding due to ovulatory dysfunction)?

Abnormal bleeding caused by hormonal imbalance without a structural cause such as fibroids or polyps

What are the signs and symptoms of dysfunctional uterine bleeding?

Irregular menstrual cycles

Prolonged bleeding

Heavy bleeding

Spotting between periods

Missed periods followed by excessive bleeding

What is a common cause of dysfunctional uterine bleeding?

Anovulation, which results in unopposed estrogen stimulation of the endometrium

How is dysfunctional uterine bleeding evaluated?

Pregnancy testing

Pelvic examination

Transvaginal ultrasound

Hormone evaluation when indicated

Endometrial biopsy in patients at risk for endometrial cancer

What is endometriosis?

A disorder in which endometrial tissue grows outside the uterus, commonly on the ovaries, fallopian tubes, and pelvic peritoneum

What are the classic signs and symptoms of endometriosis?

Severe dysmenorrhea

Chronic pelvic pain

Dyspareunia (pain during intercourse)

Painful bowel movements or urination during menstruation

Infertility

Why does endometriosis cause infertility?

Inflammation and scar tissue (adhesions) can distort pelvic anatomy, impair ovulation, and interfere with fertilization or implantation

What is the gold standard for diagnosing endometriosis?

Laparoscopy with direct visualization (and often biopsy) or endometrial implants

What is adenomyosis?

A condition in which endometrial tissue grows into the muscular wall (myometrium) of the uterus

What are the sign and symptoms of adenomyosis?

Heavy menstrual bleeding

Painful menstruation (dysmenorrhea)

Chronic pelvic pain

A uniformly enlarged, tender uterus

What are fibrocystic breast changes?

Benign changes in breast tissue characterized by lumpy, tender breasts and fluid-filled cysts that often worsen before menstruation

How do fibrocystic breast changes differ from breast cancer?

Fibrocystic changes are usually bilateral, tender, and fluctuate with the menstrual cycle, whereas breast cancer is more likely to present as a hard, painless, fixed lump that does not change with the menstrual cycle

What are common warning signs of breast cancer?

A hard painless lump

Skin dimpling (“peau d’orange”)

Nipple retraction

Bloody nipple discharge

Enlarged axillary lymph nodes

What diagnostic tests are commonly used to evaluate a suspicious breast mass?

Diagnostic mammography

Breast ultrasound

Biopsy (the definitive method for diagnosis)