chapter 26 - exam 3

menstrual cycle - follicular stage

day 1-14 - starts on the first day of mensuration

key hormones:

• GnHR from the hypothalamus → stimulates pituitary

• FSH from pituitary → stimulates growth of ovarian follicles and estrogen secretion by the ovary

• estrogen from ovary → thickens the uterine lining, prepares uterus for potential implantation

peak levels of FSH causes the pituitary to release LH

phase ends w/ ovulation

menstrual cycle - ovulation phase

around day 14

is triggered by surge in LH from pituitary when FSH peaks

ovulation = the release of the ovum from the Graafian follicle. the ovum will travel from the ovary → fallopian tube → uterus

some women feel mittelschmerz (mid-cycle pain)

menstrual cycle - luteal phase

day 15 - 28

after ovulation, the ruptured follicle becomes the corpus luteum which will secrete progesterone

progesterone prepares the uterine lining for implantation and stops FSH and LH production (prevents another ovulation)

if no fertilization → corpus luteum degenerates and progesterone levels fall which triggers mensuration and FSH and LH are up again

menstrual cycle - mensuration

day 1 of new cycle

shedding of the uterine lining occurs due to a drop in progesterone

marks the start of a new cycle

infertility

FSH and LH from the pituitary stimulate ovulation but hormonal problems will disrupt this cycle

hormonal problems include → stress, inc. or decrease in body wt, PCOS, low progesterone, premature ovarian failure

septate → wedge of fibrous tissue dividing the uterine cavity

Asherman’s syndrome → adhesions crossing the lining of the uterus

bicornate uterus → incomplete uniting of uterus

risk factors of infertility

females → age >32, smoking, excessive caffeine or alc. intake, obesity or underweight, autoimmune disorders

males → alc. or weed use, heat (hot tubes, tight underwear), radiation/toxins, meds that reduce sperm ct, ED

dx disorders of the female repo. system - blood tests and hormone testing

• bone age and density → checks for delayed puberty or estrogen deficiency

• thyroid fx

• prolactin lvl → increased may suppress ovulation

• FSH, LH estradiol, progesterone, testosterone lvls → can indicate ovarian fx and hormone lvls

dx disorders of the female repo. system - cervical and CA screenings

• pap

• anal pap

• thin prep → improved method for paps; also detects HPV

• colposcopy → bx of cervix

• CA-125 blood test → tumor marker used to scrn for ovarian CA (can also be elevated in non-cancerous conditios)

dx disorders of the female repo. system - imaging or scope based testing

• laparoscopy → scope inserted through the abdo to view repo. organs (detects endometriosis, scarring, cycts, etc.)

• proctoscopy → examines rectum and anus for possible metastatic lesions from gyn cancers

• mammogram

• culdoscopy → scope that is inserted into the vagina looks at fallopian tubes and ovaries

• hysteroscopy → looks at the interior of uterus

• colposcopy → looks at cervix

endometriosis

patho: growth of endometrial tissue outside of the uterus where the tissue will respond to hormones leading to cyclic bleeding, inflammation, and scarring

sx: pelvic pain, painful periods, pain during intercourse

dx: laparoscopy provides a visual inspection and bx

adenomyosis

patho: endometrial growth inside the myometrium that will respond to hormone cycles and cause bleeding and inflammation in the uterine wall which leads to uterine enlargement, hyperplasia, and chronic pain

sx: menorrhagia (prolonged, heavy bleeding), painful periods, pelvic pain

dx: pelvic US, or MRI; definitive dx is usually a post-hysterectomy

endometrial polyps

patho: neoplastic growths that are usually begin that stick out from the endometrium into the uterine cavity. size can vary (tiny like a pencil eraser, or large like a golf ball). they may contain atypical hyperplasia or endometrial CA; most common in ages 40-60

sx: may have no sx but if sx → abnml uterine bleeding like spotting between periods, heavy or prolonged periods, postmenopausal bleeding. bleeding may occur if the polyp ulcerates and dies

dx: transvaginal US w/ 3D doppler, hysteroscopy, endometrial bx

leiomyomas (uterine fibrosis)

patho: benign tumors of the uterus aka fibroids - most common type of benign tumors in humans. the cause is unknown. oral contraceptives may decrease risk. the tumors grow in the myometrium and the growing is estrogen sensitive

sx: often asymptomatic but if not, pains, bleeding, infertility

dx: transvaginal or transabdominal US

dysfunctional uterine bleeding

patho: irregular bleeding from the uterus; chronic occurs for 6+ months and acute is sudden and heavy bleeding needing immediate care

causes by age:

• teens → due to immature hormone regulation

• postmenopausal women → likely due to structural lesions or cancer

sx: heavy mensural bleeding, irregular periods, missed periods, bleeding after sex, pelvic or abdo pain, anemia sx

dysfunctional uterine bleeding - anovulatory cycles

no ovulation

progesterone deficiency and estrogen excess leading to a thickened endometrial lining which leads to irregular bleeding

dysfunctional uterine bleeding - ovulatory

bleeding despite ovulation due to → poor vessel control, vasodilation, excess prostaglandins, anemia

breast disorders - fibrocystic breast disease

benign nodular that is very common in women over the age of 30. it is caused by hormonal changes (especially during second half of the menstrual cycle)

sx: breast tenderness, swelling, lumpiness, cystic breast pain can come from BC or hormonal therapy

dx: US, mammo, fine needle aspiration

breast disorders - fibroadenoma

benign, rubbery, round movable mass that is common in women aged 25-45

sx: asymptomatic

dx: US, mammo, fine needle aspiration

breast disorders - mastitis

ascending infection to interior ductile structures; can happen during breast feeding and in early postpartum

caused by bacteria

sx: swelling, redness, pain, warmth in breast

breast disorders - galactorrhea

milk-like d/c that comes from the nipple w/o recent childbirth or breastfeeding.

caused by nipple stimulation, hormonal imbalance, meds or pituitary tumors

sx: bilateral white or clear d/c

dx: preg test, prolactin lvl, thyroid/renal labs, breast or brain imaging