Reproductive Issues and Disorders

What is primary dysmenorrhea?

Painful menstruation related to duration and amount

Primary dysmenorrhea occurs in ____% of women

15-25%

What are the clinical manifestations of primary dysmenorrhea?

- Pelvic pain at menses onset

- Backache

- Headache

What is the pathophysiology of primary dysmenorrhea?

- Excessive prostaglandins (PGs) - they are potent myometrial stimulants, vasopressin enhances PG effects

- Excessive leukotrienes enhance pain fiber sensitivity

What can be benefical for primary dysmenorrhea?

Oral contraceptives

What is primary amenorrhea?

Failure of menses to occur by the age of 16

What are the 4 compartments of primary amenorrhea pathophysiology?

1. An anatomic defect

2. Ovarian involvement

3. Disorders of anterior pituitary

4. Hypothalamic disorder

Describe compartment I of primary amenorrhea

An anatomic defect - lack of uterus and vagina, normal ovarian function with secondary sex characteristics

Describe compartment II of primary amenorrhea

Ovarian involvement - dysgenesis, lack of follicle development and estrogen secretion, no secondary sex characteristics, high levels of FSH and LH

Describe compartment III of primary amenorrhea

Disorders of anterior pituitary - cannot make and/or secrete FSH/LH, growth and secondary sex characteristics may be present, depends on when deficiency occurs

Describe compartment IV of primary amenorrhea

Hypothalamic disorder - no GnRH

What is secondary amenorrhea?

Absence of menstrual bleeding in a women who had been menstruating but later stops menstruating for 3+ months

What causes secondary amenorrhea?

- Wide variety of possible conditions

- Dramatic weight loss (malnutrition, exercise)

What are some clinical manifestations of secondary amenorrhea?

- Absence of menses

- Infertility

- Vaginal atrophy

- Acne

- Hirsutism

What does PCOS stand for?

Polycystic ovary syndrome

What is PCOS?

A very common female phenotype consisting of a combination of signs and symptoms of androgen excess and ovarian dysfunction

PCOS prevalence

6-20%

How is PCOS treated?

Estrogen and progestin can decrease androgen production and regulate estrogen to regulate the menstrual cycle

What is endometriosis?

Presence of endometrial tissue outside of the uterus

Endometriosis is most likely due to...

retrograde menstrual flow through fallopian tubes. Genetic and immunologic factors are involved

What is first-line therapy for endometriosis?

Hormonal contraceptives, pregnancy also suppresses endometriosis

What are 4 signs/symptoms of endometriosis?

1. Fatigue and depression

2. Pain

3. Infertility

4. Heavy and painful periods

What happens if SPO11 does not work or is not present?

SPO11 defect -- impaired programmed DSB formation -- impaired meiotic recombination -- meiotic arrest -- infertility

What is Androgen Insensitivity Syndrome?

Males with AIS have mutations in the androgen receptor gene and are unable to respond appropriately to testosterone during development