Reproductive Clinical Science

\ \ What are the hormonal changes seen in anovulatory cycles:: Increased estrogen and decreased progesterone Pathologically classify adenomyosis:: found in 30-50 year olds. hypertrophy of myometrium. endometrial element found ectopically inside Leiomyomas:: Most common tumour of female genital tract fibroids, smooth muscle and benign PV bleeding Compression of bladder enlarge with pregnancy Complications of leiomyoma include:: infertility, spontaneous abortion, malpresentation of fetus Leiomyomas histologically and macroscopically: circumscribed, round, gray-white, fascicles of smooth band cells. No atypia How would you treat leiomyoma?:: myomectomy- to remain fertile. hysterectomy- large and multiple What is endometriosis: endometrial elements outside of the uterus What are the common features of endometriosis:: infertility, responds to cyclical hormonal stimulation, reproductive age groups. What is seen macroscopically in endometriosis:: red/blue to yellow brown fibrosis (haemorrhage and haemosiderin deposition) fibrotic scarring, chocolate/haemorrhagic cysts in ovaries. \ Common microbial causes of PID:: N. gonorrohea , chlamydial symptoms of PID:: bilateral, crampy and dull pain (few days after menses), mucopurulent discharge and postvaginal bleeding complications of PID:: infertility, chronic pelvic pain, ectopic pregnancy How do you classify PID?:: * I – PID w/out peritoneal irritation * II – involves peritonitis & bilateral lower quadrant rebound tenderness * III – mass or abscess * IV – rupture of tubo-ovarian abscess **__Abnormal menstrual bleeding ⇒ PALM COEIN__**  Causes of abnormal menstrual bleeding (PALM COEIN):: Polyps; adenomyosis; leiomyoma; malignancy & hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; not otherwise classified  * How do you treat abnormal menstrual bleeding::   * Drugs ⇒ cyclokapron (anti-fibrinolytc), HRT * Invasive ⇒ ablation; embolization of uterine arteris; high intensity U/S to burn area; myomectomy/ hysterectomy  * Primary amenorrhoea:: ≥14y w/out 2ndry sexual characteristics OR ≥16y even w. 2ndry sexual characteristics  * Secondary amenorrhoea:: menstruated but stopped > 3 n. cycle lengths / ≥ 6 months  * PCOS symptoms:: polycystic ovaries on sonar, hyperandrogenism (like testosterone), hyperinsulinemia; oligo/amenorrhoea, ± overweight; ±hirsutism;  * How do you treat PCOS:: weight loss, drugs (like the pill if desire menstruation or ovulation induction drugs if desires pregnancy)  * Secondary causes of amenorrhoea:: PCOS, Prolactinoma, Hyperinsulinaemia  \ * If cycle last > 38days :: oligomenorrhoea  * If cycle