Pathology of Female Reproductive System

Abdominal Pain and Bleeding

• Pressure in the abdomen, pain in the hips, lower back, and inner thighs, and upset stomach with vomiting and loose stools can be symptoms of abdominal vaginal bleeding
• Treatment options include drug therapy with NSAIDS, prostaglandin blockers, oral contraceptives, relaxation techniques, heat therapy, exercise, acupuncture, and transcutaneous nerve stimulation

Abnormal Uterine Bleeding

• Oligomenorrhea: light or infrequent menstrual periods (> 35 days interval, 4-9 times per year)
• Amenorrhea: absence of menses
• Menorrhagia: prolonged menstrual bleeding
• Metrorrhagia: bleeding from the uterus between menstrual periods
• Complications of vaginal bleeding include anemia, toxic shock syndrome, and infertility

Complications of Vaginal Bleeding

• Anemia: assess for excessive fatigue, monitor vital signs, and provide safety measures for the weak patient
• Toxic Shock Syndrome (TSS): assess for high fever, vomiting, diarrhea, weakness, myalgia, and sunburn-like rash; avoid using superabsorbent tampons and pads, and change them frequently

Treatment of Vaginal Bleeding

• Drug therapy with oral contraceptives and balloon thermotherapy
• Surgical therapy with myomectomy and endometrial ablation

Menopause

• Absence of menstrual periods for 12 months, with a decline in reproductive hormones
• Stages: premenopause, perimenopause, menopause, and postmenopause
• Causes include natural decline of reproductive hormones, hysterectomy, bilateral oophorectomy, chemotherapy, radiation therapy, and primary ovarian insufficiency
• Treatment options include drug therapy with hormone replacement therapy, antidepressants, and selective estrogen receptor modulators, as well as non-hormonal therapy with a cool environment, loose fitting clothing, moisturizing soaps and lotions, a healthy diet with vitamin D, and exercise

Pelvic Inflammatory Disease (PID)

• Infection of the uterus, fallopian tubes, ovaries, and peritoneal cavity
• Causes: gonorrhea and chlamydial infections
• Manifestations: abdominal pain, fever, and vaginal discharge
• Complications: septal shock, infertility, and ectopic pregnancy
• Treatment: drug therapy, force fluids, heat to abdomen or Sitz bath, and patient teaching for prevention of re-infection

Endometriosis

• Presence of normal endometrial tissue outside the uterine cavity
• Characterized by endometrial glands and stroma in a location outside the endomyometrium
• Clinical manifestations: dysmenorrhea, pelvic pain, dyspareunia, dysuria, and infertility
• Diagnosis: pelvic exam, ultrasound, and laparoscopy
• Treatment options include ibuprofen, oral contraceptives, medroxyprogesterone, danazol, gonadotropin-releasing hormone agonists, and surgical therapy with laparoscopic laser surgery and hysterectomy

Benign Reproductive System Tumors

• Leiomyomas: benign smooth muscle tumors in the uterus, diagnosed with hysteroscopy
• Polycystic ovary syndrome (PCOS): bilateral enlarged ovaries with multiple outer follicular cysts, absence of corpora lutea, and hyperplastic ovarian stroma with thickening capsule

Cancers of the Female Reproductive System

• Cervical cancer: early changes in cervical epithelial tissue consist of dysplasia, with etiology linked to STDs, multiple sex partners, and environmental factors
• Staging: cervical intraepithelial neoplasia (CIN) graded from I to III
• Treatment options: surgical therapy with hysterectomy, chemotherapy, and radiation with brachytherapy
• Endometrial cancer: major risk factor is prolonged exposure to estrogen, with other risk factors including age, infertility, diabetes, family history, and lifestyle
• Diagnosis: endometrial biopsy
• Treatment options: surgical therapy with hysterectomy, chemotherapy, and radiation with brachytherapy
• Ovarian cancer: greatest risk factor is family history, with other risk factors including age, high-fat diet, greater number of ovulatory cycles, hormone replacement therapy, and use of infertility drugs
• Clinical manifestations: increase in abdominal girth, bowel and bladder dysfunctions, persistent pelvic or abdominal pain, and menstrual irregularities
• Diagnosis: CA-125, ultrasound, and yearly pelvic examination
• Vaginal cancer: risk factors include age, cancer of the cervix or endometrium, and young women with DES exposure
• Clinical manifestations: bleeding not related to menses, dyspareunia, dysuria, and vaginal discharge
• Vulvar cancer: risk factors include age, chronic irritation, and history of HPV or Herpes 2
• Clinical manifestations: pruritus, burning, enlarged inguinal lymph nodes, asymmetry, lesions or mass, and change in color
• Treatment options for all cancers: surgery, chemotherapy, and radiation