Pathophysiology of Uterus, Vagina, and Adnexa (BMS 250, January 24, 2025) PDF

PATH OP HYSIOLOGY OF UTER US, VAGINA AND ADNEX A Dr. Zeynep Uraz, ND BMS 250 January 24, 2025 BY T H E E ND O F T H I S L ES SO N , S T UD E N T S WI L L B E AB L E TO : Discuss common medical conditions affecting the ovaries, uterus and vagina, and the impac...

PATH OP HYSIOLOGY OF UTER US, VAGINA AND ADNEX A Dr. Zeynep Uraz, ND BMS 250 January 24, 2025 BY T H E E ND O F T H I S L ES SO N , S T UD E N T S WI L L B E AB L E TO : Discuss common medical conditions affecting the ovaries, uterus and vagina, and the impact of these on reproductive health and fertility ○ Causes of abnormal uterine bleeding, dysmenorrhea, amenorrhea; including endometriosis ○ Endometrial hyperplasia, fibroids, uterine myoma ○ Pelvic organ prolapse ○ Ovarian cysts (not PCOS) ○ Cervical dysplasia ○ Vaginitis ○ Major cancers ○ Explain the relevance of hormonal regulation of the ovarian-based sexual and reproductive systems to these conditions, including the processes of oogenesis, ovulation, and menstruation Describe the mechanisms of action, efficacy, and side effects of various contraceptive methods, including hormonal contraceptives, barrier methods, and intrauterine devices (IUDs). (introduction) 3 PARTS TO THIS LECTURE 1. Menstrual Disorder 2. Conditions of cervix, vagina and vulva 3. Contraception Anatomic landmarks of the uterus and adjacent organs. (Redrawn, with permission, from Chandrasoma P et al. Concise Pathology, 3rd ed. Originally published by Appleton & Lange. Copyright © 1998 by The McGraw-Hill Companies, Inc.) Citation: Chapter 22 Disorders of the Female Reproductive Tract, Hammer GD, McPhee SJ. Pathophysiology of Disease: An Introduction to Clinical Medicine, 8e; 2019. Available at: https://accessmedicine.mhmedical.com/content.aspx?bookid=2468&sectionid=198224594 Accessed: January 22, 2025 Copyright © 2025 McGraw-Hill Education. All rights reserved Schematic drawing of the sequence of changes that occur in the alveolar secretory units and duct system of the female breast before, during, and after pregnancy and lactation: (1) Before pregnancy, the glands are inactive, with small ducts and only a few small secretory alveoli; (2) early in pregnancy, alveoli develop and begin to grow; (3) by midpregnancy, the alveoli and ducts are enlarged with dilated lumens; (4) at parturition and during lactation, the alveoli are greatly dilated and active in milk production; and (5) after weaning, the alveoli and ducts regress by apoptotic cell death. (Redrawn, with permission, from Mescher AL. Junqueira’s Basic Histology, 14th ed. McGraw-Hill, 2016.) Citation: Chapter 22 Disorders of the Female Reproductive Tract, Hammer GD, McPhee SJ. Pathophysiology of Disease: An Introduction to Clinical Medicine, 8e; 2019. Available at: https://accessmedicine.mhmedical.com/content.aspx?bookid=2468&sectionid=198224594 Accessed: January 22, 2025 Copyright © 2025 McGraw-Hill Education. All rights reserved  Disorder in this system typically manifests as altered menstruation, pelvic pain, infertility Higher incidence of cancers in late - reproductive or menopausal years - SYSTEMIC CAUSES OF REPRODUCTIVE DISORDERS Brain Hypothalamus Pituitary Thyroid Adrenals Kidneys Liver Typically present painlessly - SYSTEMIC EFFECTS OF REPRODUCTIVE DISORDERS Ovarian hormones maintain various tissues; their dysfunction can lead to: Osteoporosis (bone mass loss) * Estrogen has a stimulatory effect on bones Atrophic vaginitis (estrogen deprivation) Protective effect on CV system & Cardiovascular risks (atherogenesis, altered vascular compliance) Cancer risk (e.g., endometrial carcinoma from estrogen excess AND progesterone deficiency) Pregnancy-related disorders: Gestational diabetes Preeclampsia-eclampsia (5% of pregnancies, high cardiovascular risk) PREGNANCY RELATED DISORDERS Pregnancy-related disorders: Gestational diabetes Preeclampsia-eclampsia (5% of pregnancies, high cardiovascular risk) High risk of cardiovascular death  CHALLENGES IN EARLY DETECTION Ovaries & Fallopian Tubes: Deep location, difficult to palpate Few sensory nerves, often asymptomatic Breasts: Large amounts of adipose tissue obscure tumors A- Cervical Cancer Exception: Easily accessible for screening (Pap smear, HPV testing) Reduced mortality due to effective screening programs OVERVIEW OF DISORDERS OF FEMALE REPRODUCTIVE TRACT Disorders categorized by dysfunction at different levels of the neuroendocrine axis: Central: Pituitary, hypothalamus, or brain centers influencing the hypothalamus Ovarian: Intrinsic ovarian dysfunction End-organ: Uterine, fallopian tube, or vaginal dysfunction DISORDERS OF CE NTRAL HYPOTHALAMIC–PITU ITARY FU NCTION Changes in GnRH secretion affect pituitary responsiveness: GnRH dysregulation → altered gonadotropin secretion Pituitary dysfunction → disordered ovarian function (e.g., anovulation) End-organ effects → menstrual irregularities, endometrial atrophy Influencing factors: 33 Central: Stress, emotional factors Peripheral: Body fat, energy balance Common presentation: Amenorrhea (e.g., athletic young women) DISORDERS OF THE OVARY Key components of ovarian function: 53 Responsiveness to gonadotropins Follicular viability Paracrine signaling within follicles Polycystic Ovary Syndrome (PCOS):Pathophysiology: Self-perpetuating - feedback disruption - DISORDERS OF THE OVARY Manifestations: Anovulation Hirsutism Infertility Dyslipidemia Abnormal uterine bleeding or amenorrhea DISORDERS OF THE U TERU S, FALLOPIAN TUBES, AND VAGINA Uterine Disorders Primary concern: Endometrial dysfunction Common causes: Hormonal dysfunction Fibroids (myomas) – benign tumors of myometrium - Endometrial cancer 2 Key symptom: Abnormal vaginal bleeding Menorrhagia & metrorrhagia DISORDERS OF THE U TERU S, FALLOPIAN TUBES, AND VAGINA Pelvic Infections & Complications Causes: Gonorrhea Chlamydia Anaerobic bacteria DISORDERS OF THE U TERU S, FALLOPIAN TUBES, AND VAGINA Complications: Endometrial & fallopian tube scarring → infertility Tubo-ovarian abscesses → may require surgical drainage Presentation: Abdominal & pelvic pain Fever & elevated white blood cell count And testing! m Positive endocervical culture Importance of early treatment: Aggressive screening & antibiotics prevent permanent damage DISORDERS OF PREGNANCY Beyond the scope of this course PART 1: MENSTRUAL DISORDERS AMENORRHEA (PRIMARY AND SECONDARY), DYSMENORRHEA (PRIMARY AND SECONDARY), BLEEDING DISORDERS (AUB) CONDITIONS CAUSING AMENORRHEA Scarring & adhesions INITIAL DIAGNOSTIC APPROACH Step 1: Rule out pregnancy. Step 2: Assess thyroid function (serum TSH) and pituitary function (serum - prolactin). - Step 3: Further investigation based on clinical history and physical exam. THEN, LOOK AT… 1. Uterine Causes Ie scarring 2. Disorders of the Ovary Primary ovarian insufficiency Chronic anovulation Hormonal feedback disorders Pituitary disorders Hypothalamic disorders Indirect influences UTERINE DISORDERS Uterine Disorders - Overview The endometrium regenerates from underlying stem cells. - Damage to these stem cells can result in amenorrhea. Common causes: Endometritis post-curettage (scraping of the endometrium) for postpartum bleeding or abnormal uterine bleeding. Failure of endometrial regeneration leads to thin lining on ultrasound (