Reproductive Function: Ovarian System PDF

Reproductive Function: Ovarian System Pathophysiology Terrel Master, PhD Learning Objectives Discuss normal female reproductive anatomy and physiology. Describe and compare common menstrual disorders. Discuss various disorders of the reproductive structures: prolapse, disorders o...

Reproductive Function: Ovarian System Pathophysiology Terrel Master, PhD Learning Objectives Discuss normal female reproductive anatomy and physiology. Describe and compare common menstrual disorders. Discuss various disorders of the reproductive structures: prolapse, disorders of the uterus/ovaries/breasts Describe and compare infectious disorders of the reproductive system. Describe and compare cancers of the reproductive system. Female Reproductive System Anatomy Review Disorders of the Breasts Menstrual Disorders Benign Breast masses Abnormal Mastitis bleeding/Amenorrhea/Dysmeno rrhea Infectious Disorders Premenstrual syndrome/PMDD Candidiasis (yeast infection) Prolapses – pelvic organ, Pelvic Inflammatory Disease vaginal wall, uterine Disorders of the Uterus Cancers Endometriosis Breast Fibroids Cervical Disorders of the Ovaries Endometrial Ovarian Cysts Ovarian Anatomy Review – Ovarian System Ovaries Uterus Uterine Tube Body Cervix Endometrium/Myometrium Vagina Labia/Clitoris Mammary Glands  Menstrual Cycle Pituitary hormones cause the follicles to mature during the reproductive years ~28-day cycle Three phases: Menstrual – shedding of the endometrium, triggered by drop in progesterone caused by degradation of the corpus luteum Proliferative – Endometrial wall rebuilds, follicles mature, estrogen builds as follicles develop in the ovaries Ovulation – triggered by LH & FSH peak from pituitary gland Secretory – high progesterone levels from corpus luteum Each phase is marked by changes in hormone levels Repeats until pregnancy or menopause occurs Menstrual Disorders Abnormal uterine bleeding (AUB) Amenorrhea Previous terms like menorrhagia, metrorrhagia, Absence of menstruation etc. are not used May be primary, secondary, or normal Widely experienced, especially at menarche and perimenopause Causes: Acute or chronic genetic disorders, congenital defects, Abnormal frequency, regularity, duration and/or hypothalamic tumors, volume for most of past 6 months stress, sudden weight loss, extreme reduction in body fat, anemia, Heavy menstrual bleeding (HMB): pregnancy, lactation, and menopause increased daily/monthly volume Dysmenorrhea Intermenstrual bleeding (IMB): Painful menstruation bleeding between regular menses Cramping pain impairs usual daily Causes: PALM-COEIN activities; begins at end of ovulation and Structural: Polyp, Adenomyosis, Leiomyoma, continues through menstruation Malignancy and hyperplasia Causes: unknown, reproductive conditions Nonstructural: Coagulopathy, Ovulatory (e.g., endometriosis or reproductive dysfunction, Endometrial disorder, Iatrogenic, cancers), and after childbirth Not otherwise classified Premenstrual Syndromes Premenstrual syndrome PMS Group of physical and emotional symptoms that affect many women for reasons not fully understood Manifestations: irritability, depression, fatigue, headache, abdominal bloating, joint pain, breast tenderness, weight gain, and sleep disturbances that usually begin 5 to 11 days before menstruation Premenstrual dysphoric syndrome: PMD severe form of PMS characterized by severe depression, tension, and irritability Treatment: hormone therapy; antidepressants; analgesics; comfort measures; and decreasing intake of caffeine, soda, processed sugars, and alcohol Pelvic Organ Prolapses Muscles, ligaments, and fascia normally support the bladder, uterus, and rectum in female pelvis These canasymptomatic, Manifestations: weaken with age,of childbirth, visualization the trauma, and cervix or uterus from the vaginal opening, feeling hormonal of fullness in thechanges during pelvis or vagina, difficult menopause or painful sexual intercourse, vaginal bleeding, and This causes difficulty organs with urination to shift out of normal position and defecating Cystocele (urethrocele): bladder protrudes into anterior wall of the vagina Rectocele: rectum protrudes through the posterior wall of the vagina Uterine Prolapse Descent of the uterus or cervix into the vagina Classification system First degree: cervix has dropped into the vagina Second degree: cervix is apparent at the vaginal opening Third degree: cervix and uterus bulge through the vaginal opening Disorders of the Uterus Endometriosis Endometrium grows in areas outside the uterus Most commonly grows in the fallopian tubes, ovaries, and peritoneum, but the tissue can grow anywhere in the body The abnormal endometrial tissue continues to act as it normally would during menstruation Blood becomes trapped and irritates the surrounding tissue Complications: pain, cysts, scarring, adhesions, and infertility Manifestations: dysmenorrhea, menorrhagia, pelvic pain, infertility, and pain during or after intercourse Disorders of the Uterus Leiomyomas (Fibroids) Firm, rubbery growth of the myometrium, occurring as well- defined, unencapsulated masse Can range from microscopic to weighing several pounds Cause: unknown, but most seem to grow during the menstruation years in the presence of estrogen and shrink after menopause Do not usually interfere with fertility, Manifestations: asymptomatic; but do increase the risk of menorrhagia; pain in the pelvis, back, or spontaneous abortion and preterm legs; urinary frequency; urinary tract labor slightly infections; constipation; abdominal distension; pain during sexual intercourse; and anemia Disorders of the Ovaries Ovarian Cysts Benign, fluid-filled sacs on the ovary, often formed in the ovulation process May rupture, causing abdominal/pelvic pain Complications: hemorrhaging, peritonitis, infertility, and amenorrhea Manifestations: asymptomatic, abdominal pain or discomfort, abnormal menstrual bleeding, and abdominal distension Polycystic ovary syndrome: ovary enlarges and contains numerous cysts Exact cause is unknown, but linked to hormone and endocrine abnormalities Manifestations: infertility (anovulation), amenorrhea, hirsutism, acne, male-pattern baldness Disorders of the Breast Can be benign or malignant, most are not life-threatenin Affect lactation, breastfeeding, and self-image Fibrocystic Breast Mastitis Changes/Masses Breast tissue inflammation Numerous benign nodules in the associated with infection and breast, more frequent during lactation childbearing years Usually develops within 6 weeks of Firm, movable masses more prominent childbirth due to a staphylococcal or and painful during menstruation streptococcal bacterium introduced Manifestations: dense, irregular, to the nipple through breastfeeding bumpy breast tissue; dull, heavy Complications: blockage of milk breast pain or tenderness; flow and abscesses Treatment: usually not required, needle aspiration of fluid, surgical Manifestations: breast removal of cysts, analgesics, a tenderness, swelling, redness, supportive bra, heat/cold and warmth; pain or a burning application sensation and fever Infectious Diseases Candidiasis Manifestations: thick, white Yeast infection caused by the vaginal discharge; vulvular common fungus Candida albicans erythema and edema; vaginal Opportunistic infection that can arise and labial itching and burning; anywhere in the body dysuria; and painful sexual In the reproductive system, intercourse candidiasis most frequently occurs Treatment (most cases can be in the vagina and is a common managed at home): cause of vaginitis (inflammation of Antifungal agents the vagina) Practicing safe sex and proper Candida and many other microorganisms are part of the perineum care normal flora present in the vagina Avoidance of douching, feminine and usually balance each other hygiene or perfumes, tight-fitting Imbalance often occurs in the synthetic clothing, presence of vaginal pH changes Maintaining blood glucose Infectious Diseases Pelvic Inflammatory Disease Infection of the female reproductive system; bacteria usually ascend from the vagina Can be either acute or chronic Causes: STI; bacteria introduced during childbirth, endometrial procedures Complications: reproductive structure obstructions, peritonitis, abscesses, septicemia, adhesions, chronic pelvic pain, ectopic pregnancies, infertility Manifestations: indications of infection; pain or tenderness in the pelvis, lower abdomen, or lower back; abnormal vaginal and cervical discharge; bleeding after sexual intercourse; painful sexual intercourse; urinary frequency; dysuria; dysmenorrhea; amenorrhea Breast Cancer Most common malignancy in women, second leading cause of cancer death in women Breast cancer can occur in men, but it is rare Contributing factors: age, early onset of menstruation, family history, genetic predisposition (BRCA1 and BRCA2 genes), obesity, and exogen estrogen exposure Most are estrogen-dependent and originate in the duct system Early, the tumor is freely moving; tumor becomes fixed as the cancer progresses Metastasis can occur to nearby lymph nodes, lungs, brain, bone, and liver Manifestations: asymptomatic; mass in the breast or axillary that is hard, has uneven edges, and is usually painless; change in the size, shape, or feel of the breast or nipple; and nipple drainage that may be bloody, clear to yellow, green, or purulent Diagnosis: monthly self-breast examinations, mammogram, and biopsy Cervical Cancer Rates have been declining in recent years with screening advancements and vaccinations Almost all cervical cancers are caused by HPV Can be transmitted to oral/head and neck region…. Higher risk of head and neck cancer Manifestations: asymptomatic; continuous vaginal discharge; AUB between menstruation, after intercourse, or after menopause Diagnosis: Pap smear Prevention: HPV vaccine Ovarian Cancer Ninth most frequent cancer in women and fifth leading cause of cancer death Risk factors: genetic predisposition (defects on the BRCA1 and BRCA2 genes), advancing age, infertility, excessive estrogen exposure, obesity, and androgen hormone therapy Manifestations: abdominal distention, pelvic pain, eating disturbances, bowel pattern changes, gastrointestinal discomfort, pain during sexual intercourse, malaise, urinary frequency, and menstruation changes