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Reproductive pathologies Dr. Gary Mumaugh UNW St. Paul

Reproductive pathologies Dr. Gary Mumaugh UNW St. Paul. Alterations of Sexual Maturation. Delayed puberty Secondary sex characteristics have not appeared in girls by age 13 Secondary sex characteristics have not appeared in boys by age 14 95% of cases are simply a constitutional delay

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Reproductive pathologies Dr. Gary Mumaugh UNW St. Paul

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  1. Reproductive pathologiesDr. Gary MumaughUNW St. Paul

  2. Alterations of Sexual Maturation Delayed puberty Secondary sex characteristics have not appeared in girls by age 13 Secondary sex characteristics have not appeared in boys by age 14 95% of cases are simply a constitutional delay 5% are caused by some type of disruption of the hypothalamic-pituitary-gonadal axis

  3. Alterations of Sexual Maturation Precocious puberty Sexual maturation before age 6 in black girls and age 7 in white girls Sexual maturation before age 9 in boys

  4. Female Reproductive disorders

  5. Disorders of the Female Reproductive System Hormonal and menstrual alterations: Primary dysmenorrhea Painful menstruation associated with prostaglandin release in ovulatory cycles Related to the duration and amount of menstrual flow Secondary dysmenorrhea Painful menstruation related to pelvic pathology Can occur any time in the menstrual cycle

  6. Dysmenorrhea • Most common of all gynecologic complaints • Affects over 50% of women • The leading cause of absenteeism • Characterized by lower abdominal cramps and pain from mild to debilitating • Often associated with nausea, vomiting, diarrhea, headaches, vertigo, back pain

  7. Two Types of Dysmennorrhea • Primary Dysmenorrhea • Pain without pelvic pathology • Usually starts before age of 20 • With nausea 50% of time • With vomiting 25% of time • With stool frequency 35% of time • Pain usually starts a few hours before menses • Usually lasts a few hours to a few days

  8. Two Types of Dysmennorrhea • Secondary Dysmennorrhea • Pain with pelvic pathology and lesions • Endometriosis, P.I.D., Surgical Adhesions • Also caused by I.U.D. • Usually lateralized to one side • Usually is later in life • Begins a few days before menses • Lasts several days

  9. Dysmenorrhea Etiology • Like all chronic pain problems, the etiology is often multi-factoral. • On the biochemical level, Prostogladins (PGS) account for most of the symptoms. • Stimulation of the uterus by estrogen and progesterone increases the endometrial stores of Arachidonic Acid, which is the main PGS causing pain and symptoms.

  10. Arachidonic Acid • Has been found to cause significant symptoms, especially in teenagers • Dietary Considerations • Beef - red meats • Chicken and turkey • Dairy products • Whole milk

  11. Dysmenorrhea • Diagnosis • Diagnosis of primary is self-apparent • Diagnosis of secondary with ultrasound for fibroids, CT for endometriosis, cervical culture for PID • Treatment • Primary – NSAIDs and oral contraceptives • Secondary – treat the primary cause • Remove IUD, remove fibroids

  12. Hormonal and Menstrual Alterations Primary amenorrhea Absence of menstruation by age 14 Secondary amenorrhea Absence of menstruation for a time equivalent to three or more cycles or 6 months in women who have previously menstruated

  13. Hormonal and Menstrual Alterations Primary amenorrhea Causes: Congenital defects of gonadotropin production Genetic disorders Congenital central nervous system defects Congenital anatomic malformations Acquired CNS lesions

  14. Hormonal and Menstrual Alterations Secondary amenorrhea Causes: Pregnancy Dramatic weight loss Malnutrition or excessive exercise Anovulation Hyperprolactinemia Hirsutism

  15. Abnormal Bleeding • Normal – 2-3 ounces per cycle (4 days) • Amenorrhea – absence • Primary – period never begins • Pituitary, genetic, thyroid • Secondary – period began normally then stopped • Malnutrition, tumors, endocrine, anorexia nervosa, PTSD, excessive exercise • Hypomenorrhagia – light or scanty periods • Polymenorrhea - frequent periods • Caused by oral contraceptives, endocrine, thyroid, pituitary, diabetes • Diagnosis with US and laporoscapy

  16. Menorrhagia – long and heavy periods • Caused by uterine fibroids, oral contraceptives, IUD, thyroid disorders • S & S • Soaking through pads or tampons every hour or two • Needing double protection on frequent basis • Prolonged heavy periods more than one week • Passing large clots • Constant cramping • Possible anemia symptoms • Metrorrhagia • Dysfunctional irregular uterine bleeding • Commonly caused by fibroids

  17. Hormonal and Menstrual Alterations Polycystic ovarian syndrome Oligo-ovulation or anovulation Elevated levels of androgens or clinical signs of hyperandrogenism and polycystic ovaries Leading cause of infertility in the United States Multifactorial Hyperinsulinism Hypertension Dyslipidemia Dysfunction of follicle development

  18. Hormonal and Menstrual Alterations Premenstrual syndrome (PMS) Cyclic physical, psychological, or behavioral changes that impair interpersonal relationships or interfere with usual activities Premenstrual dysphoric disorder (PMDD) in 3% to 8% of women Greater than 200 physical, emotional, and behavioral signs and symptoms

  19. Even the king of the jungle knows who is boss !

  20. PMS Pathophysiology • Recurrent, cyclical set of physical and behavioral symptoms occurring 7-14 days before the cycle • Troublesome enough to interfere with daily life • Occurs up to 40% of women • Most severe cases 5% of 25-35 year olds

  21. Proposed Etiologies of PMS • Hormonal • Estrogen deficiency or excess • Progesterone deficiency or excess • Prolactin excess • Beta-endorphin deficiency • Altered estrogen : progesterone ratio • Fluids and Electrolytes • Vasopressin excess • Aldosterone excess • Sodium : Potassium ratio Na : K

  22. More Causes of PMS • Neurotransmitters • Serotonin deficiency • Cortisol excess • Adrenal insufficiency • Thyroid abnormalities • Hypoglycemia or decreased glucose tolerance • Prostaglandins • Excess or deficiency • Essential fatty acid deficiencies • Heredity

  23. Still More Causes of PMS • Vitamins and Minerals • Pyridoxine deficiency • Vitamin A and E deficiency • Magnesium deficiency • Calcium deficiency or excess • Potassium deficiency • Zinc deficiency • Dopamine deficiency • Trace mineral deficiency

  24. And the list goes on … • Psychological factors • Beliefs around menses • Coping skills • Self esteem • Psychiatric problems • Social Factors • Stress and social network • Marital and sexual relationships (current & former) • Psychosexual experiences • Attitudes of PMS

  25. Symptoms of PMS • Nervousness, fatigue, mood swings, tender breasts • Back pain, diarrhea, clumsiness, social isolation • Anxiety, lethargy, water retention, headache, acne • Decreased libido, dizziness, insomnia, irritability • Depression, abdominal bloating, appetite change • Sugar cravings, constipation, low self esteem, joint pain

  26. Classifications of PMS • PMS – A Anxiety • Caused by increased estrogen • PMS – C Carbohydrate craving • Caused by increased binding of insulin • PMS – D Depression • Caused by decreased estrogen • PMS – H Hyper hydration • Caused by increased aldosterone

  27. Consider other medical conditions • It is important to address any underlying medical conditions that may be masked by PMS. • One study found that 75% of women receiving care for PMS actually had another diagnosis that accounted for many of the major symptoms of depression and mood swings.

  28. Infection and Inflammation Pelvic inflammatory disease (PID) Acute inflammatory disease caused by infection May involve any organ of the reproductive tract Salpingitis Oophoritis Sexually transmitted diseases migrate from the vagina to the upper genital tract Polymicrobial infection

  29. Pelvic Inflammatory Disease (PID)

  30. Pelvic Inflammatory Disease (PID)

  31. Infection and Inflammation Vaginitis Infection of the vagina Sexually transmitted pathogens, bacterial vaginosis, and Candida albicans Acidic nature of the vagina provides some protection Maintained by cervical secretions, normal flora, and lactobacillus acidophilus Cervicitis Inflammation or infection of the cervix Mucopurulent cervicitis (MPC)

  32. Vulvitis Inflammation of the female external genitalia Causes: Contact with soaps, detergents, lotions, hygienic sprays, shaving, menstrual pads, perfumed toilet paper, or nonabsorbing or tight-fitting clothing Vaginal infections that spread to the labia Infection and Inflammation

  33. Bartholinitis Inflammation of one or both ducts that lead from the vaginal opening to the Bartholin glands Caused by microorganisms that infect the lower female reproductive tract Inflammation narrows the distal portion of the ducts Leads to obstruction and stasis of glandular secretions Infection and Inflammation

  34. Bartholinitis

  35. Pelvic Relaxation Disorders The bladder, urethra, and rectum are supported by the endopelvic fascia and perineal muscles The muscular and fascial tissue loses tone and strength with aging Fails to maintain organs in proper position

  36. Pelvic Relaxation Disorders Cystocele and rectocele Urethrocele Cystourethrocele Enterocele Vaginal prolapse Uterine prolapse

  37. Pelvic Relaxation Disorders

  38. Pelvic Relaxation Disorders

  39. Benign Growths and Proliferative Conditions Benign ovarian cysts Unilateral Produced when a follicle or number of follicles are stimulated but no dominant follicle develops and reaches maturity Follicular cysts Corpus luteum cysts Dermoid cysts Cysts can cause ovarian torsion

  40. Benign Growths and Proliferative Conditions Endometrial polyps Benign mass of endometrial tissue Intermenstrual; excessive bleeding can occur Leiomyomas Commonly called uterine fibroids Benign tumors of smooth muscle cells in the myometrium Cause abnormal uterine bleeding, pain, and symptoms related to pressure on nearby structures

  41. Benign Growths and Proliferative Conditions Adenomyosis Islands of endometrial glands surrounded by benign endometrial stroma within the myometrium Asymptomatic, or abnormal bleeding, dysmenorrhea, uterine enlargement, and tenderness

  42. Diseases of the Uterus • Adenomyosis • Non-cancerous overgrowth of endometrial tissue • Mainly in 35-50 nulliparous women • S & S • Heavy, painful periods (menorrhagia) and bleeding between periods (metrorrhagia) • Uterus enlarges 2-3 times normal • Dyspareunia

  43. Uterine Fibroids • Noncancerous tumors of smooth muscle cells and fibrous tissue • Also called leiomyomas, fibromas, fibromyomas • Starts off microscopic and grows over the years • The most common pelvic tumor • Incidence • 25% to 50% of women from 25-45 • Up to ¼ in white women and ½ in black women • Autopsy results consistent with 75%

  44. Uterine Fibroids

  45. Leiomyomas

  46. Benign Growths and Proliferative Conditions Endometriosis Presence of functioning endometrial tissue or implants outside the uterus Responds to hormone fluctuations of the menstrual cycle Possible causes: Retrograde menstruation Spread through vascular or lymphatic systems Stimulation of multipotential epithelial cells on reproductive organs Genetic predisposition

  47. Endometriosis

  48. Female Reproductive Cancer Cervical cancer Cervical dysplasia (CIN) Cervical carcinoma in situ Invasive carcinoma of the cervix Risk factors: HPV and HIV Multiple sexual partners

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