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Women's Health - Menstruation and Conception (*Pathologies/Conditions,…
Women's Health - Menstruation and Conception
*Pathologies/Conditions
Adenomyosis
endometrial cells infiltrating the myometrium
Clinical Case
Notes
:
note that adenomyosis is actually a fairly common pathology for middle aged women who have multiple parities and children
they present with menorrhagea = heavy menstrual bleeding and also a diffusely enlarged uterus
--> the enlarged uterus is beacuse the endometrial cells have invaded the myometrium and cause inflammation and proliferation of the myometrium of the uterus
note you must rule out a possible pregnancy with a dipstick pregnancy test first
adenomyosis can be differentiated from Leiyomyomas = uterine fibromas because these are enlargements of the uterus or tumors that are not uniform
Uterine Leiomyomas / Fibromas
Clinical Case
Notes
:
leiomyomas are benign tumors of smooth muscle in the uterus that present with menorrhagia and pelvic pain
they are more common in black women and women in their 30s and 40s
they can be in all the locations seen on the right
Amenorrhea
Primary Amenorrhea
when there is no menorrhea by age 15
average age of menarche = 12.5 years
if hasn;t happened by age 15
--> diagnosis of amenorrhea must be treated or investigated
Differentials of Amennorrhea
Imperforate Hymen
mucocolpos at birth --> causes non-degeneration of fibrous band
--> hematocolpos
Imperforate Hymen
one of the major differentials of primary amenorrhea
Notes
:
Imperforate hymen is one of the main differentials for primary amenorrhea = no menarche by age 15
other presenting complaints are due to the fact that the girl is having her periods but they are stuck in the uterus
--> cramping and abdominal pains, + vaginal bulge at same time monthly
Case presentation:
Notes
:
defined as no menstruation for 1 or more cycles
also defined if no menarche by the age of 15
most common cause of amenorrhea is pregnancy
--> since you technically lose your period
Menarche
Notes
:
average age of menarche = 12.5 years
if menarche hasn't happened by age 15
--> diagnosis of amenorrhea must be treated or investigated
*Variations in Menstruation
terms
:
amenorrhea
= absent menstruation
dysmenorrhea
= pain during menstruation (menstrual cramps)
menorrhagia
= abnormally heavy bleeding during menstruation
menarche
= first occurrence of menstruation
*Menstrual Cycle
*Phases of the Uterine Cycle
Day 14
Ovulation
Day 21
Day 28
Begin Menses
Secretory Uterine Phase
days 0-14
1 more item...
Day 7
.
Day 0
Begin Menses
Proliferative Uterine Phase
days 0-14
*Phases of the Ovarian Cycle
Day 14
Ovulation
Day 21
Day 28
Begin Menses
*Menstrual Phase
note that the sloughing off of the endometrium is actually apoptosis of the endometrial cells
--> this comes from the withdrawal of progesterone (= think mifesprestone)
--> causes release of prostanglandins (= think misoprostol PGE1)
1 more item...
Luteal Ovarian Phase
days 0-14
Day 7
.
Day 0
Begin Menses
follicular ovarian Phase
days 0-14
Phases of both uterine and ovarian phases
ovarian
phases
"FIRST and LAST"
--> follicular phase and Luteal Phase
*Anovulation
failure to ovulate in a woman
*Anovulation in Polycystic ovarian disease
tx = menotropin + hcG
key for tx is to mimic the FSH and LH hormones to get ovulation
menotropin = FSH analogue
alpha - hCG = tries to mimic LH surge for rupture of the dominant follicle and ovum release
--> recall that all sex hormones have an alpha and beta subunit
--> reason why we measure beta-hCG and NOT alpha hCG
--> this tells you that the alpha subunit is common to all of them
*Anovulation tx = pulsatile GnRH
*Life Cycle of Menstruation
puberty annovulation, ovulation, premenopause annovulation, menopause
*Anovulation
this normally happens to young women when they first start having their menstruation
cycles stabilize as you reach your 20s
then as you approach your menopause in late 40s annovulation comes back
presents as spotting throughout the cycle with irregular periods that are on/off
--> the on periods are heavy bleeding
Clinical Cases
Clinical Case
Clinical Case
Notes
:
note that
*Childbearing Age
peaks at 30-40
*Menopause
average age = 50
defined as no menstruation for consecutive 12 months
very low estrogen levels and hence loss of regular feedback
--> get high FSH since it is controlled by estrogen
menopause is controlled by not having anymore follicles left int he ovaries
