Female Reproductive Disorders

 



Premenstrual Syndrome:

Premenstrual Syndrome:  Also called PMS   -The effects of this disorder ranges from minimal discomfort to severe, disruptive behavioral and somatic changes.  Symptoms usually appear 7 to 14 days before menses and usually subside with its onset.

Cause:  Direct cause unknown, PMS may result from a progesterone deficiency in the luteal phase ot the menstrual cycle or from an increased estrogen-progesterone ratio.  Approximately 10% of patients with PMS have elevated prolactin levels


Symptoms:

Behavioral changes:  Mild to severe personality changes

Nervousness

Hostility

Irritability

Agitation

Sleep disturbance

Fatigue

Lethargy

Depression

Somatic changes :

Breast tenderness or swelling

Abdominal tenderness or bloating

Joint pain

Headache

Edema

Diarrhea or constipation

Patient may also experience exacerbations of skin problems such as; ache - respiratory problems such as asthma, and neurologic problems such as seizures.


Treatment:

Treated symptomatically:  treatment may include;

Antidepressants, NSAID's (nonsteroidal anti-inflammatory drugs),

Vitamins

Tranquilizers

Sedatives

Progestins

Treatment may require; a diet that is low in simple sugars, caffeine, and salt, with adequate amounts of protein, high amounts of complex carbohydrates, and possibly, vitamin supplements formulated for PMS

There is also a self - help groups that exist for women with PMS check in your local area.

 


Reverse and Eliminate Ovarian Cysts


Ovarian Cysts

Ovarian Cysts:  Usually, these cysts are nonneoplastic sacs that contain fluid or semisolid material.  Ovarian cysts are usually small and produce no symptoms, ovarian cysts should be thoroughly investigated as possible sites of malignant change.  Common types ;include follicular, cysts, which are usually very small, semitransparent, and fluid-filled; and lutein cysts, including corpus luteum cysts, which are functional, nonneoplastic enlargements of the ovaries; and theca-lutein cysts, which are commonly bilateral and filled with clear, straw-colored fluid.  Polycystic (or sclerocystic) ovary disease is part of the Stein-Leventhal syndrome.

Ovarian cysts can develop any time between puberty and menopause, including during pregnancy.  Corpus luteum cysts occur infrequently, usually during early pregnancy.

Cause: Follicular cysts arise from follicles that over distend instead of going through the atretic stage of the menstrual cycle.  Corpus luteum cysts are caused by excessive accumulation of blood during the hemorrhagic phase of the menstrual cycle.  Theca-lutein cysts are commonly associated with hydatidiform mole, choriocarcinoma, or hormone therapy.  Polycystic ovary disease results from endocrine abnormalities.


Symptoms:

Usually small cysts produces no symptoms, unless torsion or rupture causes signs of acute abdomen.

Low back pain

Mild pelvic discomfort

Dyspareunia ( difficult and or painful intercourse)

Abnormal uterine bleeding

Acute abdominal pain (similar to that of appendicitis) -in ovarian cysts with torsion

In corpus luteum cysts appearing early in pregnancy, the patient may develop unilateral pelvic discomfort and (with rupture) massive intraperitoneal hemorrhage.

In polycystic ovary disease, the patient may develop amenorrhea ( abnormal absence or stoppage of menses), Oligomenorrhea (abnormally infrequent menstruation), or infertility secondary to the disorder as well as bilaterally enlarged ovaries.


Treatment:

Follicular cysts usually don't require treatment because they tend to disappear spontaneously within 60 days.  If they interfere with daily activities, Clomiphene citrate P.O. for 5 days or progesterone I.M. for 5 days, reestablishes the ovarian hormonal cycle and induces ovulation.

Oral contraceptives may also accelerate involution of functional cysts (including both types of lutein cysts and follicular cysts).

Treatment for corpus luteum cysts that occur during pregnancy is symptomatic because these cysts diminish during the third trimester and rarely require surgery.

Theca-lutein cysts disappear spontaneously after elimination of hydatidiform mole or choriocarcinoma, or discontinuation of HCG or clomiphene citrate therapy.

Polycystic ovary disease treatment may include; drugs, such as clomiphene citrate to induce ovulation or if drug therapy fails to induce ovulation, surgical wedge resection of one-half to one-third of the ovary.

Surgery may become necessary for both diagnosis and treatment.  For example, a cyst that remains after one menstrual period should be removed.  Pathologic studies confirm the diagnosis.

 



Endometriosis

Endometriosis:  Endometrial tissue appears outside the lining of the uterine cavity.  This ectopic tissue usually remains in the pelvic area, most commonly around the ovaries, uterovesical peritoneum, uterosacral ligaments, and the cul-de-sac, but it can appear anywhere in the body. Active endometriosis usually occurs between ages 30 and 40, more so in women who postpone child-bearing.  It is uncommon before age 20.  Severe symptoms of endometriosis may occur abruptly ore develop slowly over many years.  Endometriosis usually becomes progressively severe during the menstrual years, and subsides after menopause.  Infertility is the primary complication.  Spontaneous abortion may also occur.

Cause:  Direct cause is unknown, but familial susceptibility or recent surgery that required opening the uterus may predispose a woman to edometriosis.  Researcher shows the possible cause of endometriosis are:
1.) trasportation---during menstruation, the fallopian tubes expel endometrial fragments that implant of the ovaries or pelvic peritoneum
2.) formation in situ--inflammation or a hormonal change triggers metaplasia (differentiation of coelomic epithelium to endometrial epithelium)
3.) induction--this is a combination  of transportation and formation in situ and is the most likely cause.  The endometrium chemically induces undifferentiated mesenchyma to form endometrial epithelium


Symptoms:

Dysmenorrhea (painful menstruation)--  Pain usually begins 5 to 7 days before menses reaches its peak and last for 2 to 3 days.  It is less cramping and less concentrated in the abdominal midline than primary dysmenorrheal pain.

Lower abdominal pain and in the vagina --

Pain to posterior pelvis and back

Multiple tender nodules on uterosacral ligaments or in the rectovaginal system.  They enlarge and become more tender during menses.  Ovarian enlargement may also be evident.

Other symptoms depend on the location of the ectopic tissue:

Ovaries and oviducts--infertility and profuse menses

Ovaries or cul-de-sac--deep-thrust dyspareunia (painful intercourse)

Bladder--suprapubic pain, dysuria (painful or difficulty urinating), hematuria (Presence of blood in the urine)

Rectovaginal septum and colon--painful defecation, rectal bleeding with menses, pain in the coccyx or sacrum

Small bowel and appendix--nausea and vomiting, which worsen before menses, and abdominal cramps

Cervix, vagina, and perineum--bleeding from endometrial deposits in these areas during menses


Diagnostic tests:  Laparoscopy  may confirm the diagnosis and determine the stage of the disease.  barium enema rules out malignant or inflammatory bowel disease.
Treatment:

Treatment varies according to the stage of the disease and t he patient's age and the desire t have children.

For young women who want to have children includes:  androgens, such as danazol, which produce a temporary remission in Stages I and II.  Oral contraceptives and progestins also relieve symptoms.

Stage III and IV (when ovarian masses are present), they should be removed to rule out cancer.  The patient may undergo conservative surgery, but the treatment of choice for women who don't want to bear children or who have extensive disease (StageIII and IV) is a total abdominal hysterectomy performed with bilateral salpingo-oophorectomy.

 



Uterine Leiomyomas/Myomas/Fibromyomas/Fibroids

Uterine leiomyomas:  Known also as Myomas, Fibromyomas, and Fibroids, these neoplasms (tumor; any new and abnormal growth) art the most common benign tumors in women.  They usually occur in the uterine corpus, although they may appear on the cervix or on the round or broad ligament. Uterine Leiomyomas are usually multiple and usually occur in women over age 35; they affect blacks three times more often than whites.

Cause:  The cause is unknown, but excessive levels of estrogen and human growth hormone (HGH) probably influence tumor formation by stimulating susceptible fibromuscular elements.  Large doses of estrogen and the later stages of pregnancy increase both tumor size and HGH levels.  When estrogen production decreases, uterine leiomyomas usually shrink or disappear (usually after menopause)


Symptoms:

Pain

Submucosal hypermenorrhea (excessive menstrual bleeding, but occurring at regular intervals and being of usual duration)

Possibly other forms of abnormal endometrial bleeding

Dysmenorrhea (abnormally painful menses)

If tumor is large, the patient may develop a feeling of heaviness in the abdomen;

Increasing pain

Intestinal obstruction

Constipation

Urinary frequency or urgency

Irregular uterine enlargement


Diagnostic tests:

Blood studies/ anemia will support the diagnosis

D&C (dilatation and curettage)

Submucosal hysterosalpingoraphy - detects submucosal leiomyomas

Laparoscopy - visualizes subserous leiomyomas on the uterine surface


Treatment:

Treatment of choice for women who desire to have children - A surgeon may remove small leiomyomas that have caused problems in the past or that appear likely to threaten a future pregnancy

Tumors that twist or grow large enough to cause intestinal obstruction require a hysterectomy, with preservation of the ovaries if possible

Pregnant patient:  If a patient uterus no larger than a 6 month normal uterus by the 16th week of pregnancy, the outcome for the pregnancy remains favorable, and surgery is usually unnecessary.  However if a pregnant woman has a leiomyomatous uterus the size of a 5 to 6 month normal uterus by the 9th week of pregnancy, spontaneous abortion will probably occur, especially with a cervical leiomyoma.  If surgery is necessary, a hysterectomy is usually performed 5 to 6 months after delivery (when involution is complete), with preservation of the ovaries if possible

Appropriate intervention depends on the severity of symptoms, the size and location of the tumors, and the patient's age, parity, pregnancy status, desire to have children, and general health.

Call your doctor immediately if there is any abnormal bleeding or pelvic pain

 



Menopause

Menopause:  The mechanisms of menstruation cease to function.  Menopause results from a complex, long term syndrome of physiologic changes, the climacteric-cause by declining ovarian function.

Cause:  Physiologic menopause, the normal decline in ovarian function caused by aging, begins in most women between ages 40 and 50 and results in infrequent ovulation, decreased menstruation, and eventually, cessation of menstruation ( usually ages 45 - 55)

Pathologic menopause (premature menopause), the gradual or abrupt cessation of menstruation before age 40, cause unknown, however certain disorders, especially severe infections and reproductive tract tumors, may cause pathologic menopause by seriously impairing ovarian function.  Other factors that may incur pathologic menopause include malnutrition, debilitation, extreme emotional stress, excessive radiation exposure, and surgical procedures that impair ovarian blood supply.

Artificial menopause is the cessation of ovarian function following radiation therapy or surgical procedures.


Symptoms:

Declining ovarian function and decreased estrogen levels accompanying all forms of menopause produce various menstrual irregularities;

Decrease in the amount and duration of menstrual flow

Spotting

Episodes of amenorrhea (absence or abnormal stoppage of menses) and polymenorrhea (abnormal frequent menstruation) (possible with hypermenorrhea)-excessive menstrual cycle

These irregularities may last only a few months or may persist for several years before menstruation ceases permanently.

Changes in the body's systems usually don't occur until after the permanent cessation of menstruation

Reproductive system:  changes may include; shrinkage of vulval structures and loss of subcutaneous fat, possible leading to atrophic vulvitis; atrophy of vaginal mucosa and flattening of vaginal rugae, possibly causing bleeding after coitus or douching; vaginal itching and discharge from bacterial invasion; and loss of capillaries in the atrophying vaginal wall, causing the pink, rugose lining to become smooth and white.  Menopause may also produce excessive vaginal dryness and dyspareunia due to decreased lubrication from the vaginal walls, and decreased secretion from Bartholin's glands; a reduction in the size of the ovaries and oviducts; and progressive pelvic relaxation as the supporting structures of the reproductive tract lose their tone from the absence of estrogen

Urinary system:  Atrophic cystitis, resulting from the effects of decreased estrogen levels on bladder mucosa and related structures, may produce pus in the urine (pyuria), painful or difficulty urinating (dysuria), and urgency, and incontinence.  May have on occasion have blood in the urine (hematuria)

Breasts:  Menopause may cause reduced breast size

Integumentary system:  Estrogen deprivation may lead to loss of skin elasticity and turgor.  The patient may have slight alopecia (balding), and may experience loss of pubic and axillary hair.

Autonomic nervous system:  Hot flashes and night sweats. Patient may experience vertigo, syncope, tachycardia, dyspnea, tinnitus, emotional disturbances such as irritability, nervousness, crying spells, and fits of anger.  Patients may also experience and exacerbation of preexisting neurotic disorders such as; depression, anxiety, and compulsive, manic, or schizoid behavior

Vascular and musculoskeletal systems:  Menopause may also induce atherosclerosis and osteoporosis.
Artificial menopause, without estrogen replacement, produces symptoms within 2 to 5 years in 96% of women.  Since menstruation in both pathologic and artificial menopause often ceases abruptly, severe vasomotor and emotional disturbances may result.

Menstrual bleeding after 1 year of amenorrhea may indicate organic disease


Treatment:

Since physiologic menopause is a normal process, it may not require intervention.

Atypical or adenomatous hyperplasia requires drug therapy

Cystic endometrial hyperplasia doesn't require treatment

If osteoporosis occurs, calcium is given

Estrogen therapy
Women who take estrogen must be monitored regularly to detect possible cancer early.  If the uterus remains progestin is recommended in addition to estrogen.

 



Female Infertility

Female Infertility:  Infertility may be caused by any defect or malfunction of the hypothalamic - pituitary - ovarian axis, such as certain neurologic diseases.  Other possible cause include:

Cervical factors, such as infection and possibly cervical antibodies that immobilize sperm

Psychological problems

Ovarian factors

Tubal and peritoneal factors, such as tubal loss or impairment secondary to ectopic pregnancy

Uterine abnormalities, such as; congenitally absent, double uterus; leiomyomas or Asherman's syndrome, in which the anterior and posterior uterine walls adhere because of scar tissue formation

Approximately 15% of all couples in the US cannot conceive after regular intercourse for at least 1 year without contraception.  45 to 50% of all infertility is attributed to the female.


Symptoms:

Diagnosis requires a complete examination and health history.  Questions includes patient's reproductive and sexual function, past diseases, mental state, previous surgery, types of contraception used in the past, and family history


Treatment:

Intervention aims to correct the underlying abnormality or dysfunction within the hypothalamic-pituitary-ovarian complex.

Hormone therapy may be necessary in hyperactivity ;or hypoactivity of the adrenal or thyroid gland

Progesterone replacement for progesterone deficiency

Anovulation requires treatment with clomiphene citrate

If mucus production decreases (an adverse effect of clomiphene citrate), small doses of estrogen may be given concomitantly to improve the quality of cervical mucus

Surgical restoration may correct certain anatomic causes of infertility, such as fallopian tube obstruction

Artificial insemination has proven to be an effective alternative strategy for dealing with infertility problems

In vitro (test tube) fertilization has also been successful

 



Pelvic Inflammatory Disease

Pelvic Inflammatory Disease:  Or PID -  recurrent, acute, subacute, or chronic infection of the oviducts and ovaries, with adjacent tissue involvement.  PID may refer to inflammation of the cervix, uterus, fallopian tubes, and ovaries, which can extend to the connective tissue lying between the broad ligaments (parmetritis).  Early diagnosis and treatment prevent damage to the reproductive system.  Complications of PID may include potentially fatal septicemia, pulmonary emboli, shock and infertility.  Untreated PID may be fatal.
Symptoms:

Clinical features vary with the affected area.

They may include profuse, purulent vaginal discharge

Low-grade fever

Malaise

Lower abdominal pain

Three types of PID:

Salpingo-oophoritis (fallopian tubes, and ovaries):  Acute:  sudden onset of lower abdominal and pelvic pain, usually after menses, increased vaginal discharge; fever; malaise; lower abdominal pressure and tenderness; tachycardia; pelvic peritonitis
Chronic: recurring acute episodes

Cervicitis (inflammation of the cervix):  Acute- purulent, foul-smelling vaginal discharge; vulvovaginitis, with itching or burning; red, edematous cervix; pelvic discomfort; sexual dysfunction; metrorrhagia; infertility; spontaneous abortion
Chronic- cervical dystocia, laceration or eversion of the cervix, ulcerative vesicular lesion (when cervicitis results from herpes simplex virus type II)

Endometritis (inflammation of the uterus):  Acute- mucoopurulent or purulent vaginal discharge oozing from cervix; edematous, hyperemic endometrium, possible leading to ulceration and necrosis; lower abdominal pain and tenderness; fever; rebound pain; abdominal muscle spasm; thrombophlebitis of uterine and pelvic vessels
Chronic- recurring acute episodes (more common from multiple sexual partners and sexually transmitted infections)


Cause: PID can result from infection with aerobic or anaerobic organisms.

Risk factors: Any sexually transmitted infection
More than one sex partner
Conditions or procedures, such as cauterization of the cervix, that alter or destroy cervical mucus, allowing bacteria to ascend into the uterine cavity
Any procedure that risks transfer of contaminated cervical mucus into the endometrial cavity by instrumentation such as use of a biopsy curet
Infection during or after pregnancy
Infectious foci within the body, such as drainage from a chronically infected fallopian tube


Treatment:

Effective management eradicates the infection, relieves symptoms, and avoids damaging the reproductive system.

Aggressive therapy with multiple antibiotics begins immediately after culture specimens are obtained.

Infection may become chronic if treated inadequately

Supplemental treatment of PID may include bed rest, analgesics, and I.V. therapy

Narcotics may be needed, NSAID's are preferred for pain relief.

Development of a pelvic abscess requires adequate drainage.  A ruptured pelvic abscess is a life-threatening condition.  If this complication develops, the patient may need a total abdominal hysterectomy, with bilateral salpingo-oophorectomy

 



Vaginismus

  See Vaginal problems for more information

  Vaginismus:  Painful spasm of the vagina. CLICK

Latest Article: Female Reproductive Disorders

Premenstrual Syndrome Ovarian Cysts Endometriosis Uterine Leiomyomas Female Infertility Pelvic Inflammatory Disease Vaginismus Menopause   Premenstrual Syndrome: Premenstrual Syndrome:   Also called PMS    -The effects of this disorder ranges from minimal discomfort...

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