This document is a summary of all the educational activities provided in the abdomen cluster regarding gynaecology. This includes learning goals (ie. post menopausal bleeding, abnormal menstrual cycles), an example of a patient case (SOEPEL), lectures (i.e. menstrual disorders, cancers) and skills ...
- Uterine Layers
- Endometrial: columnar epithelium and connective tissue
- Basal layer and functional layer (sheds)
- Myometrium: smooth muscle cells
- Perimetrium: epithelial cells enveloping the uterus
Menstrual Cycle
GnRH
-> FSH and LH
-> primary follicles turn into antral follicles
(containing granulosa cells)
-> estrogen secretion
-> FSH receptor stimulation and follicle
growth
-> positive feedback on ant. Pituitary gland +
estrogen increase
-> LH secretion
-> growth and maturation
-> FSH and LH surge
-> converts estrogen producing cells to
progesterone producing cells
-> estrogen drop => ovulation
-> granulosa and theca cells form luteal cells
-> progesterone + inhibin (negative feedback
on progesterone)
-> corpus luteum degeneration =>
menstruation
Postmenopausal Hormones
,Sperm Production and Fertilisation
- Sperm production
- Hypothalamus: GnRH production -> pituitary production of FSH, LH
- Pituitary
- FSH -> androgen binding protein on Sertoli cells to produce sperm and
support blood-testis barrier
- LH -> stimulates Leydig cells for testosterone production and secretion
- Testes: spermatogonial stem cell development via testosterone stimulation
- Epididymis: maturation ; sperm move up the tube and are stored until ejaculation
- Vas deferens: muscular tube transporting the sperm
- Spermatic cord = vas deferens + nerves + blood vessels
- Seminal vesicles: seminal fluid including fructose (provides ATP for mobility)
- Ejaculatory duct
- Prostate gland: adds alkaline fluid to seminal fluid
- Urethra: join ejaculatory duct from bladder ; continues until glans penis
- Sperm cell: life-death = 60 days
II. Menstrual Cycle Disorders
1. Menorrhagia
- Definition: prolonged menstrual periods and/or excessive bleeding
- Excessive bleeding: lasts more than 7 days, loss of over 80 mL of blood
- Average woman loses 30 mL of blood
- Can be accompanied by pain
- Concerning Factors
- Soaking through a pad/tampon every 1-2 hours for several hours
- Heavy periods regularly lasting 10 or more days
- Bleeding between periods or during pregnancy
- Pathology: often no causative reason
- Pregnancy or miscarriage
- Hormonal imbalance: common around menarche and menopause
- Ovulation problems: anovulation leads to stopped progesterone production which
can cause heavy bleeding
, - Uterine fibroids (leiomyomas): increased menstrual loss if protruding into central
cavity -> increase endometrial surface area
- Uterine polyps: small benign growths or other structural abnormalities in the
uterus causing bleeding
- Endometriosis: extension of endometrial tissue outside the uterus trying to shed
-> painful and abnormal bleeding
- Adenomyosis: endometrial tissue develops within muscle layers of the uterus ->
painful and heavy bleeding
- Infectious: uterine or cervical infection ; PID
- Cancer (painless): uterine, ovarian, cervical, endometrial ; bleeding can be
excessive, irregular, in between periods, postmenopausal
- Coagulation defects: rare ; painless ; normal coagulation must occur to limit and
eventually stop the blood flow
- Medication: anticoagulants anti-inflammatory medications, IUDs
- Other: systemic lupus erythematosus, diabetes, PID, cirrhosis, thyroid disorders
2. Amenorrhea
- Definition: absence of menstruation
- 1ry: no menstruation by the age of 16
- 2ry: periods stop for at least 3 months
- Pathology
- Normal: pregnancy, breastfeeding, hormonal contraception, perimenopause,
adolescence
- 1ry:
- Delayed puberty: failure of ovarian development ; genetic factor
- Congenital genital tract abnormalities
- 2ry:
- Stress: physical/emotional stress blocks release of LH causing temporary
amenorrhea
- Weight loss, eating disorders: extreme weight loss and reduced fat stores
cause hypothyroidism and hypercortisolism in turn impairing gonadotropin
hormones (low estrogen)
- Athletic training: linked to stress and weight loss or use of anabolic
steroids
- Polycystic ovarian syndrome (PCOS): ovarian overproduction of
androgens (testosterone)
- Premature ovarian failure (POF): early depletion of follicles before age 40
leading to low estrogen and premature menopause ; causes infertility
- Structural problems: scarring/structural problems in the uterus prevents
menstrual flow
- Hyperprolactinemia: reduced gonadotropin hormones inhibiting ovulation
- Pituitary tumors: low estrogen levels
- Endometriosis: see above
- Other: epilepsy, thyroid problems, celiac sprue, metabolic syndrome,
Cushing’s disease
, 3. Oligomenorrhea
- Definition: menstruation occurs more than 35 days apart
- Common in early adolescence (hormonal changes/puberty) ; can occur in healthy
adult women
- Flow can vary
- Pathology: same as amenorrhea
4. Other
- Polymenorrhea (frequency)
- Definition: cycles with intervals of 21 days or fewer
- Metrorrhagia (bleeding)
- Definition: bleeding occurring at irregular intervals with variable amounts
occurring between periods or unrelated to periods
- Menometrorrhagia (bleeding)
- Definition: heavy and prolonged bleeding occurring at irregular intervals occurring
at the time of menstruation or between menstruations
- Dysfunctional uterine bleeding (bleeding)
- Definition: abnormal uterine bleeding referring to extra or excessive bleeding
caused by hormonal problems
- Usually occurs at the start of menstruation or at perimenopause
I. Clinical Features
- Risk factors
- Age: menarche at a younger age increases risk for pain, longer periods, longer
menstrual cycles ; perimenopause can cause oligomenorrhea or menorrhagia
- Weight: overweight/underweight
- Menstrual cycles/flow: associated with pain
- Pregnancy history:
- High number of pregnancies: increases risk of menorrhagia
- No pregnancies: higher risk of dysmenorrhea
- Smoking: increases risk for heavier periods
- Stress: blocks LH causing temporary amenorrhea
- Diagnosis
- History taking: menstrual cycle patterns, medical conditions, family history,
history of pelvic pain, use of medications, diet history (includes caffeine, alcohol,
smoking), past/present contraceptive use, stress, sexual history
- Physical examination: vaginal examination
- Extra
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller anasanchez-moreno. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $3.79. You're not tied to anything after your purchase.
