Transcript 05. Disorders of mens. function

By I. Korda
 The menstrual cycle
is a cycle of
physiological changes
that occurs in fertile
females.
The female menstrual
cycle is determined by a
complex interaction of
hormones.
Menstrual cycle:
Days 1-5: Estrogen Falls,
FSH Rises.
Menstrual bleeding begins
on Day 1 of the cycle and
lasts approximately 5 days.
During the last few days
prior to Day 1, a sharp fall
in the levels of estrogen
and progesterone signals
the uterus that pregnancy
has not occurred during
this cycle. This signal
results in a shedding of the
endometrial lining of the
uterus.
 Days 6-14: Estrogen Is Secreted, FSH
Falls.
 Estrogen is secreted by the follicle
during this phase of the menstrual
cycle. It stimulates the endometrial
lining of the uterus suppresses the
further secretion of FSH.
 At about mid-cycle (Day 14), the
estrogen helps stimulate a large and
sudden release of luteinizing hormone
(LH).
 This LH surge, which is accompanied by
a transient rise in body temperature, is
a sign that ovulation is about to
happen.
 The LH surge causes the follicle to
rupture and expel the egg into the
Fallopian tube.
 Days 14-28: Estrogen And
Progesterone Secretion First Rise,
then Fall.
 After rupture of the follicle, it is
transformed into the corpus
luteum and produces progesterone.
 P supports to prepare the
endometrial lining for
implantation of the fertilized egg.
(If the egg is fertilized, a small amount of
human chorionic gonadotrophin (hCG)
is released that stimulates further
progesterone production.)
 After implantation, the
trophoblast will secrete
human Chorionic
Gonadotropin (hCG) into
the maternal circulation.
 HCG keeps the corpus
luteum viable.
The corpus luteum
continues to produce
estrogen and progesterone,
which keep the endometrial
lining intact.
 By about week 6 to 8 of
gestation, the newly formed
placenta takes over the
secretion of progesterone.
 If the egg is not fertilized, the
corpus luteum shrinks, and
the levels of estrogen and
progesterone drop, the uterus
sheds its lining, and
menstruation begins.
In addition, with no estrogen
to suppress it, FSH levels again
start to rise. Thus, one cycle
ends and another begins.
Normal Menses:
 Flow lasts 2-7 days
 Cycle 21-35 days in length
 Total menstrual blood loss
20-60 mL
 The menstruation must be
regular, painless.
 puberty is the process of physical changes by which a
child's “body becomes an adult body capable of
reproduction.
 menarche - A woman's first menstruation is termed, and
occurs typically around age 12. The menarche is one of
the later stages of puberty in girls.
 menopause - the end of a woman's reproductive phase,
which commonly occurs somewhere between the ages of
45 and 55.
Climacteric: 47-55 years
Premenopause: 5 years before
Postmenopause starts 1 year after
menopause
Perimenopause: transitional phase between pre- and
postmenopause: 2 years before and 1 year after
Menstrual cycle irregularities:
1. abnormal frequency
Kaltenbach chart:
Normal cycle
Abnormal frequency:
oligomenorrhea
Abnormal frequency:
polymenorrhea
Duration: 28 d 5
Amount: 3-5 pads
or tampons
(35 mL)
Duration > 35 days
Duration < 22 days
Menstrual cycle irregularities:
2. abnormal amount of duration
Kaltenbach chart:
Normal cycle
Duration: 28 d 5
Amount: 3-5 pads
or tampons
35 mL)
Hypomenorrhea
Hypermenorrhea
Menorhagia
Amount < 2 per day
Amount > 5 per day
Duration 7-14 days
at regular intervals
Differential Diagnosis
 Primary amenorrhea
 Gonadal failure
 Anorexia nervosa
 Secondary amenorrhea
 Hypothalamic disorders 49-62 %
 Pituitary
7-16 %
 Ovarian disorder
10 %
 Ascherman’s syndrome
7%
Dysorder of Hypothalamus
 Abnormalities Affecting Release of
Gonadotropin-Releasing Hormone
 Variable Estrogen Status
 Anorexia nervosa
 Exercise-induced
 Stress-induced
 Pseudocyesis(false pregnancy )
 Malnutrition
 Chronic diseases :
Renal, Lung, Liver,
Chronic infection, Addison’s disease
 Hyperprolactinemia
 Thyroid dysfunction
 Obesity
 Hyperandrogenism
 Cushing’s syndrome (impaired
cortisol rhythm)
 Congenital adrenal
hyperplasia
 Androgen secreting adrenal
tumor
 Androgen secreting ovarian
tumor
 Granulosa cell tumor
 idiopatic
Polycystic Ovary Syndrome
(PCOS)
 The ovaries contain many small follicles or cysts.
Each has an egg, but they do not grow normally and
shrink before ovulation. Each month, new follicles
develop and shrink into cysts.
 The fertility is reduced.
 Most PCOS cases are unexplained.
•
The disorder may be inherited.
•
Deficiency in luteinizing hormone (LH)
•
Resistance to insulin. A similar effect on the ovaries
can occur in women with eating disorders (anorexia or
bulimia), or women whose bodies do not properly
make estrogen and other steroids (for example,
women with congenital adrenal hyperplasia).
Polycystic Ovary Syndrome (PCOS)
Clinical consequences of persistent
anovulation
1. Infertility
2. Menstrual
dysfunction
3. Hirsutism,
Alopecia, Acne
4. Risk of
endometrial cancer ,
breast cancer
5. Risk of CVS
disease
6. Risk of DM in
patients with insulin
resistance
Prolactin Secreting Adenoma
 Most common pituitary
tumor
 50% identified at
autopsy
 Disruption of the
reproductive mechanism
 Amenorrhea
field defect
-Visual
 Galactorrhea
Headache
 Treatment
 Medical : dopamine
agonist
 Surgical
-
Surgical Treatment
 Dilation and
Curettage



quickest way to stop
bleeding in patients
who are hypovolemic
appropriate in older
women (>35)to
exclude malignancy
but is inferior to
hysteroscopy
follow with
medroxyprogesterone
acetate, OCP’s, or
NSAID’s to prevent
recurrence
Surgical Treatment:
 Laser ablation
 Loop
electrode
resection
 Roller
electrode
ablation
 Hysterectomy
Sheehan’s syndrome
 Postpartum hemorrhage
 Acute infarction and
necrosis
 Hypopituitarism= early in
the PP period
 Failure of lactation
 Loss of pubic and axillary
hair
 Deficiencies :
 GH, Gn (FSH,LH),
 ACTH, TSH (in frequency)
Turner’s Syndrome
Gonadal dysgenesis associated with 45,XO
Most common chromosomal abnormality
in spontaneous abortion
Characteristics
Sexual infantilism
-Less common
Short stature
Autoimmune
Webbed neck
CVS
anomalies
cubitus valgus
Renal
anomalies
Mosaicism
Treatmant
1. Asherman’s Syndrome
Cause :
Curettage,
Uterine surgery
Diagnosis :
HSG
Hysteroscope
S/S :
Miscarriage
Dysmenorrhea
Hypomenorrhea
2. Mullerian anomalies
Lack of Mullerian
Development
Ovaries : Normal
Associated anomalies
urinary
skeleton
Investigation :
U/S , MRI,
Laparoscope
Imperforate Hymens
3. Androgen Insensitivity
(Testicular Feminization)
 Male Pseudohermaphrodite
 Gonadal Sex :46xy
 Phenotype Female
 Blind vaginal canal
 Uterus absent
 Absent or meager pubic and
axillary hair
 Malignancy,
 Hormone :
 T
or slightly
 LH
Premenstrual Syndrome
 20 year old Jessica
Case
 Episodes of irritability and
moodiness
 Lead to huge arguments
with her boyfriend.
 Sleeps away the day and
miss school or work
 Her boyfriend jokes and
makes off-the-wall remarks
about PMS. She comes to
you for advice.
 Bloated, tired and hungry
during the days just prior to
menses.
Symptoms
Anger Outbursts
Symptoms
Cravings
Irritability
Mood Lability
Approach
Thank you for your attention!