1. Chapter 40 Disorders of the Female Genitourinary System

2. Female Reproductive Anatomy

3. Estrogens Sexual maturation, skeletal growth, fat distribution
Ovulation, implantation, pregnancy, parturition
Development, maintenance of female accessory organs
Cell division in the breasts and endometrium
Maintain skin and blood vessels
Decrease bone resorption
Increase HDL, triglycerides; decrease LDL, cholesterol
Sodium and water retention

4. Progesterones Maintain pregnancy Breast and endometrium development
Decrease sodium reabsorption
Increase body temperature
Smooth muscle relaxation

5. The Menstrual Cycle
Gonadotropin-releasing hormone (GnRH) from the hypothalamus begins the cycle.
GnRH stimulates the anterior pituitary to release follicle- stimulating hormone (FSH) and luteinizing hormone (LH).
FSH stimulates development of follicle cell layers.
This is the follicular phase of the menstrual cycle.

6. The Menstrual Cycle (cont.)
The developing follicle produces estrogen.
Estrogen decreases FSH release; LH increases.
Only the strongest follicles survive the drop in FSH.
Follicles continue to make estrogen.
Estrogen now stimulates LH release from the anterior pituitary.
LH stimulates the mature follicle to burst.

7. The Menstrual Cycle (cont.)
LH surge causes release of the egg = ovulation.
Follicle cells become corpus luteum, producing progesterone.
This is called the luteal phase of the cycle.
Progesterone prepares the body for pregnancy.
If pregnancy does not occur, the corpus luteum replaced by corpus albicans.
The drop in progesterone tells the hypothalamus to secrete GnRH and begin a new cycle.

8. Disorders of the External Genitalia
Bartholin gland cyst and abscess
Leukoplakia
Inflammatory dermatosis
Nonneoplastic epithelial disorders
Lichen sclerosus, lichen planus, lichen simplex chronicus
Premalignant and malignant lesions
Vulvodynia
Localized, generalized

9. Vulvar Carcinomas In younger women:
Often preceded by vulvar intraepithelial neoplasia
Related to human papillomavirus infection
In older women
Often preceded by nonneoplastic disorders
Lesions cause itching and repeated injury
Healing cells are more likely to mutate

10. Cervical Epithelium Exocervix – stratified squamous epithelium
Endocervix – columnar epithelium
Hormones and acid in vagina – transforms columnar epithelium to squamous epithelium
Transformation zone cells are more likely to become cancerous

11. Question
True or false?
HPV is a contributing factor to both vulvular and cervical cancer.

12. Answer
True
Rationale: In young women, HPV has been linked to vulvular cancer; it also causes 70% of cervical cancers.

13. Uterine Disorders Endometritis Pelvic inflammatory disease
Endometriosis
Adenomyositis
Endometrial cancer
Uterine leiomyomas
Disorders of uterine support

14. Pelvic Inflammatory Disease
Infection ascends through uterus to fallopian tubes and ovary
Inflammation causes
Pain in lower abdomen, back and cervix
Purulent discharge
Fever
Increased WBC count
Increased C-reactive protein

15. Endometriosis Endometrial tissue outside uterus
Retrograde menstruation
Metastasis through lymphatics or vascular system
Activation of dormant cells that were always there
Ectopic implants respond to hormones
Go through menstrual cycle
During menstrual period, tissue dies and bleeds
Pain and adhesions result

16. Disorders of Pelvic Support
Cystocele
Rectocele
Enterocele
Uterine prolapse
First, second, third degree

17. Ovarian Disorders Ovarian cysts Polycystic ovary syndrome
Ovarian cancer

18. Polycystic Ovary Syndrome
Chronic anovulation
 Amenorrhea or irregular menses
LH > FSH
Stimulates androgen production
Interferes with ovulation
Ovaries contain many unovulated follicles
Acne, hirsutism

19. Ovarian Cancer Ovulatory age – most significant risk factor
BRCA1 and BRCA2 increase susceptibility
High-fat diet and genital talc powders linked
Causes vague GI symptoms
No good screening tests available

20. Question
True or false?
Early detection through screening tests has improved the prognosis of ovarian cancer.

21. Answer
False
Rationale: Because the signs and symptoms of ovarian cancer are so vague, the majority of patients do not seek medical attention until the disease is advanced (the cancer has usually metastasized by then).
There are currently no good screening tests available to detect ovarian cancer.

22. Menstrual Disorders Dysfunctional menstrual cycles
Dysfunctional bleeding
Amenorrhea
Dysmenorrhea
Premenstrual syndrome
Menopause and aging changes

23. Menopause or Climacteric
Decreased ovary function
Low estrogen
Osteoporosis risk
Atherosclerosis risk
Less inhibition of pituitary
Increased FSH and LH
Hot flashes

24. Question Why are postmenopausal women at risk for osteoporosis?
Diminished function of the ovaries
Decreased progesterone levels
Decreased estrogen levels
Increased levels of FSH and LH

25. Answer C. Decreased estrogen levels
Rationale: Estrogen stimulates osteoblasts (bone cells that build/synthesize bone tissue). Lower levels of estrogen = less stimulation of osteoblasts = decreased bone density = increased risk of osteoporosis (decreased bone density, especially spongy bone).

26. Disorders of the Breast
Inflammatory disorders
Mastitis, ductal ectasia, fat necrosis
Benign epithelial disorders
Nonproliferative breast changes, proliferative breast disease without atypia, proliferative breast disease with atypia
Breast cancer

27. Breast Anatomy

28. Breast Cancer Cancer develops when cells mutate and are not repaired
BRCA1 and BRCA2 genes code for proteins that help repair DNA after it has mutated
Mutation of BRCA1 or BRCA2 increase risk
In a cancer, cells continue dividing too fast
Estrogen and other growth factors stimulate breast cell division
Breast cells with too many estrogen or growth factor receptors are more likely to become cancerous