1. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell Chapter 26 Copyright © 2016 F.A. Davis Company

2. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell Copyright © 2016 F.A. Davis Company

3. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell Copyright © 2016 F.A. Davis Company

4. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell Copyright © 2016 F.A. Davis Company

5. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell  Follicular phase is characterized by increased pituitary gland production of FSH.  FSH stimulates estrogen secretion by the ovary and initiates development of an ovum that rises to the surface at a region called the Graafian follicle.  Proliferation of the uterine lining  Day 1 to 14 Copyright © 2016 F.A. Davis Company

6. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell  At a peak level of FSH, the pituitary releases LH, resulting in ovulation, which is defined as the release of an ovum from the ovary.  The ovum travels from the ovary to the uterus via the fallopian tube.  The ovarian germination region is called the corpus luteum. Copyright © 2016 F.A. Davis Company

7. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell  Corpus luteum  progesterone  From day 14 through 28  Secretory phase of uterine lining  Corpus luteum degenerates if no pregnancy; corpus luteum continually supplies progesterone if pregnancy. Copyright © 2016 F.A. Davis Company

8. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell Copyright © 2016 F.A. Davis Company

9. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell  The permanent cessation of menstrual cycles because of normal, physiological degeneration of the ovaries and the decline of estrogen levels over 12 months.  In the time frame before menopause, called perimenopause, there is gradual decline in hormone production; this decline can last several years and cause physiological changes that include erratic menses, atrophic vaginitis, and vasomotor instability.  Estrogen sharply declines during this time, which causes feedback to the pituitary gland. Copyright © 2016 F.A. Davis Company

10. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell  Estrogen sharply declines during this time, which causes feedback to the pituitary gland.  The pituitary gland, in an attempt to increase ovarian secretion of estrogen, secretes high levels of FSH.  However, with the degeneration of the ovaries, estrogen is no longer secreted.  The stage of perimenopause can be confirmed by an elevated FSH level. Copyright © 2016 F.A. Davis Company

11. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell  Infection of the endometrium, which is the uterine lining, can occur in association with instrumentation of the uterus, abortion, childbirth, pelvic inflammatory disease (PID), or an implanted intrauterine device (IUD).  Microorganisms such as Gonococcus, Chlamydia trachomatis, Enterococcus, and several strains of anaerobic bacteria are the most common causes of endometritis. Copyright © 2016 F.A. Davis Company

12. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell Copyright © 2016 F.A. Davis Company

13. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell  Endometriosis is the growth of endometrial tissue outside the uterus.  The most common sites are the ovaries, uterine ligaments, rectovaginal septum, pelvic peritoneum, umbilicus, vagina, vulva, and appendix.  Endometrial tissue in these sites bleed monthly.  Endometriosis commonly causes infertility, dysmenorrhea, and pelvic pain. Copyright © 2016 F.A. Davis Company

14. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell  Pelvic pain in the reproductive years is a common presentation of endometriosis.  There are no physical examination findings.  Definitive diagnosis requires laparoscopy. Copyright © 2016 F.A. Davis Company

15. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell Copyright © 2016 F.A. Davis Company

16. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell  A mass that protrudes into the endometrial cavity  They are usually benign, but coexistence of atypical endometrial hyperplasia or adenocarcinoma is common.  Tamoxifen is a common cause. Copyright © 2016 F.A. Davis Company

17. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell Copyright © 2016 F.A. Davis Company

18. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell  Commonly referred to as fibroid tumors  Benign tumors  Sharply circumscribed firm growths that are most commonly found in the myometrium  Cause abnormal vaginal bleeding, bladder compression, dysmenorrhea, back pain, or infertility  Excessive menstrual bleeding can occur that causes anemia. Copyright © 2016 F.A. Davis Company

19. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell  Abnormal uterine bleeding that is caused by a disturbance of the menstrual cycle.  The diagnosis of DUB can indicate an excessive loss of blood from the uterus or it can indicate lack of normal menstruation at cyclical periods.  It can occur in anovulatory or ovulatory menstrual cycles. Copyright © 2016 F.A. Davis Company

20. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell  Anovulatory cycles are the most common cause of DUB.  Anovulatory DUB can be demonstrated as a condition of missed periods, prolonged intervals between menses, more frequent periods than normal, or excessive menstrual blood loss. Copyright © 2016 F.A. Davis Company

21. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell  A thick layer of endometrium accumulates with no stimulus for menstruation; consequently, amenorrhea occurs.  Eventually, the excessive endometrial layer does break down and the woman experiences an irregular menstrual cycle and flow irregularities such as menorrhagia, metrorrhagia, menometrorrhagia, intermenstrual spotting, and oligomenorrhea. Copyright © 2016 F.A. Davis Company

22. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell  In women with ovulatory DUB, there is an increased rate of blood loss resulting from endometrial vascular vasodilatation, decreased vascular tone, and excessive prostaglandins.  Women suffer heavy menstrual blood loss, up to three times normal.  Large menstrual blood loss often causes anemia. Copyright © 2016 F.A. Davis Company

23. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell Copyright © 2016 F.A. Davis Company

24. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell  Normally for ovulation to occur, the ovary develops a follicle (Graafian follicle) that matures on the ovary surface and contains an ovum.  The Graafian follicle containing the ovum normally ruptures and ejects the ovum in a process known as ovulation.  When the follicle does not eject the ovum, this is called a follicular cyst. Copyright © 2016 F.A. Davis Company

25. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell  PCOS is the most common endocrine disturbance affecting young women and is the leading cause of infertility in the United States. Copyright © 2016 F.A. Davis Company

26. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell  The etiology of PCOS involves a dysfunctional hypothalamic-pituitary-ovary axis.  High serum concentrations of androgenic hormones are present.  Multiple cysts develop on the ovary because of multiple areas of follicular cyst formation.  Ova develop, come to the surface of the ovary, and form follicular cysts.  There is no ovulation.  The ovarian surface develops multiple areas of unreleased ova that resemble multiple cysts. Copyright © 2016 F.A. Davis Company

27. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell  PCOS may be associated with metabolic syndrome; patients with the disorder should be checked for hypertension, hyperlipidemia, hyperinsulinemia, and glucose intolerance. Copyright © 2016 F.A. Davis Company

28. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell  Fibrocystic breast disease is the most common disorder of the breast.  It presents as benign nodular, granular breast masses that are most prominent during the progesterone-dominant phase of the menstrual cycle.  Breast tenderness, vascular engorgement, and cystic distension are the symptoms. Copyright © 2016 F.A. Davis Company

29. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell  Commonly found in premenopausal women, 25 to 45 years old.  Benign tumors  Singular, rubbery, round, movable mass  There are usually no symptoms, but biopsy or excision is needed to exclude the possibility of cancer. Copyright © 2016 F.A. Davis Company

30. Pathophysiology: Introductory Concepts and Clinical Perspectives by Theresa Capriotti and Joan Parker Frizzell Copyright © 2016 F.A. Davis Company