Clinical Management for Reproduction - answer✔Primary Prevention: disease prevention and
wellness-related approaches to promoting sexual health
Patient education
Counseling
Referral
Secondary Prevention
Screening - diagnose existing disease in its early stages.
This is referred to as screening with a goal of reducing morbidity and
mortality and preserving quality of life.
Primary Prevention focus areas: abstinence, contraception, safer sex practices, STIs healthy
relationships, and community resources.
Featured Exemplars for Reproduction - answer✔Menstrual Dysfunction
PCOS
Endometriosis, Uterine Fibroids
Sexually Transmitted Infections
Family Planning
Menstrual Cycle- Proliferative Phase: - answer✔Proliferative (Follicular) Phase
Days 1-12 (Stimulation to Ovulation)
Low estrogen/progesterone production in ovaries signals hypothalamus to produce gonadotropin-
releasing hormone (GnRH).
GnRH orders ant. pituitary to release follicle stimulating hormone (FSH)
FSH stimulates follicle production in ovary (10-20 start to develop but usually only 1 matures).
Developing follicles in ovary produce estrogen.
Estrogen stimulates endometrial cells (lining of uterus) to enlarge: endometrial spiral arteries
dilate, lining thickens 6-8 fold, cervical mucus thins and becomes more alkaline to allow sperm
to penetrate
Menstrual Cycle -Luteal Phase - answer✔Secretory (Luteal) Phase
Days 17-26-Ovulation to Menstruation
Ovaries continue to produce estrogen
Corpus luteum (site of follicular development) on ovary produces progesterone in anticipation of
human chorionic gonadotropin feedback from trophoblastic cells of conceptus.
Progesterone made in the corpus luteum on the ovary accentuates swelling of endometrium in
anticipation of receiving a fertilized egg
Corpus luteum: why does it produce progesterone in anticipation of conceptus?
What is HcG? What is a trophoblast?
Corpus luteum (if egg gets fertilized) hangs around until placenta takes over
Menstrual Cycle - Ischemic Phase - answer✔Ischemic Phase Days 27-28
No fertilization means no HCG production.
Corpus luteum degenerates and stops producing progesterone.
Epithelial lining necroses as spiral arteries constrict and retract.
Sloughing stimulates uterine contractions by day 29 or so when bleeding is visible
Keep the corpus luteum in mind. We will talk about it again next week.
Polycystic Ovarian Syndrome - answer✔The most common endocrine disorder in women of
reproductive age.
Multifaceted disorder characterized by-
Hyperandrogenemia
Hyperinsulinemia
Increased risk of type 2 diabetes and CV disease
Can affect many aspects of a woman's life including:
menstrual cycle
ability to have children
hormones
heart
blood vessels
appearance
These women have a concomitant risk of type 2 diabetes and cardiovascular disease related to
metabolic syndrome
Androgen becomes the dominant hormone with PCOS
Women with PCOS are generally amyneric (they do not have a period)
PCOS is the leading cause of infertility in the US
Depression is a big issue with these women and often goes undiagnosed or underestimated
Polycystic Ovarian Syndrome: Effects on the Menstrual System - answer✔Menstrual effects:
PCOS can make periods infrequent, absent or irregular
Ovary doesn't make all the necessary hormones for the egg to mature...they remain as follicles or
cysts
Ovulation then does not occur and progesterone is not made...
Seeing a "string of pearls" on US is indicative of PCOS
Polycystic Ovarian Syndrome-Infertility - answer✔Infertility:
Obviously impossible to get pregnant without ovulating
PCOS is the most common cause of female infertility
Overproduction of androgen
Underproduction of progesterone
Women with PCOS struggle with obesity, elevated lipids, glucose, and insulin resistance
Some ask what comes first? Does obesity cause PCOS and insulin resistance or does PCOS
cause obesity/insulin resistance? PCOS is a metabolic system wide disorder.
Polycystic Ovarian Syndrome - Appearance - answer✔Appearance:
Hirsutism
Increased acne and oily skin
Weight gain...usually around the waist
Male-pattern baldness or thinning hair
Patches of dark brown/black skin around skin folds
Skin tags
Polycystic Ovarian Syndrome- Incidence: - answer✔Incidence:
Between 1-10 and 1-20 women of childbearing age have PCOS
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