WOMEN'S HEALTH - REVIEW EXAM 2 -
CH 25-32, 15, 9, 13, 14. Women's
Gynecologic Health (Schuiling & Likis,
2017) - FALL 2018
HYPERANDROGENISM - Associated w/ Polycystic Ovary Syndrome (PCOS); Degrees
of ovulatory dysfunction;
Oligo-anovulation; Infertility result of anovulation; Endocrinopathy; Occurs in 6-15% of
all women; 70% w/ Hirsutism, Acne, Androgenic Alopecia; Obesity, insulin resistance,
dyslipidemia of metabolic syndrome; risk for CV disease & DM;
Increased risk for adverse health outcomes (Endometrial CA; T2DM)
OVARIES - Source of increased Testosterone & Androstenedione; Source of increased
androgen production; key to determining cause of Hyperandrogenism
ANDROGEN
PRODUCTION - ovaries/adrenal glands
HYPERANDROGENISM
CYCLE - Elevated Androgens & Insulin suppress SHBG synthesis; results in increase in
free testosterone; exacerbates insulin resistance
HIRSUTISM - Excessive terminal hair growth in women; occurs in anatomic areas
where hair follicles are most androgen sensitive; not all women with PCOS have
hirsutism
ALOPECIA - Prolonged exposure to circulating androgens may cause hair loss
ACNE - Presents in 20s; alerts clinician to possibility of Hyperandrogenemia
VIRILIZATION - Clitoral hypertrophy, severe hirsutism, deepening voice, increased
muscle mass, breast atrophy, male pattern baldness
POLYCYSTIC OVARIES SYNDROME (PCOS) - Oligo- or anovulation, Clinical and/or
biochemical signs of Hyperandrogenism, Polycystic Ovaries, Exclusion of other
Androgen Excess or related disorders; Associated w/ classic ovarian morphology; ½ of
Pts. w/ PCOS = OBESE; Obesity increases risk for developing PCOS: Increased
peripheral aromatization of androgens; Decreased levels of hepatic SHBG; Insulin
resistance; Increases menstrual dysfunction/infertility; 50-70% w/PCOS have Insulin
,Resistance; Rates of Depressive Disorders, Anxiety Disorders, Binge-eating = higher in
Women with POCS; Also 3x Increased risk of developing Endometrial CA.
DYSLIPIDEMIA - Found in women w/ PCOS;
Vulvar Dermatoses - Dermatoses can appear on vulva; Physical SX's; w/ psychological
consequences; Women w/ Chronic Dermatoses may benefit from joining support
groups; SX's: pruritus, pain, burning, bleeding, vaginal discharge; Definitive Diagnostic:
BX;
Irritant Contact Dermatitis (ICD);
Allergic Contact Dermatitis (ACD);
SX's: burning, pruritus, pain
Lichen Sclerosus (LS) - Benign, chronic, progressive disease of skin;
SX's: inflammation, epithelial thinning, distinctive dermal changes; Figure-8 formation
surrounds vulva and perianal area
Lichen Planus (LP) - Inflam'ty condition of scalp, skin, nails, mucous membranes;
Usually perimenopausal or postmenopausal; SX's: Vaginal discharge, vulvar pruritus,
vulvar pain/ burning, vaginal soreness, dyspareunia, postcoital bleeding; Classic LP:
affects vulva; Hypertrophic LP: affects perineum; perianal area; Erosive LP: affects
vulva & vagina
Lichen Simplex Chronicus (LSC) - Localized variant of atopic dermatitis; HX:
Allergies/Asthma; result fr. Vulvar disorder that causes pruritus; SX: itch-scratch-itch
cycle
Psoriasis - Chronic, immune-mediated, genetic disease; manifests in skin & joints; SX's:
papules or plaques covered with silvery-white scales; Vulvar form: erythema common;
scaling finer
CERVICAL POLYPS - Occur in up to 10% of women; very rarely malignant; Polyps
w/vascular congestion appear moist, red, glandular; Polyp w/ atypical appearance
needs BX (necrosis, contact bleeding, change in color); Bothersome atypical polyps
should be removed
ENDOMETRIAL
POLYPS - Hyperplastic overgrowth of endometrial glandular & stromal cells; vascular
core; Incidence: 7-35% of women; often Asymptomatic; common cause of abnormal
vag. bleeding; Hysteroscopic polypectomy = removal method of choice
Uterine Fibroids - Benign growths that arise fr. smooth muscl. of UT (Myomas or
Leiomyomatas); Range in size fr. micro. to Lrg. tumors weighing several pounds;
Classified by UT Layer affected:
Subserosal: exterior uterus;
Intramural / Myometrial: in myometrium; Submucosal: in endometrium
, Increases with age prior to menopause; prevalent in black women; SX's: pelvic
pressure/pain; dyspareunia
Adenomyosis - Endometrial tissue in myometrium; Diffuse lesions distributed w/in
myometrium; SX's: Menorrhagia & Dysmenorrhea; DIAG'S: Endometrial BX; Transvag.
U/S; Treatment: LNG-IUS; hysterectomy; UAE
Endometriosis - Endometrial glands & stroma outside of uterus: most common sites for
endometrial implants: ovaries, A/P cul-de-sac, poster. broad lig's, uterosacral lig's,
Fallop. tubes, Sigm. colon, Appndx, Round Ligaments; Origin: retrograde menstruation;
Often asymptomatic; may be severe & debilitating condition; SX's: Dysmenorrhea,
Dyspareunia, Dyschezia, Dysuria, or chronic or intermittent dull, throbbing, or sharp
pelvic, ABD or back pain; Histologic DX's: require surgical BX for confirmation; TX:
expectant management, medical therapy, surgery
BENIGN OVARIAN MASSES - Ovarian cysts, mature Cystic Teratomas, Serous or
Mucinous Cystadenomas, Endometriomas; Testing: pregnancy test R/O Ectopic;
Gonorrhea & Chlamydia testing; Ectopic pregnancy, tubo-ovarian abscess, Ovarian CA
= most common causes; Transvaginal Ultrasound: classify mass as cystic, solid,
complex; Most functional cysts resolve within 3 mos.; Complex & Solid Ovarian masses
warrant further assessment; Special considerations: Adolescents; Pregnant, & Older
Follicular Cysts - BENIGN - From unruptured Follicle; torsion/rupture > cyst size
Mature Cystic Teratomas - BENIGN - Ovarian germ cell; most common ovarian tumors
Serous or Mucinous Cystadenomas - BENIGN - Arise from Ovarian Epithelium
ENDOMETRIOMAS - Caused by Endometriosis; masses range size fr. few cm's to
weighing several pounds; assess location, size, shape, texture, mobility, tenderness of
palpable mass
Vulvar Cancer - 4% of all reproductive-organ CA: usually curable; 80% in women > 50
y/o; Risk not inheritable;
Related to HPV infection, or Vulvar Intraepithelial neoplasia (VIN) disorders; Vulvar
lump or mass with prolonged HX of Vulvar Pruritus; 50% of women with vulvar cancer =
Asymptomatic;
Vulvar bleeding, discharge, dysuria, pain;
Majority of Vulvar malignancies = Squamous Cell CA; Early identification important;
annual pelvic exams for all women 21+ y/o; Biopsy required for definitive diagnosis
Cervical Cancer - Abnormal vaginal bleeding = common; Thorough pelvic, ABD.,
inguinal lymph node, rectal exam
PAP test; liquid-based cytology; STI testing; wet mount preparation; R/O'd prior to
diagnosing CA: cervicitis or STI, vaginitis, cervical polyps, PID;
4TH most common genital malignancy in women;
CH 25-32, 15, 9, 13, 14. Women's
Gynecologic Health (Schuiling & Likis,
2017) - FALL 2018
HYPERANDROGENISM - Associated w/ Polycystic Ovary Syndrome (PCOS); Degrees
of ovulatory dysfunction;
Oligo-anovulation; Infertility result of anovulation; Endocrinopathy; Occurs in 6-15% of
all women; 70% w/ Hirsutism, Acne, Androgenic Alopecia; Obesity, insulin resistance,
dyslipidemia of metabolic syndrome; risk for CV disease & DM;
Increased risk for adverse health outcomes (Endometrial CA; T2DM)
OVARIES - Source of increased Testosterone & Androstenedione; Source of increased
androgen production; key to determining cause of Hyperandrogenism
ANDROGEN
PRODUCTION - ovaries/adrenal glands
HYPERANDROGENISM
CYCLE - Elevated Androgens & Insulin suppress SHBG synthesis; results in increase in
free testosterone; exacerbates insulin resistance
HIRSUTISM - Excessive terminal hair growth in women; occurs in anatomic areas
where hair follicles are most androgen sensitive; not all women with PCOS have
hirsutism
ALOPECIA - Prolonged exposure to circulating androgens may cause hair loss
ACNE - Presents in 20s; alerts clinician to possibility of Hyperandrogenemia
VIRILIZATION - Clitoral hypertrophy, severe hirsutism, deepening voice, increased
muscle mass, breast atrophy, male pattern baldness
POLYCYSTIC OVARIES SYNDROME (PCOS) - Oligo- or anovulation, Clinical and/or
biochemical signs of Hyperandrogenism, Polycystic Ovaries, Exclusion of other
Androgen Excess or related disorders; Associated w/ classic ovarian morphology; ½ of
Pts. w/ PCOS = OBESE; Obesity increases risk for developing PCOS: Increased
peripheral aromatization of androgens; Decreased levels of hepatic SHBG; Insulin
resistance; Increases menstrual dysfunction/infertility; 50-70% w/PCOS have Insulin
,Resistance; Rates of Depressive Disorders, Anxiety Disorders, Binge-eating = higher in
Women with POCS; Also 3x Increased risk of developing Endometrial CA.
DYSLIPIDEMIA - Found in women w/ PCOS;
Vulvar Dermatoses - Dermatoses can appear on vulva; Physical SX's; w/ psychological
consequences; Women w/ Chronic Dermatoses may benefit from joining support
groups; SX's: pruritus, pain, burning, bleeding, vaginal discharge; Definitive Diagnostic:
BX;
Irritant Contact Dermatitis (ICD);
Allergic Contact Dermatitis (ACD);
SX's: burning, pruritus, pain
Lichen Sclerosus (LS) - Benign, chronic, progressive disease of skin;
SX's: inflammation, epithelial thinning, distinctive dermal changes; Figure-8 formation
surrounds vulva and perianal area
Lichen Planus (LP) - Inflam'ty condition of scalp, skin, nails, mucous membranes;
Usually perimenopausal or postmenopausal; SX's: Vaginal discharge, vulvar pruritus,
vulvar pain/ burning, vaginal soreness, dyspareunia, postcoital bleeding; Classic LP:
affects vulva; Hypertrophic LP: affects perineum; perianal area; Erosive LP: affects
vulva & vagina
Lichen Simplex Chronicus (LSC) - Localized variant of atopic dermatitis; HX:
Allergies/Asthma; result fr. Vulvar disorder that causes pruritus; SX: itch-scratch-itch
cycle
Psoriasis - Chronic, immune-mediated, genetic disease; manifests in skin & joints; SX's:
papules or plaques covered with silvery-white scales; Vulvar form: erythema common;
scaling finer
CERVICAL POLYPS - Occur in up to 10% of women; very rarely malignant; Polyps
w/vascular congestion appear moist, red, glandular; Polyp w/ atypical appearance
needs BX (necrosis, contact bleeding, change in color); Bothersome atypical polyps
should be removed
ENDOMETRIAL
POLYPS - Hyperplastic overgrowth of endometrial glandular & stromal cells; vascular
core; Incidence: 7-35% of women; often Asymptomatic; common cause of abnormal
vag. bleeding; Hysteroscopic polypectomy = removal method of choice
Uterine Fibroids - Benign growths that arise fr. smooth muscl. of UT (Myomas or
Leiomyomatas); Range in size fr. micro. to Lrg. tumors weighing several pounds;
Classified by UT Layer affected:
Subserosal: exterior uterus;
Intramural / Myometrial: in myometrium; Submucosal: in endometrium
, Increases with age prior to menopause; prevalent in black women; SX's: pelvic
pressure/pain; dyspareunia
Adenomyosis - Endometrial tissue in myometrium; Diffuse lesions distributed w/in
myometrium; SX's: Menorrhagia & Dysmenorrhea; DIAG'S: Endometrial BX; Transvag.
U/S; Treatment: LNG-IUS; hysterectomy; UAE
Endometriosis - Endometrial glands & stroma outside of uterus: most common sites for
endometrial implants: ovaries, A/P cul-de-sac, poster. broad lig's, uterosacral lig's,
Fallop. tubes, Sigm. colon, Appndx, Round Ligaments; Origin: retrograde menstruation;
Often asymptomatic; may be severe & debilitating condition; SX's: Dysmenorrhea,
Dyspareunia, Dyschezia, Dysuria, or chronic or intermittent dull, throbbing, or sharp
pelvic, ABD or back pain; Histologic DX's: require surgical BX for confirmation; TX:
expectant management, medical therapy, surgery
BENIGN OVARIAN MASSES - Ovarian cysts, mature Cystic Teratomas, Serous or
Mucinous Cystadenomas, Endometriomas; Testing: pregnancy test R/O Ectopic;
Gonorrhea & Chlamydia testing; Ectopic pregnancy, tubo-ovarian abscess, Ovarian CA
= most common causes; Transvaginal Ultrasound: classify mass as cystic, solid,
complex; Most functional cysts resolve within 3 mos.; Complex & Solid Ovarian masses
warrant further assessment; Special considerations: Adolescents; Pregnant, & Older
Follicular Cysts - BENIGN - From unruptured Follicle; torsion/rupture > cyst size
Mature Cystic Teratomas - BENIGN - Ovarian germ cell; most common ovarian tumors
Serous or Mucinous Cystadenomas - BENIGN - Arise from Ovarian Epithelium
ENDOMETRIOMAS - Caused by Endometriosis; masses range size fr. few cm's to
weighing several pounds; assess location, size, shape, texture, mobility, tenderness of
palpable mass
Vulvar Cancer - 4% of all reproductive-organ CA: usually curable; 80% in women > 50
y/o; Risk not inheritable;
Related to HPV infection, or Vulvar Intraepithelial neoplasia (VIN) disorders; Vulvar
lump or mass with prolonged HX of Vulvar Pruritus; 50% of women with vulvar cancer =
Asymptomatic;
Vulvar bleeding, discharge, dysuria, pain;
Majority of Vulvar malignancies = Squamous Cell CA; Early identification important;
annual pelvic exams for all women 21+ y/o; Biopsy required for definitive diagnosis
Cervical Cancer - Abnormal vaginal bleeding = common; Thorough pelvic, ABD.,
inguinal lymph node, rectal exam
PAP test; liquid-based cytology; STI testing; wet mount preparation; R/O'd prior to
diagnosing CA: cervicitis or STI, vaginitis, cervical polyps, PID;
4TH most common genital malignancy in women;
