LOM Female Reproductive System Notes

CHAPTER 5 - FEMALE REPRODUCTIVE

SYSTEM

INTRODUCTION

Sexual reproduction is the union of the nuclei of the ovum (the female sex cell) and the
sperm cell (the male sex cell) that results in the creation of an embryo. The ovum and the
sperm cell are specialized cells that differ from normal body cells. Each sex cell, known as
a gamete, contains exactly half the number of chromosomes of a normal body cell. When
the nuclei of ovum and sperm cell unite, the cell produced receives half of its genetic
material from its female parent and half from its male parent; thus, it contains a full,
normal complement of hereditary material.

Special organs called gonads in males and females produce the egg and sperm cells. The
female gonads are the ovaries, and the male gonads are the testes. After an ovum leaves
the ovary, it travels down one of two fallopian tubes leading to the uterus (womb). If
coitus (copulation, sexual intercourse) has occurred and sperm cells travel into the
fallopian tube, they can penetrate the ovum. This is fertilization. The fertilized ovum is
then known as a zygote. After many cell divisions, a ball of cells forms, and the zygote is
called an embryo (2 to 8 weeks) and finally a fetus (8 to 38 or 40 weeks). The period of
development within the uterus is gestation, or pregnancy.

The female reproductive system consists of organs that produce ova and provide a place
for the growth of the embryo. In addition, the female reproductive organs supply
important hormones that contribute to the development of female secondary sex
characteristics (body hair, breast development, structural changes in bones and fat).

The eggs, or ova, are present from birth in the female ovary but begin to mature and are
released from the ovary in a 21- to 28-day cycle when secondary sex characteristics
develop. The occurrence of the first cycle is called menarche. Menstrual cycles continue
until menopause, when all eggs have been released, hormone production diminishes, and
menstruation ends. If fertilization occurs during the years between menarche and
menopause, the fertilized egg may grow and develop within the uterus. A new, blood
vessel–rich organ called a placenta (connected to the embryo by the umbilical cord)

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develops to nourish the embryo, which implants in the uterine lining. Various hormones are
secreted from the ovary and from the placenta to stimulate the expansion of the placenta.
If fertilization does not occur, hormone changes result in shedding of the uterine lining,
and bleeding, or menstruation, occurs.

The hormones of the ovaries, estrogen and progesterone, play important roles in the
processes of menstruation and pregnancy, and in the development of secondary sex
characteristics. The pituitary gland, located at the base of the brain, secretes other
hormones that govern the reproductive functions of the ovaries, breasts, and uterus.

Gynecology is the study of the female reproductive system (organs, hormones, and
diseases); obstetrics (Latin obstetrix means midwife) is a specialty concerned with
pregnancy and the delivery of the fetus; and neonatology is the study of the care and
treatment of the newborn.

UTERUS, OVARIES, AND ASSOCIATED ORGANS

The ovaries (only one ovary is shown in this lateral view) are a pair of small almond-shaped
organs located in the pelvis. The fallopian tubes (only one is shown in this view) lead from
each ovary to the uterus, which is a fibromuscular organ situated between the urinary
bladder and the rectum. The uterus (womb) normally is the size and shape of a pear and is

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about 3 inches long in a non-pregnant woman. Midway between the uterus and the rectum is
a region in the abdominal cavity known as the cul-de-sac.

The vagina, a tubular structure, extends from the uterus to the exterior of the body.
Bartholin glands are two small, rounded glands on either side of the vaginal orifice.
These glands produce a mucous secretion that lubricates the vagina. The clitoris is an organ
of sensitive, erectile tissue located anterior to the vaginal orifice and in front of the
urethral meatus. The region between the vaginal orifice and the anus is the perineum.
The external genitalia of the female are collectively called the vulva. Figure 8-2 shows the
various structures that are part of the vulva. The labia majora, the outer lips of the vagina,
surround the smaller, inner lips, the labia minora. The hymen, a thin membrane partially
covering the entrance to the vagina, is broken apart during the first episode of
intercourse. The clitoris and Bartholin glands also are parts of the vulva.

Each ovary is held in place on either side of the uterus by an utero-ovarian ligament.

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Within each ovary are thousands of small sacs—the ovarian follicles. Each follicle contains
an ovum. During ovulation, an ovum matures; its follicle ruptures through the surface and
releases the ovum from the ovary. A ruptured follicle fills with a yellow, fat-like material.
It is then called the corpus luteum, meaning yellow body. The corpus luteum secretes
hormones (both estrogen and progesterone) that maintain the very first stages of
pregnancy.

A fallopian tube is about 5½ inches long and lies near each ovary. Collectively, the fallopian
tubes, ovaries, and supporting ligaments are the adnexae (accessory structures) of the
uterus. The finger-like ends of the fallopian tube are the fimbriae. They catch the egg
after its release from the ovary. Cilia (small hairs) line the fallopian tube and, through
their motion, sweep the ovum along. It usually takes the ovum about 2 to 3 days to pass
through the fallopian tube.

If sperm cells are present in the fallopian tube, fertilization may occur. If sperm cells are
not present, the ovum remains unfertilized and eventually disintegrates.

The fallopian tubes, one on each side, lead into the uterus, a pear-shaped organ with
muscular walls and a mucous membrane lining filled with a rich supply of blood vessels.
The rounded upper portion of the uterus is the fundus, and the larger, central section is
the corpus (body of the organ). The inner layer, a specialized epithelial mucosa of the
uterus is the endometrium; the middle, muscular layer of the uterine wall is the
myometrium; and the outer, membranous tissue layer is the uterine serosa, a lining that
produces a watery, serum-like secretion. The outermost layer of an organ in the abdomen
or thorax is known as a serosa.

The narrow, lowermost portion of the uterus is the cervix (Latin cervix means neck).
The cervical opening leads into a 3-inch-long muscular, mucosa-lined canal called the vagina,
which opens to the outside of the body.

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THE BREAST (ACCESSORY ORGAN OF REPRODUCTION)

The breasts, located on the upper anterior region of the chest, are composed mostly of
mammary glands. The glandular tissue contains milk glands or lobules that develop in
response to hormones from the ovaries during puberty. The breasts also contain fibrous
and fatty tissue, special lactiferous (milk-carrying) ducts, and sinuses (cavities) that carry
milk to the nipple, which has small openings for the ducts to release their milk.
The breast nipple is the mammary papilla, and the dark pigmented area around the
mammary papilla is the areola.

During pregnancy the hormones from the ovaries and the placenta stimulate glandular and
other tissues in the breasts to their full development. After parturition (giving birth),
hormones from the pituitary gland stimulate the normal secretion of milk (lactation).

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MENSTRUATION AND PREGNANCY

MENSTRUATION

Menarche, or onset of menstruation with the first menstrual cycle, occurs at the time of
puberty. An average menstrual cycle lasts for 28 days but may be shorter or longer, and
cycles may be irregular in length. These days can be divided into four time periods, useful
in describing the events of the cycle. The approximate time periods are as follows:

Days 1 to 5 (menstrual period)

Discharge of bloody fluid containing disintegrated endometrial cells, glandular secretions,

and blood cells.

Days 6 to 12 (Follicular phase)

After bleeding ceases, the endometrium begins to repair itself. The maturing follicle in
the ovary releases estrogen, which aids in the repair. The ovum grows in the follicle during
this period.

Days 13 and 14 (ovulatory period)

On about the 14th day of the cycle, the follicle ruptures and the egg leaves the ovary
(ovulation), passing through the fallopian tube.

Days 15 to 28 (Luteal phase)

The empty follicle fills with a yellow material and becomes the corpus luteum. The corpus
luteum functions as an endocrine organ and secretes the hormone progesterone into the
bloodstream. This hormone stimulates the building up of the lining of the uterus in
anticipation of fertilization of the egg and pregnancy.

If fertilization does not occur, the corpus luteum in the ovary stops producing
progesterone and regresses. At this time, lowered levels of progesterone and estrogen
probably are responsible for some women’s symptoms of depression, breast tenderness,
and irritability before menstruation. The combination of these symptoms is known as
premenstrual syndrome (PMS). After 2 days of decrease in hormones, the uterine
endometrium breaks down, and the menstrual period begins (days 1 to 5).

PREGNANCY

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If fertilization does occur in the fallopian tube, the fertilized egg travels to the uterus
and implants in the uterine endometrium. The corpus luteum in the ovary continues to
produce progesterone and estrogen. These hormones support the vascular and glandular
development of the uterine lining.

The placenta, a vascular organ, now forms, attached to the uterine wall. The placenta is
derived from maternal endometrium and from the chorion, the outermost membrane that
surrounds the developing embryo. The amnion, the innermost of the embryonic membranes,
holds the fetus suspended in an amniotic cavity surrounded by a fluid called the amniotic
fluid. The amnion with its fluid is also known as the “bag of waters” or amniotic sac,
which ruptures (breaks) during labor.

The maternal blood and the fetal blood never mix during pregnancy, but important
nutrients, oxygen, and wastes are exchanged as the blood vessels of the fetus (coming
from the umbilical cord) lie side by side with the mother’s blood vessels in the placenta.

As the placenta develops in the uterus, it produces its own hormone, human chorionic
gonadotropin (hCG). When women test their urine with a pregnancy test kit, presence or
absence of hCG confirms or rules out that they are pregnant. This hormone stimulates the
corpus luteum to continue producing hormones until about the third month of pregnancy,
when the placenta takes over the endocrine function and releases estrogen and
progesterone. Progesterone maintains the development of the placenta. Low levels of

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LOM Female Reproductive System Notes

progesterone can lead to spontaneous abortion in pregnant women and menstrual

irregularities in nonpregnant women.

The uterus normally lies within the pelvis. During pregnancy the uterus expands as the
fetus grows, and the superior part rises out of the pelvic cavity to become an abdominal
organ. By about 28 to 30 weeks, it occupies a large part of the abdominopelvic cavity and
reaches the epigastric region.

The onset of true labor is marked by rhythmic contractions, dilation and thinning
(effacement) of the cervix, and a discharge of bloody mucus from the cervix and vagina
(the “show”). In a normal delivery position, the baby’s head appears first (cephalic
presentation). After vaginal delivery of the baby, the placenta follows, and the umbilical
cord is cut. The expelled placenta is the afterbirth.

HORMONAL INTERACTIONS
The events of menstruation and pregnancy depend on hormones not only from the ovaries
(estrogen and progesterone) but also from the pituitary gland. The pituitary gland
secretes follicle-stimulating hormone (FSH) and luteinizing hormone (LH) after the onset
of menstruation. As their levels rise in the bloodstream, FSH and LH stimulate maturation
of the ovum and ovulation. After ovulation, LH in particular influences the maintenance of
the corpus luteum and its production of estrogen and progesterone.

During pregnancy, the high levels of estrogen and progesterone from the ovary and
placenta cause the pituitary gland to stop producing FSH and LH. Therefore, while a

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woman is pregnant, additional eggs do not mature and ovulation cannot occur. Oral
contraceptives (birth control pills) work in the same way.

Another female birth control method is an IUD (intrauterine device). A physician inserts
the IUD, a small device designed to remain inside the uterus. It works by preventing
implantation of the embryo. Birth control pills and an IUD do not protect a woman against
sexually transmitted disease or HIV infection. See page 290 for a table of contraceptive
choices and their features.

When all of the ova are released and secretion of estrogen from the ovaries lessens,
menopause begins. Menopause signals the gradual ending of the menstrual cycle.
Premature menopause occurs before age 45, whereas delayed menopause occurs after age
55. Artificial menopause occurs if the ovaries are removed by surgery or made
nonfunctional as a result of radiation therapy or some forms of chemotherapy.

During menopause, when estrogen levels fall, the most common signs and symptoms are hot
flashes (temperature regulation in the brain is disturbed), insomnia, and vaginal atrophy
(lining of the vagina dries and thins, predisposing the affected woman to irritation and
discomfort during sexual intercourse). Hormone replacement therapy (HRT), given orally
or as a transdermal patch or vaginal ring, relieves these symptoms of menopause and
delays the development of weak bones (osteoporosis). HRT use may be associated with an
increased risk of breast cancer, endometrial cancer, stroke, or heart attack. This therapy
should be used only after careful consideration of potential risks and benefits.

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LOM Female Reproductive System Notes

VOCABULARY

Adnexa Accessory parts of a structure

Atresia Congenital absence or closure of a normal
body opening, such as the
Vagina
Choriocarcinoma Malignant neoplasm of the uterus or at the
site of an ectopic pregnancy
Contraceptive diaphragm Contraceptive device consisting of a
hemisphere of thin rubber bonded to
a flexible ring; inserted into the vagina
together with spermicidal jelly or
cream up to 2 hours before coitus so that
spermatozoa cannot enter the
uterus, thus preventing conception
Corpus luteum Ovarian scar tissue that results from
rupturing of a follicle during ovulation and
becomes a small yellow body that produces
progesterone after ovulation
Dyspareunia Occurrence of pain during sexual
intercourse
Endocervicitis Inflammation of the mucous lining of the
cervix uteri
Fibroids Benign uterine tumors composed of muscle
and fibrous tissue; also called
leiomyomas (myomas) and fibromyomata
uteri
Infertility Inability or diminished ability to produce
offspring
Hormonal contraception Use of hormones to suppress ovulation and
prevent conception
Oral contraceptive pills Birth control pills containing estrogen and
progesterone in varying
Proportions
Menarche Beginning of menstrual function
Oligomenorrhea Scanty or infrequent menstrual flow
Perineum Region between the vulva and anus that
constitutes the pelvic floor
Puberty Period during which secondary sex

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characteristics begin to develop and

the capability of sexual reproduction is
attained
Pyosalpinx Pus in the fallopian tube
Retroversion Turning or state of being turned back,
especially an entire organ, such as
the uterus, being tipped from its normal
position
Sterility Inability of the female to become pregnant
or the male to impregnate the
Female
Vaginismus Painful spasm of the vagina from
contraction of its surrounding muscles
Viable Capable of sustaining life; denotes a fetus
sufficiently developed to live
outside of the uterus

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LOM Female Reproductive System Notes

Obstetrics

abortion Termination of pregnancy before the

embryo or fetus is capable of surviving
outside the uterus
Abruptio placentae Premature separation of a normally situated
placenta
amnion Membrane, continuous with and covering the
fetal side of the placenta,
that forms the outer surface of the
umbilical cord
breech presentation Common abnormality of delivery in which
the fetal buttocks or feet present first
rather than the head
Down syndrome, trisomy 21 Congenital condition characterized by
physical malformations and some
degree of mental retardation
Dystocia Difficult labor, which may be produced by
the large size of the fetus or
the small size of the pelvic outlet
Eclampsia Most serious form of toxemia during
pregnancy
Ectopic pregnancy Pregnancy in which the fertilized ovum does
not reach the uterine cavity but
becomes implanted on any tissue other than
the lining of the uterine cavity,
such as a fallopian tube, an ovary, the
abdomen, or even the cervix uteri
Gravida Pregnant woman
The term gravida may be followed by
numbers, indicating number of
pregnancies, such as gravida 1, 2, 3, 4 or I,
II, III, IV, and so forth

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LOM Female Reproductive System Notes

Obstetrics
Multigravida Woman who has been pregnant more than
once
Multipara Woman who has delivered more than one
viable infant
Para Woman who has given birth to one or more
viable infants
Parturition Process of giving birth
Pelvimetry Measurement of pelvic dimensions to
determine whether the head of the
fetus will be able to pass through the bony
pelvis during the delivery
process
Placenta previa Condition in which the placenta is attached
near the cervix and ruptures
prematurely, with spotting as the early
symptom
Primigravida Woman pregnant for the first time
Primipara Woman who has given birth to one viable
infant, her first child, indicated
by the notation para I on the patient’s chart
Puerperium Period of 42 days after childbirth and
expulsion of the placenta and membranes,
during which the reproductive organs
usually return to normal

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LOM Female Reproductive System Notes

PATHOLOGICAL CONDITIONS

SYMPTOMS

Abnormal uterine bleeding: Bleeding before puberty and after menopause is considered
abnormal.

Amenorrhea: Absence of menstrual period.

Cysts: These are fluid-filled sacs that may develop in the breast and can easily be felt.

Dysfunctional uterine bleeding: This results from hormonal changes, rather than from
injury, inflammation, pregnancy or tumor.

Dysmenorrhea: This is abdominal pain, stemming from uterine cramps during menstrual
period.

Mastalgia: Breast pain.

Mastitis: Inflammation of breasts.

Nipple discharge: Fluid leaking from the nipple.

Pelvic pain: The pelvis, which contains the uterus, fallopian tubes, ovaries, vagina, bladder,
and rectum, is the lowest part of the trunk, below the abdomen and between the hip bones.
Women feel pain in this area. Such pain varies in type and intensity and the cause can be
hard to identify.

Vaginal discharge: All women have some vaginal discharge. Normal discharge may appear
clear, cloudy white, and/or yellowish when dry on clothing. It may also contain white flecks
and at times may be thin and stringy. Changes in normal discharge can occur for many
reasons including menstrual cycle, emotional stressors, nutritional status, pregnancy, usage
of medications -including birth control pills, and sexual arousal. Any changes in color or
amount of discharge may be a sign of a vaginal infection.

Vaginal itching: Itching of the vagina and vulva.

Heavy bleeding: Menorrhagia (excessive uterine bleeding) most commonly results from a
hormonal imbalance.

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LOM Female Reproductive System Notes

PATHOLOGICAL CONDITIONS

ABRUPTIO PLACENTA

Topic Description
Disease ABRUPTIO PLACENTA
Definition Abruption of the placenta (abruptio placentae) is the
premature separation of the placenta from the wall of the
uterus, a potentially very serious situation for the mother and
baby.
Cause  The primary cause of placental abruption is usually
unknown
Risk Factors  Maternal hypertension
 Maternal trauma
 Cigarette smoking & Alcohol consumption
 Short umbilical cord
 Previous placental abruption
 Maternal age 35 years or older
 Maternal age younger than 20 years
 Male fetal sex
Types 
Signs and symptoms  Vaginal bleeding (although about 20% of cases will have
no bleeding)
 Uterine tenderness
 Rapid contractions
 Abdominal pain
 Fetal heart rate abnormalities
Diagnosis/ Investigation  Abdominal ultrasound
 Complete blood count
 Fetal monitoring
 Fibrinogen level
 Partial thromboplastin time
 Pelvic exam
 Platelet count
 Prothrombin time
 Vaginal ultrasound
Treatment  Treatment may include fluids through a vein (IV) and
blood transfusions. The mother will be carefully
monitored for symptoms of shock. The unborn baby will
be watched for signs of distress, which includes an

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LOM Female Reproductive System Notes

abnormal heart rate.

 An emergency cesarean section may be needed. If the
baby is very premature and there is only a small
placental separation, the mother may be kept in the
hospital for close observation. She may be released
after several days if the condition does not get worse
and any bleeding stops.
 If the fetus is developed enough, vaginal delivery may
be done if it is safe for the mother and child.
Otherwise, a cesarean section will be done.

CARCINOMA OF THE BREAST

Topic Description
Disease CARCINOMA OF THE BREAST
Definition Breast cancer is caused by the development of malignant cells
in the breast. The malignant cells originate in the lining of the
milk glands or ducts of the breast (ductal epithelium), defining
this malignancy as a cancer.
Risk Factors  Age
 Genetics
 A history of breast cancer or breast lumps
 Estrogen exposure and breast-feeding
 Alcohol consumption
 Hormone treatments
Types  Ductal carcinoma: This begins in the milk duct and is the
most common type.
 Lobular carcinoma: This starts in the lobules.

Signs and symptoms  Lump in the breast or in an armpit
 a pain in the armpits or breast that does not change
with the monthly cycle
 pitting or redness of the skin of the breast, like the
skin of an orange
 a rash around or on one of the nipples
 a discharge from a nipple, possibly containing blood
 a sunken or inverted nipple

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LOM Female Reproductive System Notes

 a change in the size or shape of the breast

 peeling, flaking, or scaling of the skin on the breast or
nipple

Diagnosis/ Investigation  Breast exam

 Mammogram
 Ultrasound scan
 MRI scan
 Biopsy

Treatment  radiation therapy
 surgery
 biological therapy, or targeted drug therapy
 hormone therapy
 chemotherapy

CERVICAL CARCINOMA

Topic Description
Disease CERVICAL CARCINOMA
Definition Cancer of the entrance to the womb (uterus)
The cervix is the lower, narrow part of the uterus (womb).
Cause 
Risk Factors  HPV (human papillomavirus)
 Many sexual partners or becoming sexually active early
 Smoking
 A weakened immune system
 Long-term mental stress
 Giving birth at a very young age
 Several pregnancies
 Contraceptive pill

Signs and symptoms  In early stage the person may experience no symptoms
 bleeding between periods
 bleeding after sexual intercourse
 bleeding in post-menopausal women

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LOM Female Reproductive System Notes

 discomfort during sexual intercourse

 smelly vaginal discharge
 vaginal discharge tinged with blood
 pelvic pain

Diagnosis/ Investigation  Pap test
 Pelvic examination
 Colposcopy
 Biopsy
Treatment  Radiotherapy
 Chemotherapy

CERVICITIS

Topic Description
Disease CERVICITIS
Definition Cervicitis is swelling or inflamed tissue of the end of the
uterus (cervix).
Cause  Chlamydia
 Gonorrhea
 Herpes virus (genital herpes)
 Human papilloma virus (genital warts)
 Trichomoniasis
 A device inserted into the pelvic area such as a cervical
cap, diaphragm, or pessary
 Allergy to spermicides used for birth control
 Allergy to latex in condoms
 Exposure to a chemical

Signs and symptoms  Abnormal vaginal bleeding that occurs after intercourse,
after menopause, or between periods
 Unusual vaginal discharge that does not go away:
discharge may be gray, white or yellow in color
 Painful sexual intercourse
 Pain in the vagina
 Pressure or heaviness in the pelvis

Diagnosis/ Investigation  Bimanual pelvic exam
 Pap Smear Test
 Cervical Biopsy
 Cervical Discharge Culture

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LOM Female Reproductive System Notes

Treatment  Antibiotics
 Antiviral
 Hormonal therapy (with estrogen or progesterone) may
be used in women who have reached menopause.
 Cryosurgery (freezing)
 Laser therapy

CHORIOCARCINOMA

Topic Description
Disease CHORIOCARCINOMA
Definition Choriocarcinoma is a fast-growing cancer that occurs in a
woman's uterus (womb). The abnormal cells start in the tissue
that would normally become the placenta. This is the organ that
develops during pregnancy to feed the fetus.
Signs and symptoms  A possible symptom is abnormal or irregular vaginal
bleeding in a woman who recently had a hydatidiform
mole or pregnancy.
 Irregular vaginal bleeding
 Pain
Diagnosis/ Investigation  A pregnancy test will be positive even if you are not
pregnant. The pregnancy hormone (HCG) level will
be high.
 A pelvic exam may show swelling of the womb or a
tumor.
 Quantitative serum HCG
 Complete blood count
 Kidney function tests
 Liver function tests
 CT scan
 MRI
Treatment  Chemotherapy
 Hysterectomy
 Radiation

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ECTOPIC PREGNANCY
Topic Description
Disease ECTOPIC PREGNANCY
Definition A pregnancy that is not in the uterus. The fertilized egg
settles and grows in any location other than the inner lining of
the uterus. The large majority (95%) of ectopic pregnancies
occur in the Fallopian tube.
Cause The cause of an ectopic pregnancy isn’t always clear. In some
cases, the following conditions have been linked with an
ectopic pregnancy:
 Inflammation and scarring of the fallopian tubes from a
previous medical condition, infection, or surgery
 Hormonal factors
 Genetic abnormalities
 Birth defects
 Medical conditions that affect the shape and condition
of the fallopian tubes and reproductive organs

Risk Factors  maternal age of 35 years or older
 history of pelvic surgery, abdominal surgery, or multiple
abortions
 history of pelvic inflammatory disease
 history of endometriosis
 conception occurred despite tubal ligation or intrauterine
device (IUD)
 conception aided by fertility drugs or procedures
 smoking
 history of ectopic pregnancy

Signs and symptoms  sharp waves of pain in the abdomen, pelvis, shoulder, or
neck
 severe pain that occurs on one side of the abdomen
 light to heavy vaginal spotting or bleeding
 dizziness or fainting
 rectal pressure

Diagnosis/ Investigation 
Treatment  methotrexate
 Laparotomy

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ENDOMETRIALCARCINOMA

Topic Description
Disease ENDOMETRIALCARCINOMA

Definition Endometrial cancer is cancer that starts in the endometrium,

the lining of the uterus (womb).
Cause  Idiopathic
Risk Factors  Estrogen replacement therapy without the use of
progesterone
 History of endometrial polyps
 Infrequent periods
 Never being pregnant
 Obesity
 Polycystic ovary syndrome (PCOS)
 Starting menstruation at an early age (before age 12)
 Starting menopause after age 50
 Tamoxifen, a drug used for breast cancer treatment

Signs and symptoms  Vaginal bleeding after menopause

 Bleeding between periods
 An abnormal, watery or blood-tinged discharge from
your vagina
 Pelvic pain
Diagnosis/ Investigation  Pelvic examination
 Transvaginal ultrasound
 Hysteroscopy
 Endometrial biopsy
 D&C
Treatment  Hysterectomy
 Radiation therapy
 Hormone therapy
 Chemotherapy

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ENDOMETRIOSIS
Topic Description
Disease ENDOMETRIOSIS
Definition The presence of tissue that normally grows inside the uterus
(womb) in an abnormal anatomical location
Endometriosis is very common and may not produce symptoms,
or it may lead to painful menstruation.
Cause  Retrograde menstruation
 Surgical scar implantation
 Endometrial cells transport
 Immune system disorder
Signs and symptoms  Pelvic pain
 Painful periods
 Pain in the lower abdomen before and during
menstruation
 Cramps one or two weeks around menstruation
 Heavy menstrual bleeding or bleeding between periods
 Infertility
 Pain following sexual intercourse
 Discomfort with bowel movements
 Lower back pain that may occur at any time during your
menstrual cycle

Diagnosis/ Investigation  Pelvic exam
 Ultrasound
 Laparoscopy
Treatment  Non-steroidal anti-inflammatory drugs (NSAIDs) E.g.
ibuprofen
 Hormone therapy
 Hormonal contraceptives
 Progestin therapy
 Hysterectomy


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FIBROIDS

Topic Description
Disease FIBROIDS

Definition It is a benign tumor of muscular and fibrous tissues, typically

developing in the wall of the uterus.

Cause o Exact cause is unclear, but several factors may

influence their formation.
 Hormones
 Family history
 Pregnancy
Risk Factors o pregnancy
o a family history of fibroids
o being over the age of 30
o being of African-American descent
o having a high body weight

Types 1. Intramural fibroid

2. Subserosal fibroid
3. Submucosal Fibroid
Signs and symptoms  Heavy bleeding between or during your periods that
includes blood clots
 Pain in the pelvis and/or lower back
 Increased menstrual cramping
 Increased urination
 Pain during intercourse
 Menstruation that lasts longer than usual
 Pressure or fullness in your lower abdomen
 Swelling or enlargement of the abdomen

Diagnosis/ Investigation  Ultrasound
 Pelvic MRI
 Saline infusion sonogram (hysterosonography)
 Hysteroscopy
 Endometrial biopsy
Treatment  Birth control pills to help control heavy periods
 Intrauterine devices (IUDs) that release hormones to

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help reduce heavy bleeding and pain

 Tranexamic acid to reduce the amount of blood flow
 Iron supplements to prevent or treat anemia due to
heavy periods
 Pain relievers such as ibuprofen or naproxen for cramps
or pain
 Hormone therapy shots to help shrink fibroids (done
only for a short time)
 Hysteroscopy
 Uterine artery embolization
 Myomectomy
 Hysterectomy


FIBROCYSTIC BREAST DISEASE

Topic Description
Disease FIBROCYSTIC BREAST DISEASE

Definition Fibrocystic breast disease is a noncancerous condition in which

a woman has painful lumps in her breasts.
Signs and symptoms  Pain or discomfort in both breasts
 Pain that commonly comes and goes with your period, but
may last through the whole month
 Breasts that feel full, swollen, or heavy
 Pain or discomfort under the arms
 Thick or lumpy breasts
Diagnosis/ Investigation  Clinical breast exam
 Mammogram
 Ultrasound
 Fine-needle aspiration
 Breast biopsy

Treatment  Women who have no symptoms or only mild symptoms
DO NOT need treatment.
 Take over-the-counter medicine, such as acetaminophen
or ibuprofen for pain
 Apply heat or ice on the breast
 Wear a well-fitting bra or a sports bra
 Birth control pills

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OVARIAN CARCINOMA

Topic Description
Disease OVARIAN CARCINOMA
Definition Ovarian cancer refers to any cancerous growth that occurs in
the ovary. The majority of ovarian cancers arise from the
epithelium (outer lining) of the ovary.
Risk Factors  Family history
 Age
 Bloating
 Pelvic or abdominal pain
 Trouble eating or feeling full quickly
 Urinary symptoms such as urgency or frequency
 Fatigue
 Upset stomach
 Pain during sex
 Constipation
 Menstrual changes
 Abdominal swelling with weight loss
Diagnosis/ Investigation  Physical examination
 A blood test (for CA-125, beta-human chorionic
gonadotropin, alpha-fetoprotein)
 Transvaginal ultrasound
 Rectovaginal examination

Treatment  Surgery
 Chemotherapy
 A combination of surgery with chemotherapy
 Radiotherapy

OVARIAN CYST

Topic Description
Disease OVARIAN CYST
Definition An ovarian cyst is a fluid-filled sac within the ovary.
Signs and symptoms  Abdominal bloating or swelling
 Painful bowel movements
 Pelvic pain before or during the menstrual cycle
 Painful intercourse

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 Pain in the lower back or thighs

 Breast tenderness
 Nausea and vomiting
Diagnosis/ Investigation  Pelvic examination+
 Ultrasound
 CT scan
 MRI
Treatment  Oral contraceptives
 Laparoscopy

PELVIC INFLAMMATORY DISEASE

Topic Description
Disease PELVIC INFLAMMATORY DISEASE
Definition Pelvic inflammatory disease is an infection of a woman's womb
(uterus), ovaries, or fallopian tubes.
Cause  Bacteria from chlamydia and gonorrhea
Signs and symptoms  Fever
 Pain or tenderness in the pelvis, lower belly, or lower
back
 Fluid from your vagina that has an unusual color,
texture, or smell
 Bleeding after intercourse
 Chills
 Being very tired
 Pain when you urinate
 Having to urinate often
 Period cramps that hurt more than usual or last longer
than usual
 Unusual bleeding or spotting during your period
 Not feeling hungry
 Nausea and vomiting
 Skipping your period
 Pain when you have intercourse
Diagnosis/ Investigation  Pelvic exam
 C-reactive protein (CRP)
 Erythrocyte sedimentation rate (ESR)
 WBC count
Treatment  Antibiotic therapy (e.g. ceftriaxone, metronidazole)

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PLACENTA PREVIA

Topic Description
Disease PLACENTA PREVIA

Definition Placenta previa is a problem of pregnancy in which the placenta

grows in the lowest part of the womb (uterus) and covers all or
part of the opening to the cervix.
Risk Factors Placenta previa occurs in 1 out of 200 pregnancies. It is more
common in women who have:
 An abnormally shaped uterus
 Had many pregnancies in the past
 Had multiple pregnancies, such as twins or triplets
 Scarring on the lining of the uterus due to a history of
surgery, C-section, or abortion
 In vitro fertilization
Women who smoke, use cocaine, or have their children at an
older age may also have an increased risk.

Types Forms of placenta previa

 Marginal: The placenta is next to the cervix but does

not cover the opening.
 Partial: The placenta covers part of the cervical opening.
 Complete: The placenta covers all of the cervical
opening.
Signs and symptoms  Sudden bleeding from the vagina (Bleeding may be
severe and life threatening. It may stop on its own, but
can start again days or weeks later. Labor sometimes
starts within several days of the heavy bleeding.
Sometimes, bleeding may not occur until after labor
starts.)
 Cramps
Diagnosis/ Investigation  Pregnancy ultrasound
Treatment  Reducing your activities
 Bed rest
 Pelvic rest, which means no sex, no tampons, and no
douching
 C-section
 Blood transfusions

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 Medicines to prevent early labor

 Medicines to help pregnancy continue to at least 36
weeks
 Shot of special medicine called Rhogam if your blood
type is Rh-negative
 Steroid shots to help the baby's lungs mature

POLYCYSTIC OVARY SYNDROME

Topic Description
Disease POLYCYSTIC OVARY SYNDROME
Definition Polycystic ovary syndrome (PCOS) is a condition in which a
woman has an imbalance of female sex hormones. This may lead
to changes in the menstrual cycle, cysts in the ovaries, trouble
getting pregnant and other health problems.
Signs and symptoms  Excess hair on the face, chest, stomach, thumbs, or
toes
 Decrease in breast size
 Deeper voice
 Hair loss
 Acne
 Weight gain
 Pelvic pain
 Depression
 Infertility
Diagnosis/ Investigation  Thyroid function test
 Fasting blood sugar
 Lipid level test
 Vaginal ultrasound
 Pelvic laparoscopy

Treatment  Healthy diet and regular exercise

 Birth control pills
 Anti-androgens
 Ovarian drilling

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PREECLAMPSIA

Topic Description
Disease PREECLAMPSIA
Definition Preeclampsia is when you have high blood pressure and
protein in your urine during pregnancy
Cause  The exact cause of preeclampsia is unknown
Risk Factors
Types 
Signs and symptoms  Rapid weight gain (caused by body fluid and seen as
swelling in face, hands, and feet)
 Abdominal pain
 Severe headaches
 Changes in reflexes
 Reduced urine output
 Dizziness
 Excessive nausea and vomiting
 Visual changes (blurry vision, flashing lights, floaters)
Diagnosis/ Investigation Physical exam
 Blood test
 Urinalysis
 Pregnancy ultrasound
 Non-stress test

Treatment  Antihypertensives
 Anticonvulsants
 Corticosteroids


PREMATURE MENOPAUSE

Topic Description
Disease PREMATURE MENOPAUSE
Definition Menopause (permanent cessation of menses) occurring before
age 40
Cause  Genetics
 Lifestyle
Signs and symptoms

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 Heavy bleeding
 Spotting
 Periods that last longer than a week
 A period after a year of no bleeding
 Moodiness
 Changes in sexual feelings or desire
 Vaginal dryness
 Trouble sleeping
 Hot flashes
 Night sweats
 Loss of bladder control

Diagnosis/ Investigation 
Treatment  Hormone therapy
 Oral contraceptive pills are a form of HT that is
sometimes used to help relieve menopausal symptoms.
 Antidepressant medications: the selective serotonin
reuptake inhibitors (SSRIs)
 Non-hormonal vaginal gels, creams, and lubricants can
help prevent the symptoms of vaginal dryness


PREMENUSTRUAL SYDROME
Topic Description
Disease PREMENUSTRUAL SYDROME
Definition Premenstrual syndrome, or PMS, is a group of symptoms that
start one to two weeks before your period. Most women have
at least some symptoms of PMS, and the symptoms go away
after their periods start. For some women, the symptoms are
severe enough to interfere with their lives. They have a type
of PMS called premenstrual dysphoric disorder, or PMDD.
Cause  Unknown, but hormonal changes trigger the symptoms.
Signs and symptoms  Breast swelling and tenderness
 Acne
 Bloating and weight gain
 Pain - headache or joint pain
 Food cravings
 Irritability, mood swings, crying spells, depression
Treatment  Over-the-counter pain relievers such as ibuprofen,

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aspirin or naproxen may help ease cramps, headaches,

backaches and breast tenderness. Exercising, getting
enough sleep, and avoiding salt, caffeine, and alcohol
can also help.

Rh INCOMPATIBILITY

Topic Description
Disease Rh INCOMPATIBILITY

Cause  Once the pregnant woman has Rh-negative blood type

and her unborn baby has Rh-positive blood type, then
pregnant woman’s body will mistake the Rh-positive
protein in the blood of the unborn baby as an outside
substance. The blood from the baby can get into the
mother’s blood stream, any time during pregnancy,
labor, or (most probably) during the time of delivery.
If this happens, the immune system of the mother will
develop antibodies against her own unborn baby’s red
blood cells. These antibodies might cross the placenta
to attack the baby’s red blood cells. These antibodies,
generally, do not create issues if the woman is
pregnant for the first time. It is due to the fact that
the baby is usually delivered before the antibodies in
the blood increases.
Once the antibodies have been formed, they stay in
the woman’s body. The body will make more Rh
antibodies in successive pregnancies. Therefore, Rh
incompatibility tends to cause complications in the
next pregnancy.
Signs and symptoms  Polyhydramnios
 After birth, the infant may have:
 Yellowing of the skin and whites of the eyes
(jaundice)
 Low muscle tone (hypotonia) and lethargy

Diagnosis/ Investigation  A positive direct Coombs test result
 Higher-than-normal levels of bilirubin in the baby's
umbilical cord blood
 Signs of red blood cell destruction in the infant's blood

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
Treatment  Infants with mild Rh incompatibility may be treated with
phototherapy
 For infants severely affected, an exchange transfusion of
blood may be needed


VAGINITIS / VULVITIS

Topic Description
Disease VAGINITIS / VULVITIS
Definition Vulvovaginitis is an inflammation or infection of the vulva and
vagina. It’s a common condition that affects women and girls
of all ages, and it has a variety of causes. Other names for
this condition are vulvitis and vaginitis.

Cause  Yeast (Candida albicans)

 Viruses (herpes and human papillomavirus (HPV))
 Parasites (Pinworms, scabies, and lice)
 Environmental factors (Poor hygiene, Tight clothing)
 Sexually transmitted infections (trichomonas vaginitis)
 Exposure to allergens
 Chemical irritants (parabens, sodium sulfate)

Signs and symptoms  Irritation of the genital area
 Itching
 Inflammation around the labia and perineal areas
 An increased, strong-smelling vaginal discharge
 Discomfort while urinating
Diagnosis/ Investigation  Pelvic examination

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PROCEDURES

CLINICAL

amniocentesis Transabdominal puncture of the amniotic

sac under ultrasound guidance using a needle
and syringe to remove amniotic fluid
insufflation Delivery of pressurized air or gas into a
cavity, chamber, or organ to allow visual
examination, remove an obstruction, or apply
medication

ENDOSCOPIC

colposcopy Visual examination of the vagina and cervix

with an optical magnifying instrument
laparoscopy Visual examination of the abdominal cavity
with a laparoscope through one or more
small incisions in the abdominal wall, usually
at the umbilicus

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chorionic villus sampling (CVS) Sampling of placental tissues for prenatal

diagnosis of potential genetic defects
endometrial biopsy Removal of a sample of uterine endometrium
for microscopic study
Papanicolaou (Pap) test Cytological study used to detect abnormal
cells sloughed from the cervix and vagina,
usually obtained during routine pelvic
examination

LABORATORY

RADIOGRAPHIC

mammography Radiographic examination of the breast to

screen for breast cancer
hysterosalpingography Radiography of the uterus and uterine tubes
(oviducts) following injection of a contrast
medium
ultrasonography (US) Process by which high-frequency sound
waves (ultrasound) produce and display an
image from reflected “echoes” on a monitor;
also called ultrasound, sonography, and echo

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SURGICAL

Breast implant revision Surgery designed to correct an

unsuccessful procedure that has created a
cosmetic problem or poses a health risk
Cerclage Suturing the cervix to prevent it from
dilating prematurely during pregnancy, thus
decreasing the chance of a spontaneous
abortion. The sutures are removed prior to
delivery
Cesarean birth Incision of the abdomen and uterus to
remove the fetus; also called C-section
Colpocleisis Surgical closure of the vaginal canal
Conization Excision of a cone-shaped piece of tissue,
such as mucosa of the cervix,
for histological examination
Cordocentesis Sampling of fetal blood drawn from the
umbilical vein and performed under
ultrasound guidance
Cryosurgery Process of freezing tissue to destroy cells;
also called cryocautery
Dilatation and curettage (D&C) Widening of the cervical canal with a dilator
and scraping of the uterine endometrium
with a curette
episiorrhaphy Repair of a lacerated vulva or an episiotomy
episiotomy Incision of the perineum from the vaginal
orifice usually done to prevent tearing of
the tissue and to facilitate childbirth
hysterectomy Excision of the uterus
intrauterine device Plastic or metal object placed inside the
uterus to prevent implantation of a
fertilized egg in the uterine lining
lumpectomy Excision of a small primary breast tumor (a
“lump”) and some of the normal tissue that
surrounds it
mammoplasty Surgical reconstruction of the breast(s) to
change the size, shape, or position
mastectomy Excision of the entire breast
myomectomy Excision of a myomatous tumor, generally
uterine

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reconstructive breast surgery Reconstruction of a breast that has been

removed because of cancer or other disease
transverse rectus abdominis Surgical creation of a skin flap using skin
muscle (TRAM) flap and fat from the lower half of the abdomen
which is passed under the skin to the breast
area. The abdominal tissue (flap) is shaped
into a natural-looking breast and sutured
into place
salpingo-oophorectomy Excision of an ovary and fallopian tube
tubal ligation Procedure that ties (ligates) the fallopian
tubes to prevent pregnancy

ABBREVATION

AB; Ab, ab: antibody; abortion

AI: artificial insemination

BSE: breast self-examination

CA: cancer; chronological age; cardiac arrest

D&C: dilatation (dilation) and curettage

DUB: dysfunctional uterine bleeding

FSH: follicle-stimulating hormone

G: gravida (pregnant)

GC: gonococcus (Neisseria gonorrhoeae)

GYN: gynecology

HRT: hormone replacement therapy

HSG: hysterosalpingography

HSV: herpes simplex virus

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IUD: intrauterine device

LH: luteinizing hormone

LMP: last menstrual period

LSO: left salpingo-oophorectomy

OCPs: oral contraceptive pills

Pap: Papanicolaou (test)

PID: pelvic inflammatory disease

PMP: previous menstrual period

PMS: premenstrual syndrome

RSO: right salpingo-oophorectomy

STD: sexually transmitted disease

TAH: total abdominal hysterectomy

TRAM: transverse rectus abdominis muscle

TVH: total vaginal hysterectomy

VD: venereal disease

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Fetal-Obstetrical

CPD: Cephalopelvic disproportion

CS: C-section cesarean section

CVS: Chorionic villus sampling

CWP: Childbirth without pain

FECG, FEKG: Fetal electrocardiogram

FHR: Fetal heart rate

FHT: Fetal heart tone

FTND: Full-term normal delivery IUGR intrauterine growth rate; intrauterine growth
retardation

IVF-ET: In vitro fertilization and embryo transfer

LBW: Low birth weight

NB: Newborn

OB: Obstetrics

para 1, 2, 3: Unipara, bipara, tripara (number of and so on viable births)

UC: Uterine contractions

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