HYPERANDROGENISM - Associated w/ Polycystic Ovary Syndrome (PCOS); Degrees of ovulatory dysfunction; Oligo-anovulation; Infertility result of anovulation;
... [Show More] 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 [Show Less]