80

80 CASE 80


A 28-year-old nulliparous woman visits her gynecologist complaining of pelvic pain accompanying her menses.


The patient states that the pain begins around 1 week before her menses and becomes increasingly severe until flow slackens, at which time the pubic pain subsides. The intervals of pain have been getting progressively worse over the past few months. The patient states that her menses are no longer regular or consistent and that they “feel heavier than they used to be.” She also complains of some discomfort during intercourse. The patient states that all of these symptoms have started within the last 6 months and that previously she only had mild cramping with menstruation. She is sexually active and uses condoms for contraception.



PHYSICAL EXAMINATION



VS: T 98.6°F, P 70/min, R 16/min, BP 120/70 mm Hg, BMI 24

PE: Pelvic examination is unremarkable.


LABORATORY STUDIES



MRI: Lesions along the uterus

Laparoscopy and tissue biopsy: Endometrial tissue on the ovaries and uterine tubes


DIAGNOSIS


Endometriosis



PATHOPHYSIOLOGY OF KEY SYMPTOMS


The female reproductive cycle is a recurring set of changes in the uterus and ovaries that enables successful uterine implantation of a zygote. The uterine wall consists of an external parametrium, a middle myometrium, and the internal endometrial lining. During the first half of the reproductive cycle, an ovarian follicle matures and grows in response to anterior pituitary follicle-stimulating hormone (FSH) release. Estrogen produced by the maturing follicle stimulates the growth of the epithelia, glands, blood vessels, and connective tissue that comprise the endometrium. The first half of the uterine reproductive cycle is called the proliferative phase. The duration of the proliferative phase is presented typically 14 days, but it can vary greatly (Fig. 80-1).


image

FIGURE 80–1 Uterine and vaginal changes during the menstrual cycle. After menstruation the uterine endometrium increases in size and vaginal cornification and secretions provide a nutritive environment for sperm. After ovulation the uterine endometrium enters the secretory phase, providing a suitable environment for implantation of a fertilized ovum.

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Jul 4, 2016 | Posted by in PHYSIOLOGY | Comments Off on 80

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