Female reproductive system infections and menopause

The following sections discuss the common diseases and disorders of the female reproductive system, including the signs, symptoms, etiology, diagnostic procedures, and treatments.

Sexually transmitted infections (STI)

Many pathogens cause sexually transmitted infections (STIs), but what they have in common is all of them are most efficiently transmitted by sexual contact. Sexual contact refers to intercourse or any contact between the genitals of one person and the body of another person. No one is immune to these diseases. An individual can be infected with more than one STI at a time. No cure is available for viral STIs, such as human immunodeficiency virus (HIV) infection, herpes, and venereal warts. Bacterial infections are increasingly becoming resistant to antibiotic therapy. STIs are frequently asymptomatic in men, although they can cause serious health problems and are infectious regardless of whether symptoms are present.

Endometriosis

With endometriosis, functional endometrial tissue is located outside of the uterus. It is commonly found attached to the ovaries, urinary bladder, fallopian tubes, uterosacral ligaments, intestines, and peritoneum. The endometrial tissue continues to act as it normally would during a menstrual cycle. It will thicken, break down, and bleed, just like the endometrium found in the uterus. This can cause inflammation at the implantation site that will recur with each cycle. Scar tissue and adhesions may form. Endometriosis can cause infertility and put women at higher risk for ovarian cancer.

The exact cause of endometriosis is not known, although there are some possible explanations: retrograde menstruation (the menstrual blood containing endometrial cells flows back through the fallopian tubes instead of leaving the uterus through the cervix), endometrial cells are transported through the blood vessels or lymphatic system to other parts of the body, and an immune system disorder in which the immune system does not recognize and destroy the endometrial tissue that is growing outside the uterus. Risk factors for endometriosis include never giving birth, menarche at a younger age, short menstrual cycles, low body mass index, alcohol consumption, family history of endometriosis, and uterine abnormalities. Common signs and symptoms of endometriosis include dysmenorrhea, dyspareunia , pain with bowel movements or urination, menorrhagia , menometrorrhagia , infertility, fatigue, diarrhea, constipation, bloating, and nausea.

To diagnose endometriosis, oftentimes, an ultrasound will be done. The ultrasound could be done through the abdomen or transvaginally. Another method of diagnosing endometriosis is laparoscopy . The surgeon will look inside the abdomen for signs of endometriosis. There are two methods for treating endometriosis: medications or surgery. Medications might include over-the-counter medications such as ibuprofen or naproxen sodium for pain; hormone therapy including contraceptives, gonadotropin-releasing hormone (GN-RH) agonists and antagonists, which block the production of ovarian-stimulating hormones, lowering estrogen levels and preventing menstruation; or progestin therapy, during which a progestin-only contraceptive such as an intrauterine device is used to stop menstrual periods and the growth of endometrial implants. Surgical options might include removal of the endometrial implants, which can be done laparoscopically or through an abdominal incision and will preserve the uterus and ovaries, or hysterectomy, which is removal of the uterus, cervix, and both ovaries.

Infections

The female genitalia provide an excellent environment for infections to occur. There is moisture, warmth, and plenty of nutrients that permit the infectious agents to flourish. The most common infections of the female reproductive system are discussed next.

Candidiasis

Commonly called a yeast infection. Candida organisms are part of the normal flora of the mouth, skin, intestinal tract, and vagina. Overgrowth of the organism can be caused by antibiotic use, high estrogen levels, oral contraceptive use, diabetes mellitus, pregnancy, and immunosuppressive disorders, including acquired immunodeficiency syndrome (AIDS).

This infection is caused by* Candida albicans* (fungus). Signs and symptoms include vulvovaginal itching; dry, bright red vaginal tissue; and an odorless, white, “cottage cheese” like vaginal discharge.

A diagnosis is made by means of a pelvic examination and a test of the vaginal secretions. Treatment includes antifungal medications, creams, ointments, tablets, and suppositories; some of these treatments may be available over the counter.

Cervicitis

Cervicitis is an inflammation of the cervix caused by an invading organism. This is caused by sexually transmitted infections, an allergic reaction, or a bacterial overgrowth. Signs and symptoms include thick, purulent discharge with odor, dysuria, dyspareunia, and vaginal bleeding after intercourse.

A diagnosis is made by means of a pelvic examination and test of the vaginal secretions. Treatment may not be needed unless the cervicitis is caused by an STI; then, both the patient and her partner must be treated for the STI.

Pelvic inflammatory disease (PID)

Pelvic inflammatory disease (PID) is an acute or chronic infection of the reproductive system that ascends from the vagina, cervix, uterus, fallopian tubes, and ovaries. These infections may cause the fallopian tubes to fill with pus, and chronic episodes can result in scarring of the fallopian tubes and the formation of adhesions.

PID is most often caused by gonorrhea or chlamydia, but many types of bacteria can cause PID. Initially, the patient may be asymptomatic. When signs and symptoms do occur, they could include fever, abdominal or pelvic pain, vaginal discharge, dysuria, and dyspareunia.

Diagnosis is made by means of a pelvic examination and test of the vaginal secretions. Treatment includes antibiotics for the patient and her partner and analgesics.

Menopause

Menopause is the permanent ending of menstruation as a result of the end of ovarian function. It usually occurs when a woman is between 45 and 55 years of age but can occur as early as the 30s and as late as the 60s. Menses may stop suddenly, the flow may decrease over time, or the time between menses may lengthen until menstruation completely stops. Menopause can be diagnosed only retrospectively. Only after 12 months of amenorrhea is a woman said to be in menopause, and the years after this are called postmenopausal.

Perimenopause begins when hormone-related changes start to appear, and it lasts until the final menses; this means it can be as long as 10 years before menopause occurs. During this time, women are still ovulating, but the uneven rise and fall of estrogen and progesterone may cause symptoms. Some women experience few or no symptoms, whereas others may have symptoms such as the following:

• Hot flashes
• Concentration problems
• Mood swings
• Irritability
• Migraines
• Vaginal dryness
• Urinary incontinence
• Dry skin
• Sleep disorders

Treatment focuses on relieving these signs and symptoms. The provider may prescribe very low-dose oral contraceptives to balance estrogen and progesterone levels or short-term hormone replacement therapy (HRT) to treat symptoms. The provider also may recommend that the patient consume soy products or take soy supplements for a plant source of estrogen. Vitamin E may help ease hot flashes, and vitamin B6 helps create natural serotonin, a neurotransmitter that affects mood. Other methods that help with symptoms include the following:

• Avoiding caffeine and spicy foods (to reduce hot flashes)
• Using relaxation techniques (to aid with sleep disorders)
• Consuming a low-fat diet high in calcium and vitamin D
• Performing regular weight-bearing exercise (to help prevent osteoporosis and heart disease)

Medical treatment of menopause focuses on managing uncomfortable symptoms and preventing conditions associated with a drop in blood levels of estrogen, such as osteoporosis and coronary artery disease. Providers traditionally treated perimenopause and menopause with long-term HRT for most women; however, studies indicate that although HRT does protect the menopausal woman from osteoporosis, hip fracture, and colon cancer, at the same time, it increases the risk of heart attack, stroke, breast cancer, and blood clotting. It is now recommended that providers prescribe HRT to meet individual patients’ needs over a short term (i.e., no longer than 5 years) rather than as a routine treatment for all menopausal women. Studies show that the risk for heart disease and other complications increases after 5 years of HRT. The medical assistant must be aware of the provider’s recommendations regarding HRT.

Other medications that may be prescribed include antidepressants to prevent hot flashes. Gabapentin and clonidine also may be prescribed to reduce the frequency of hot flashes.

Because the development of osteoporosis is a concern in perimenopausal and postmenopausal women, the provider may prescribe alendronate, risedronate, zoledronic acid, or ibandronate to reduce bone loss and the risk of fracture. Another drug that may be used to improve postmenopausal bone density is raloxifene; however, hot flashes are a common side effect of this medication. Vaginal dryness can be treated with estrogen administered locally by vaginal tablet, ring, or cream, or the patient can use K-Y Jelly or some other vaginal moisturizer as a lubricant.