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Disorders of the female reproductive system can occur as a result of disease in one of the many varied reproductive organs: the ovaries, the fallopian tubes, the uterus, the cervix, the vagina, or the breast. During the reproductive years, these disorders often present as altered menstruation, pelvic pain, or infertility. Cancers arising in these tissues occur more often in the late reproductive or menopausal years. Unfortunately, for several reasons, they often have high mortality rates and a high incidence of metastases when they are diagnosed. Some organs are located deep and are relatively inaccessible to palpation (ovaries). Others have few sensory nerves (ovary, fallopian tubes) and hence remain asymptomatic. Additionally, the breasts have large amounts of adipose tissue, which can make early detection of breast cancer difficult. The one exception is the uterine cervix. It has easy access to surveillance with use of the Papanicolaou smear and human papillomavirus (HPV) screening, which have led to a dramatically reduced mortality rate of cervical cancer.

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Disorders of the female reproductive system can also occur as a result of disease in other organs whose function affects reproductive organs (eg, the brain, hypothalamus, pituitary, thyroid, adrenals, kidney, and liver). Presentation of these disorders is typically painless.

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Alternatively, disorders of the reproductive system can cause disorders in other tissues. Ovarian hormones are necessary for the maintenance and health of most tissues in women. Alterations in these hormones can lead to osteoporosis (loss of bone mass), atrophy and inflammation of estrogen-deprived tissues (eg, atrophic vaginitis), atherogenesis and alterations in cardiovascular compliance, and an increased risk of some forms of cancer (eg, endometrial carcinoma as a consequence of estrogen excess). Dysfunction of the reproductive system also can contribute to unique variants of systemic disorders, such as gestational diabetes and the hypertensive syndrome of preeclampsia-eclampsia.

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Checkpoint

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  • 1. How do female reproductive system disorders present during the reproductive years?
  • 2. To what might you ascribe the lack of reduction in mortality rate from ovarian cancer in contrast to cervical cancer?
  • 3. What are some consequences of reproductive system dysfunction?

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Anatomy

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The reproductive pelvic organs include the vagina, cervix, uterus, fallopian tubes, and ovaries (Figure 22–1). The two ovaries contain thousands of follicles, each with an oocyte and surrounding granulosa cells, which are embedded in a matrix of thecal cells. These supporting cells produce steroids and paracrine products important in follicular maturation and coordination of events in reproduction (Table 22–1). The fallopian tubes, which are open to the peritoneal space, connect the ovaries to the uterus. The uterus contains an internal hormone-sensitive lining, termed the endometrium. During nonpregnant cycles, menstrual bleeding occurs as the monthly culmination of endometrial growth, development, and sloughing in response to changes in blood levels of estrogen and progesterone (Figure 22–2). During pregnancy, the endometrium produces of a wide variety of endocrine and paracrine products, ...

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