Study group pelvis Female reproductive cycle: we went through the anatomy again and the hormonal cycle

as well. With a hysterectomy > if the lining and uterus is removed > no signalling for hormones to really spike to produce eg a thickened lining. This will mean the hormone levels will change, but they will be better than if the tube and ovaries are removed. At least then there is some signalling of androgens, but no spikes. Menopause: is described as the final bleed a woman will have. 1. Occurs between 45-55 2. Can have a peri-menopause in the build up to the menopause. 3. A full hysterectomy = surgical menopause. 4. Partial hysterectomy = ovaries will produce testosterone and oestrogen post menopause (progesterone will not peak for endometrium growth as t is removed) 5. Failure of ovaries post hysterectomy: 1. Due to radiation therapy for cancer 2. blood supply from uterus.

 With endometriosis > cells of the uteral lining translated to outside of the uterus and progesterone during the hormonal cycle > tendency to thicken and therefore bleeding. visceral adhesion due to these cells relating to organ surfaces (can cause constipation due to bowel adhesion) > pain during period(dysmennoreah), infertility, chronic pelvic/abdominal/LSp pain, dysuria (painful urination) urination urgency (urge incontinence?) and dyspareunia (painful sex). Pelvic congestion > metabolites > inflammatory response. Pain is related to menstrual cycle.

Polycyctic ovaries > lack of release of eggs & eggs dont mature due to progesterone > relative testosterone > androgenic effects male charateristics e.g. facial hair, spots, sweaty/oily complexion, central obesity, hair (hairsuitism) and insulin resistance related to obesity > cholesterol, bulky mm frame perhaps if untreated. Leads to irregular periods or ammenoreah. Considered as genetic condition, 50% idiopathic. Caused by LH from anterior pituitary and insulin release in combination or separately. The egg follicles remain cysts because of disturbed ovarian function.

 Fibroids: benign growth of CT in the uterus, more common in afrocarribeans and occur in 30-40%. They respond/grow to hormonal rises during menstrual cycle. No surgery unless pelvic pain is so bad (dysmennoreah) removal by keyhole surgical. The fibroid will decrease in size post menopause due to the lack of hormonal spikes. Pt p/w heavy periods > anaemia and debilitation, or 'compression syndrome' on organs > frequency of urination, constipation and bloating, dyspauraenia (painful sex), LBP & sciatica pain, bulging of the abdomen, infertility, pregnancy issues.

 Prostate:

Prostatitis: 1. Caused by: inflammation of prostate, caused by bacterial infection (STI, urinary dysfunction/KUB/bowel infection), immune response, sex leading 2. Pt. p/w: pain over suprapubic area, genitalia, perineum, buttocks, LBP, pain on urination (stopping/starting/dribbling/ freq), ejaculation (erectile dysfunction), effects of fever tiredness, joint/mm pain, C. 3. TTT: strong antibiotics, nsaids, bladder mm relaxants eg alpha blocker for neck of bladder and prostate ( bladder filling). Finasteride - prostate enlargement (inhibits DHT) Fluxotine (anti-depressants but with mm relaxant) Amyotryptaline (pain, bladder mm relaxant, help sleep) Benign prostatic hyperplasia: 1. Common sign of aging prostate grows during puberty and at age 25 (later growth > later s). 2. Outer layer stops growing > prostate grows > urethral clamp > thickening/irritation of bladder wall > freq urination > weakness of bladder with urine retention (no fully emptying) 3. Causes: theories of BPH - related to testicular growth and aging, relative oestrogen levels with testosterone >

cellular proliferation, Dihydrotestoserone (DHT) in prostate with aging > cellular proliferation. 4. Symptoms: a hesitant, interrupted, weak stream, urgency and leaking or dribbling, and more frequent urination, especially at night. Urinary retention - caused by OTC meds for colds and allergies. 5. Cause: Urine retention and strain on the bladder > UTIs, bladder or kidney damage, bladder stones, and incontinence. Tests: digital rectal examination, PSA (prostatic specific antigen test normal is 4.0 ng/mL and below as normal), prostate U/S, biopsy for cells if PSA is high and +ve rectal exam. TTT: Finasteride inhibits DHT (dihydrotestosterone > prostate shrinkage), alpha blockers > MM relaxant of neck/urethra and prostate; high intensity directed U/S, radio-wave therapy. Prostatic cancers: abnormal cellular growth in prostate, associated with aging. Signs: urination issues as with prostatitis and BPH, pain in LBP, hips, pelvis (DD arthritis and for BPH/prostatitis). Others s include: night pain, cachexia, abdominal pain, night sweats, fatigue, malaise. Test: rectal exam, US of prostate, PSA blood test (4.0ng/mL or lower = normal), biopsy, CT/MRI/U/S, xray for bone pain s TTT: local, advanced local (outside prostate), and advanced spread (metastases). 1. Local active surveillance, careful watching, radical prostatectomy, external beam radiation, temporary brachytherapy (radioactive seed inserted and then removed), hormone therapy ( testosterone), cryotherapy, high intensity forced U/S. 2. Advanced local watchful waiting, external beam radiation, temporary brachytherapy, hormone therapy ( testosterone), radical prostatectomy. 3. Advanced Watchful waiting, hormone therapy and advanced 2nd line hormone therapy, biophosphantes (for bone metastases), palliative radiotherapy (slows growth of cancer cells, not cure), Abiraterone (hormonal TTT to slow cancerous spread, not cure),

chemotherapy (e.g. cabazitaxel, to slow cancerous spread, not cure).