Medical Terminology: Women’s Health

1. What is Women’s Health?
The menstrual cycle is the series of changes a woman’s body goes through monthly to prepare for conception and a growing fetus. If fertilization does not occur, the uterus removes the prepared lining, termed menstrual bleeding. Menstruation begins in the early teens (menarche) and ends around age 50. (menopause). The average age of menarche for African Americans is 9. to 11. years, whereas for Caucasians it is 10. to 12. years.
The cycle is controlled by hormones from the hypothalamus, pituitary, ovaries, and the uterus. A normal menstrual cycle is 28. days, but only about 25% of women actually are on this schedule. The average can run from 21. to 35. days.
The menstrual cycle is often divided into three phases, dependent on the hormones. The beginning of menstruation is the start of the follicular phase, which lasts until day 14. As hormone levels are low, the thickened lining of the uterus begins to shed. The cramping that is felt is from small uterine contractions, helping to shed the lining.
An egg follicle begins to mature because of growing levels of follicle-stimulating hormone (FSH), which also causes estrogen secretion. The increase in estrogen causes the endometrium to mature and thicken. The last 5. days of the follicular phase plus the day of ovulation are the most fertile days. Upon the ovulation phase, on day 14, the oocyte, or egg, is released from the follicle because of a surge in luteinizing hormone (LH). The egg is expelled near the opening of one of the fallopian tubes (oviducts, uterine tubes), located laterally at the top of the uterus.
Fertilization usually occurs in one of the tubes. The embryo now travels to the uterus, the primary job of which is to sustain development. As it is a muscular organ, it is capable of great stretching. At the distal end of the uterus is the cervix that attaches to the superior portion of the vagina.
The luteal phase starts next with the LH causing the follicle to secrete progesterone instead of estrogen. Progesterone causes the endometrial lining to begin to thicken in preparation for implantation of a fertilized cell. Progesterone inhibits release of FSH and LH. If fertilization does not occur, the corpus luteum, containing the oocyte, dies, which lowers the level of progesterone. Sloughing of the lining begins about the twenty-eighth day of the cycle, resulting in a flow of blood and cellular debris through the vagina.
The cycle will begin again. Primary amenorrhea is the absence of menses by age 16. Secondary amenorrhea is the absence of menses for more than 6. months in a woman who previously was menstruating regularly.

2. Breast Cancer
Studies show that by age 80, about 1. in 8. women will have had breast cancer. Ten percent of all breast cancers are inherited. Two major genes have been identified—BRCA1. and BRCA2. Despite the research and advances in medicine, the cause of breast cancer is unknown. Some studies have implicated a higher fat diet. Some medications, like estrogen, seem to increase the risk of breast cancer. Exposure to radiation also increases the risk. Childlessness and delayed childbirth also may be factors.

3. Cervical Cancer
The Pap smear has markedly increased early detection of cervical cancer and thus decreased the mortality. Abnormal cells, cervical intraepithelial neoplasia (CIN), are the initial indication on a Pap smear, and are more common in women with HIV and those infected with human papillomavirus (HPV), subtypes 16, 18. Human papillomavirus more common in women with multiple sexual partners, those having sex at an early age, and those with HIV.

4. Dysmenorrhea
Menstrual pain occurring after ovulation for which no cause can be discerned is called dysmenorrhea. Dysmenorrhea is caused by the changing hormones in the reproductive cycle. Uterine contractions from prostaglandins and blood vessel constriction in the uterine lining cause the discomfort as the enriched lining prepares to be sloughed off.

5. Ectopic Pregnancy
Ectopic pregnancy occurs when the fertilized ovum implants in an area other than the uterus. Most ectopic pregnancies occur in the fallopian tubes; however, other possible sites for ectopic pregnancy include the ovary, cervix, and peritoneum. When the fertilized ovum is unable to get to the uterus, it may settle in the fallopian tube. Any blockage, stricture, previous surgery on the tube, infection, or inflammation may impede the ovum from its final, proper destination.

6. Endometrial Cancer
One of the most common gynecologic cancers in women, it is most often diagnosed in postmenopausal women. Abnormal tissue grows rapidly, affected most often by estrogen. Eventually, this abnormal tissue, hyperplasia, turns into a cancer. Some causes of elevated estrogen levels are exogenous estrogen, polycystic ovarian disease, and estrogen-producing tumors. Risk factors for endometrial cancer include endometrial hyperplasia, tamoxifen, type 2. diabetes, nulliparity, and obesity (estrogen is stored in adipose tissue).

7. Fibroids (Leiomyomas)
Leiomyomas are smooth muscle tumors of the uterus. Because they are hormone receptive, the tumors will change in size with the menses. It is unknown what causes the proliferation of these smooth muscle tumors. Fibroids are more common in African American women.

8. Infertility
Infertility is the inability of a reproductive-age couple to conceive after 12. months of unprotected sexual intercourse. More than 50% of the time the reproductive tract of the woman is at issue. Primary infertility is when a woman has never had a pregnancy; secondary is when it occurs in a woman who has had one or more pregnancies.
At fault may be decreased secretion of hormones from the anterior pituitary, failure to ovulate, endometriosis, or past infections causing blockage of the reproductive tract. Structural problems (blocked fallopian tubes, or anovulation), poor sperm motility and/or count, or multifactorial problems can cause infertility. Prior exposure to radiation, medications, exercise frequency, and menstrual cycle and length need to be evaluated.

9. Menopause
Menopause is defined as 12. months without a menses. Few follicles are left to mature, levels of hormones decline, ovulation no longer occurs, and the uterine lining no longer needs to thicken in preparation for a fertilized egg.

10. Ovarian Cancer
Ovarian cancer is the deadliest gynecologic cancer because it is usually advanced before it is detected. There is no proven screening test for ovarian cancer. There are no early signs. A woman who has never had a child or who has had only one or two children, is at higher risk for ovarian cancer. Women with a history of breast cancer, colon cancer, or a family history of these are at a higher risk of ovarian cancer. There is an association between endometriosis and ovarian cancer.

11. Benign Ovarian Masses
The most common ovarian cysts are follicular. The egg is enclosed in a follicle as it waits to be expelled monthly from the ovary. When the follicle does not open to allow the egg out or the follicle is not reabsorbed, a benign cyst, a fluid-filled sac, may result.

12. Pelvic Inflammatory Disease (PID)
Pelvic inflammatory disease (PID) is a variety of inflammation and infection of the upper genital tract, which includes the uterus, fallopian tubes, ovaries and other structures. It includes endometritis, salpingitis, oophoritis, tuboovarian abscess, and pelvic peritonitis. Bacteria from the cervix and vagina migrate to the upper genital tract.
Usual organisms include Chlamydia trachomatis, Neisseria gonorrhoeae, Escherichia coli, and Bacteroides. Most infections are caused by a mix of bacteria. PID occurs most often in sexually active women and is more common in adolescents. PID is more common with multiple sexual partners, a young age, unprotected sex, and a history of sexually transmitted disease.

13. Trophoblastic Disease
Trophoblastic neoplasias are abnormal cells growing from a shell that forms between the embryo and the endometrium. The four disease entities are called hydatidiform mole (partial or complete), invasive mole, choriocarcinoma, and placental site trophoblastic tumor. A complete mole is formed when an egg that has no DNA is fertilized by a sperm.
A partial mole has DNA from both parents and usually fetal parts. An invasive mole is a hydatidiform mole in the endometrium. Choriocarcinomas are tumors composed of trophoblasts with bleeding. Placental site trophoblastic tumors are trophoblasts that intrude the myometrium.
All are suggestive of malignancy and require a full metastatic workup, including CT scan of brain, kidneys, liver, and lung. There is thought to be a problem with the genetic material of the zygotes. The chances are increased with an older mother, prior molar pregnancy, and a history of miscarriage.

14. Pregnancy
Gestational age is measured from the first day of the last menstrual period (LMP). At each prenatal visit, the fundus (the top of the uterus) is measured as to its location in the abdomen. This information is used to assess the growth of the fetus. Pregnancy is usually divided into trimesters.
The first trimester is from 0. to 14. weeks, and starts at implantation. During this time, it is not uncommon to feel more fatigue, nausea, and morning sickness. At 2. months, the uterus is the size of a grapefruit. At 9. weeks, the embryo is called a fetus and is about 1. inch in length. During the first trimester, most major organs have developed.
The second trimester is from 14. to 28. weeks, and is characterized by less breast tenderness, less fatigue, and a diminishing of morning sickness. However, some back pain may begin, as well as stretch marks, heartburn, and hemorrhoids. At 16. weeks, the fundus is halfway between the pubic bone and the umbilicus. At 16. to 18. weeks, fetal movement may be felt. At 27. weeks, the fundus is 2. inches above the umbilicus.
The third trimester is from 28. weeks to birth. Less movement is felt because of the limited space for the fetus to move about. The mother may feel some respiratory difficulty as the uterus is directly underneath the diaphragm, pushing up the lungs. She may experience some edema, have difficulty sleeping, and an increased urge to urinate due to pressure on the bladder. She may feel mild abdominal cramping that is called Braxton-Hicks contractions.

15. Labor and Delivery
Labor is usually shorter in women who have previously had children than in first-time mothers. The average labor is anywhere from 12. to 24. hours. Labor is typically divided into three stages, with the first stage having two phases.
The first stage starts with the beginning of labor, which is uterine contractions that result in thinning (effacement) and dilation of the cervix. The first stage of labor ends with full dilation, at 10. cm, and complete effacement. This is the longest part of labor. Contractions are milder, last 60. to 90. seconds, and are 15. to 20. minutes apart in this first phase of labor, termed the latent phase.
The active phase occurs when the cervix dilates from 4. to 8. cm, contractions become stronger, last about 30. to 45. seconds, and are closer together. This is often when the membranes rupture, releasing amniotic fluid. A backache is common, as is some vaginal bleeding. When the cervix is fully dilated at 10. cm, the second stage of labor has started. This phase is fetal expulsion. Contractions continue, but feel different. There is pressure on the rectum, and a strong urge to push.
The second stage of labor ends with the birth of the baby. Delivery of the placenta, or afterbirth, is the third stage of labor. Contractions will continue, but are milder, as the uterus contracts, which helps to expel the placenta and slow the bleeding.

16. Postpartum
Postpartum is the time from birth to 6. weeks when involutionary changes occur.

17. Rh Incompatibility
Rh incompatibility is assessed on each mother during pregnancy. If the mother is Rh negative and the fetus is Rh positive, the mother may be exposed to the fetus’s cells and develop antibodies to them.

18. Preeclampsia and Eclampsia
Preeclampsia is a condition that women may get in the latter half of pregnancy. It is pregnancy-induced hyper-tension and more often occurs in a first pregnancy. If preeclampsia is left untreated, eclampsia, which is seizures not related to a brain condition, will result.
The etiology of preeclampsia and eclampsia is unknown. Prepregnant hypertension, obesity, and poor nutrition may be contributing factors. First-time mothers have a greater risk of preeclampsia, as do women with a family history of the condition.

Basic Questions
Women’s Health

1. What is the menstrual cycle?
The menstrual cycle is the series of changes a woman’s body goes through monthly to prepare for conception and a growing fetus. If fertilization does not occur, the uterus will remove the prepared lining, termed menstrual bleeding. Menstruation begins in the early teens (menarche) and ends around age 50. (menopause). The average age of menarche for African Americans is 9. to 11. years, whereas for Caucasians it is 10. to 12. years.

2. What controls the menstrual cycle?
The cycle is controlled by hormones from the hypothalamus, pituitary, ovaries, and the uterus. A normal menstrual cycle is 28. days, but only about 25% of women actually are on this schedule. The average can run from 21. to 35. days.

3. What are the phases of the menstrual cycle?
The phases of the menstrual cycle are the follicular phase, ovulation phase, and the luteal phase.

4. What is the follicular phase?
The beginning of menstruation is the start of the follicular phase, which lasts until day 14. As hormone levels are low, the thickened lining of the uterus begins to shed. The cramping that is felt is from small uterine contractions, helping to shed the lining. An egg follicle begins to mature due to growing levels of follicle-stimulating hormone (FSH), which also causes estrogen secretion. The increase in estrogen causes the endometrium to mature and thicken.

5. What is the ovulation phase?
Upon the ovulation phase, on day 14, the oocyte, or egg, is released from the follicle due to a surge in luteinizing hormone (LH). The egg is expelled near the opening of one of the fallopian tubes, (oviducts, uterine tubes), located laterally at the top of the uterus.
Fertilization usually occurs in one of the tubes. The embryo now travels to the uterus, the primary job of which is to sustain development. As it is a muscular organ, it is capable of great stretching. At the distal end of the uterus is the cervix, which attaches to the superior portion of the vagina.

6. What is the luteal phase?
The luteal phase starts next with the LH causing the follicle to secrete progesterone instead of estrogen. Progesterone causes the endometrial lining to begin to thicken in preparation for implantation of a fertilized cell. Progesterone inhibits release of FSH and LH. If fertilization does not occur, the corpus luteum, containing the oocyte, dies, which lowers the level of progesterone. Sloughing of the lining begins about the twenty-eighth day of the cycle, resulting in a flow of blood and cellular debris through the vagina.

7. What is dysmenorrhea?
Dysmenorrhea is menstrual pain occurring after ovulation for which no cause can be discerned.

8. What is an ectopic pregnancy?
An ectopic pregnancy occurs when the fertilized ovum implants in an area other than the uterus.

9. What is leiomyomas?
Leiomyomas are smooth muscle tumors of the uterus.

10. What is infertility?
Infertility is the inability of a reproductive-age couple to conceive after 12. months of unprotected sexual intercourse.

11. What is menopause?
Menopause is defined as 12. months without a menses.

12. Why is ovarian cancer a deadly cancer?
Ovarian cancer is the deadliest gynecologic cancer because it is usually advanced before it is detected. There is no proven screening test for ovarian cancer. There are no early signs.

13. What is an ovarian cyst?
The most common ovarian cysts are follicular. The egg is enclosed in a follicle as it waits to be expelled monthly from the ovary. When the follicle does not open to allow the egg out or the follicle is not reabsorbed, a benign cyst, a fluid-filled sac, may result.

14. What is pelvic inflammatory disease (PID)?
PID is a variety of inflammations and infections of the upper genital tract, which includes the uterus, fallopian tubes, ovaries, and other structures.

15. What are common causes of pelvic inflammatory disease PID?
Usual organisms include Chlamydia trachomatis, Neisseria gonorrhoeae, Escherichia coli, and Bacteroides. Most infections are caused by a mix of bacteria.

16. What are trophoblastic neoplasias?
Trophoblastic neoplasias are abnormal cells growing from a shell that forms between the embryo and the endometrium.

17. What are the types of trophoblastic disease?
The four disease entities are called hydatidiform mole (partial or complete), invasive mole, choriocarcinoma, and placental site trophoblastic tumor.

18. What are choriocarcinomas?
Choriocarcinomas are tumors composed of trophoblasts with bleeding.

19. What are placental site trophoblastic tumors?
Placental site trophoblastic tumors are trophoblasts which intrude the myometrium.

20. From when is gestational age measured?
Gestational age is measured from the first day of the last menstrual period (LMP).

21. What are Braxton-Hicks contractions?
Mild abdominal cramping that is felt from 28. weeks to birth is called Braxton-Hicks contractions.

22. What is effacement?
Effacement is the thinning of the cervix.

23. What is preeclampsia?
Preeclampsia is a condition that women may get in the latter half of pregnancy. It is pregnancy-induced hypertension.

24. What is eclampsia?
Eclampsia are seizures not related to a brain condition.

25. How does the second phase of labor end?
The second stage of labor ends with the birth of the baby.