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Chapter 25 Concept 1 Premenstrual syndrome and premenstrual dysphoric disorder (Workbook #10) Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are the cyclic recurrence (in the luteal phase of the menstrual cycle) of distressing physical, psychologic, or behavioral changes that impair interpersonal relationships or interfere with usual activities and resolve after menstruation.Symptoms of PMS and PMDD begin after ovulation during the luteal phase and persist up to 4 days into the menstrual cycle. The psychologic and physiologic changes of PMS/PMDD occur in the luteal phase of ovulatory cycles and are linked with the complex hormonal changes of the menstrual cycle. There are many theories on the cause(s) of the disorder, including that the drop in estrogen level following ovulation and the immediate rise in progesterone level interact with hormones and neurotransmitters to cause symptoms.However, the mechanisms involved are not known and may include an individual sensitivity to hormone levels. Concept 2 HPV-associated carcinoma (Workbook #15) It is established that cervical cancer is almost exclusively caused by cervical human papillomavirus (HPV) infection. Infection with “highrisk” (oncogenic) types of HPV is a necessary precursor to development of cervical dysplasia, otherwise known as the precancerous cell changes that lead to invasive cancer. Most sexually active women will contract HPV at some point in their lifetime; most of these infections are asymptomatic and resolve spontaneously. However, high-risk HPV may persist and cause abnormal cellular changes that can become cancerous. HPV strains 16 and 18 are most often implicated as causing 70% of all cervical cancers and also contribute to many vaginal, vulvar, penile, anal, and oropharyngeal cancers. Concept 3 Endometriosis vs Adenomyosis (Workbook #43) Endometriosis is the presence of functional endometrial tissue (i.e., tissue that responds to hormonal stimulation) at sites outside the uterus. Endometriosis causes an inflammatory reaction at the site of implantation and is a cause of pain and infertility. Adenomyosis is the presence of endometrial glands and stroma within the uterine myometrium. Adenomyosis has been found in up to 30% to 60% of hysterectomy specimens from otherwise normal women; rates are higher for women taking tamoxifen. Concept 4
Rose BettsCentral precocious puberty (Workbook #45) Precocious puberty is defined as the onset of clinical signs of puberty (breast or pubic hair development) before age 8. However, some endocrinologists have recommended that the criteria be changed to reflect the trend toward an earlier onset of puberty, suggesting that pubertal changes before age 6 in black girls or age 7 in white girls are more reflective of abnormal development. Others are concerned that lowering the age of precocious puberty will miss those individuals who present after the age cut-off with a pathologic underlying condition causing early puberty. There have been many postulated causes of precocious puberty, including