PATHOPHYSIOLOGY

ANATOMY AND PHYSIOLOGY

The female reproductive system functions to produce gametes and reproductive hormones, just like the
male reproductive system; however, it also has the additional task of supporting the developing fetus
and delivering it to the outside world. Unlike its male counterpart, the female reproductive system is
located primarily inside the pelvic cavity. Recall that the ovaries are the female gonads. The gamete they
produce is called an oocyte.

The system consists of organs and tissues inside the body and some that are visible outside the body.
The internal organs include:

• ovaries -Most females have two ovaries, one on each side of the uterus. They are about the
shape and size of an almond and have two key functions: producing hormones and releasing eggs.

• fallopian tubes

The fallopian tubes are passageways that carry eggs toward the uterus. They consist of several parts:

 the infundibulum, which is a funnel-shaped opening near the ovaries

 the fimbriae, which are finger-like projections surrounding the opening
 cilia, which are hair-like structures inside the fallopian tubes
 When an ovary releases an egg, fluid and the fimbriae propel it toward the fallopian tube
opening. Once inside, the cilia move the egg toward the uterus.

• uterus - an inverted pear-shaped muscular organ of the female reproductive system, located
between the bladder and the rectum. It functions to nourish and house a fertilized egg until the fetus, or
offspring, is ready to be delivered.

• vagina - The vagina is a hollow, musculomembtanous canal located posterior to the bladder and
anterior to the rectum. It extends from the cervix of the uterus to the external vulva.

Its function is to act as the organ of intercourse and to convey sperm to the cervix. With childbirth, it
expands to serve as the birth canal.
 PATHOPHYSIOLOGY

Uterine Fibroid also known as leiomyoma (benign/ non-cancerous) tumor from smooth muscle
tissue that originates from the smooth muscle layer called myometrium of the uterus.

Uterine fibroids (leiomyomas) are the most common pelvic neoplasm in females. They are
nonmalignant monoclonal tumors arising from the smooth muscle cells of the myometrium. The
pathogenesis of leiomyomas is not well understood. Genetic predisposition, environmental factors,
steroid hormones, and growth factors important in fibrotic processes and angiogenesis all play a role in
the formation and growth of uterine fibroids. The disease is heterogeneous, and different fibroids within
the same uterus may have different etiologies and arise from different somatic mutations. Leiomyoma-
related effects on the function and structure of the endometrium are the final common pathways in the
pathogenesis of excessive bleeding in myomatous uteri, and there is evidence of both histologic changes
in the endometrium and endometrial vasculature in these uteri.
While the definitive cause of uterine fibroids is unknown, most medical professionals believe that there
are many different factors at play. Some potential causes include:3

Hormones: Unopposed estrogen levels have been shown to promote fibroid development. High
progesterone levels have also been associated with increases in fibroid growth.

Genetics: Genetic mutations in the MED12, HMGA2, COL4A5/COL4A6, or FH genes have all been
implicated in the development and growth of uterine fibroids.

Family history: Having a family member with fibroids increases your risk of developing fibroids in your
lifetime. In fact, if your mother had fibroids, you are three times more likely to have fibroids compared
with a woman with no family history of fibroids, highlighting the strong genetic component of this
condition. More research needs to be done to elucidate the genetic factors that contribute to this
condition.

Growth hormones: Hormones such as insulin-like growth factors, epidermal growth factors, and
transforming growth factors may also play a role in fibroid development.

The number of micronutrients in your blood: The amount of certain micronutrients, such as low iron
and/or vitamin D levels, may contribute to the growth of fibroids

Major stress: Some studies have cited stressful life events and possibly childhood abuse as possible
triggers of uterine fibroid development.
 PATHOPHYSIOLOGY OF UTERINE MYOMA

Predisposing Factors: Precipitating Factors:

 Age:  No history of pregnancy

 Gender Female

Increase estrogen exposure in

lifetime

Estrogen stimulates proliferation of

uterine smooth muscles cells

Benign proliferation of monoclonal

myometrial (uterine wall/muscles) cells into
discrete masses

Fibroids grows adjacent to

Spherical mass on ultrasound.
endometrium into uterine muscle

Increase endometrial surface area

Increase endometrium to proliferate and

lose during menstruation

Repeat shedding over time

Uterine Fibroids (Leiomyomas)

Signs & Symptoms:

 Prolonged & Heavy

Deficient fluid volume
menstrual bleeding lasting
for 5 days
 Pallor and pale
