A Quick Reference Guide to Female Reproductive Health Disorders

Reproductive health is essential to our overall well-being. However, many of us avoid discussing it due to stigma, cultural beliefs, fear of judgment, lack of information, privacy concerns, or anxiety about medical treatment (because no one wants to hear bad news). It’s vital to circumvent these communication barriers and foster open conversations to achieve better health outcomes and a more meaningful understanding of our bodies.

Today we’re focusing on reproductive health disorders within the sex binary (female/male), examining conditions that affect the reproductive tract in female bodies, including external organs such as the labia, clitoris, and the opening of the vagina, and internal organs such as the cervix, uterus, fallopian tubes, and ovaries. By shedding light on these common reproductive disorders, we aim to empower and encourage patients and clinicians to engage in open and vital discussions about all aspects of their health and wellness.

Let’s take a closer look at common reproductive health disorders affecting female bodies. 

Polycystic Ovary Syndrome (PCOS) 

Let’s start with a common hormonal condition: Polycystic ovary syndrome (PCOS), which is likely more common than we suppose, as many patients with this condition go undiagnosed. PCOS is driven by an imbalance of hormones, including androgens, estrogens, luteinizing hormone (LH), and insulin. High levels of androgens, in particular, contribute to multiple signs and symptoms of the syndrome, which is why PCOS is sometimes referred to as hyperandrogenic anovulation (referring to the lack of egg release from the ovaries). The exact cause of PCOS isn’t fully understood, but it’s thought to be a combination of risk factors such as genetics, environmental pollutants, and obesity.  

This hormonal imbalance leads to signs and symptoms that can manifest in early adolescence and include acne or oily skin, excess hair on the body and/or face, truncal obesity (fat around the belly), and male-pattern hair loss. A classic trait of PCOS is irregular periods, which can be heavy, absent, irregular, or just generally unpredictable. Since these periods can be anovulatory, a common complication of PCOS is infertility. Additionally, PCOS can increase the risk of other conditions such as diabetes, heart disease, and endometrial cancer.

Clinicians can use standard criteria to diagnose PCOS. An individual must have two of the following three to receive a PCOS diagnosis: 

1. Manifestations of high androgen levels, such as acne, excess body hair, or male-pattern hair loss; 
2. Irregular or absent periods;  
3. Cysts on the ovaries identified through ultrasound.  

Additionally, sometimes blood tests may be done to evaluate hormone levels or to help identify an underlying cause, but they aren’t necessary for diagnosis.  

Unfortunately, PCOS isn’t curable, but there are treatments to improve symptoms due to high androgen levels, regulate periods, and prevent complications. Hormonal birth control can help manage excess body hair and acne while also regulating periods. Fertility treatments can address infertility in some cases, and antidiabetic medications can be prescribed if diabetes develops. Lifestyle modifications such as routine physical activity and eating a balanced diet can also help with weight loss and aid in the prevention of heart disease.  

On a related note, if you’re a fan of actress Florence Pugh, you may have recently heard she froze her eggs following her PCOS diagnosis. Egg freezing is a good choice for anyone who’d like to preserve their ability to have children in the future, but especially for patients with PCOS who may have difficulty getting pregnant due to infrequent or absent ovulation.  

Infertility  

Infertility is the inability to achieve pregnancy after 12 or more months of regular, unprotected intercourse. While PCOS is a common cause of infertility in females, there are a lot of other causes, including endometriosis (we’ll get to this one!), premature ovarian insufficiency, pelvic adhesions, or even tumors on the pituitary gland.  

There aren’t any signs or symptoms of infertility other than the inability to get pregnant. However, there may be some indications if there’s an underlying condition causing infertility. For example, premature ovarian insufficiency may present with irregular periods and menopausal symptoms, while a tumor on the pituitary gland can lead to vision changes and headaches.  

Diagnosis involves a combination of patient history and physical examination findings supported by blood tests and imaging studies to help determine the underlying cause. Blood tests may include hormone levels along with performing imaging studies such as a pelvic ultrasound or hysterosalpingography (a special X-ray that uses dye to visualize the uterus and ovaries) to evaluate for any structural causes of infertility.  

Treatment depends on the underlying cause and may or may not improve fertility. Lifestyle changes may help. If an individual is overweight or underweight, seeking treatment to maintain a healthy weight can, in some cases, restore fertility. Assistive reproductive technology (ART) can help some individuals get pregnant and includes medications to induce ovulation, intrauterine insemination (IUI), and even surgery in some cases. Overall, there are a lot of factors to consider when addressing infertility, and it’s a shared decision-making process with the individual and their healthcare provider.  

Endometriosis 

We’ve already mentioned endometriosis, so let’s explain it more. Endometriosis is a condition where uterine tissue grows outside the uterus, and there are a few thoughts on what causes this. The first is that period blood flows back into the pelvic cavity, where immature cells in the blood implant and grow. Wait, what? Yes, this can happen! It’s called retrograde menstruation. It occurs when the ovaries and fallopian tubes aren’t connected, causing blood to flow backward into the abdomen. There’s a theory that cells outside the uterus undergo changes that cause them to implant and grow like uterine cells, and another that stem cells (special cells that can develop into any kind of cell) spread through the body, implant, and grow into uterine tissue.

Uterine tissue growing outside the uterus is a big problem because it causes severe, often debilitating pain. However, pain and other manifestations can vary greatly and depend on where uterine tissue grows. For example, if the intestines are affected, there might be changes to bowel habits and abdominal pain. Pain can be worse during periods while having sex and even when using the bathroom. There may also be allodynia, a phenomenon where typically non-painful stimuli cause pain. Other signs and symptoms include fatigue, heavy bleeding, bloating, and infertility. Due to its nature and severity, endometriosis commonly affects a patient’s quality of life, which can also lead to depression and anxiety.  

A patient’s history and physical exam results can indicate endometriosis. Diagnosis is confirmed through a biopsy, usually via laparoscopic surgery. It’s important to note that endometriosis can take years to be diagnosed and is frequently misdiagnosed or underdiagnosed. There are several reasons for this, some related to the condition’s unknown etiology, variance in presentation, and lack of an easy, non-invasive diagnostic test.

There are also interpersonal factors that can contribute to a late diagnosis, such as dismissal of the individual’s symptoms and lack of knowledge by healthcare providers. In fact, another pop culture icon who’s brought female reproductive health to the forefront is Bindi Irwin, who was diagnosed with endometriosis after struggling for a decade and feeling dismissed by her healthcare providers.  

While endometriosis can’t be cured, there are treatments to help improve quality of life. Medications can be used to minimize pain and may include non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and birth control pills can help with pain. More importantly, birth control can slow down the growth of uterine tissue. Some individuals may even benefit from surgical removal of uterine tissue or scar tissue that has formed. Surgery, of course, has associated risks, but for some individuals who don’t respond to medications, surgical removal can be a solution.  

Pelvic Inflammatory Disease (PID) 

Our next reproductive condition is pelvic inflammatory disease (PID), which is an infection of the upper reproductive organs, such as the uterus, fallopian tubes, and/or ovaries. It’s often caused by sexually transmitted infections (STIs), like chlamydia and gonorrhea, that ascend from the lower reproductive organs. It can also be linked to other types of infections that aren’t transmitted sexually, such as E. coli and certain types of strep, but are less common causes of PID. 

So, symptoms can vary quite a bit, and some individuals might not even experience any symptoms, which is why PID can sometimes be referred to as a “silent threat.” However, if manifestations are present, they commonly include lower abdominal pain, fever, unusual vaginal discharge, pain during sex, painful urination, and irregular periods. Even if symptoms are silent or mild, PID can quickly progress and lead to complications such as chronic pelvic pain, infertility, scarring or adhesions, abscesses, and ectopic pregnancy.  

Diagnosis begins with a history and physical examination, specifically a pelvic exam. Swabs may be used during the exam to identify the microbe responsible for the infection, and blood tests may be completed to support the diagnosis or evaluate if the infection has spread. In some cases, an ultrasound can be done to evaluate the organs and identify potential complications, like an abscess.  

The good news is that PID usually responds well to oral antibiotics, which can clear up the infection. Because PID can spread quickly, treatment shouldn’t be delayed. Antibiotics may be prescribed based on just the suspicion of PID. In more severe cases or cases where there’s high antibiotic resistance to oral antibiotics, patients may need IV antibiotics.  

Uterine Fibroids 

Our last condition is uterine fibroids. These sound, look, and can feel scary, but uterine fibroids are non-cancerous growths that pop up within the uterus (sometimes even within the wall of the uterus). They’re super common and can affect up to 70-80% of women by the fifth decade of life. The exact reason fibroids develop isn’t fully understood, but hormones, particularly estrogen and progesterone, likely play a role. 

Many individuals with fibroids don’t have any symptoms. However, others can experience heavy menstrual bleeding, prolonged periods, pelvic pain or pressure, frequent urination, and sometimes issues during pregnancy and labor. 

Diagnosis, of course, begins with a history and physical examination, including a pelvic exam. If fibroids are suspected, an ultrasound or MRI can be administered to visualize the growth while estimating its size and location. Other imaging can also be done, such as a hysteroscopy, where a thin, flexible tube with a camera is inserted into the uterus, or a hysterosalpingography.  

Treatment options depend on how large the fibroid is and how bothersome the symptoms are (if there are symptoms, not every PID patient has them). If symptoms are non-existent or tolerable, watchful waiting is recommended, where symptoms can be monitored, and treatment can begin as needed. For those with more significant or intolerable symptoms, options can include medication like hormonal treatments to help with any irregular periods or NSAIDs to help manage pain. In some cases, there are surgical options like a myomectomy, where the fibroids themselves are removed, or a hysterectomy, where the uterus and the fibroids are removed.  

The Importance of Engaging in Open Discussions About Female Reproductive Health

Knowledge is power. By breaking down the barriers that prevent candid discussions about reproductive conditions like PCOS, endometriosis, pelvic inflammatory disease, and uterine fibroids, we can pave the way for better health outcomes and improved quality of life for patients. We encourage you to seek out information, ask questions, and speak with other practitioners and patients. Let’s continue to explore, learn, and share, ensuring that reproductive health becomes a topic of awareness as well as the proactive management and celebration of our bodies.

About the Author

Kelsey LaFayette, DNP, ARNP, FNP-C, Nursing Content Manager at Osmosis from Elsevier, obtained a Bachelor of Arts in Nursing degree from Luther College in 2011. As an RN, she has a clinical background in medical and pulmonary inpatient units, urgent care, and critical care, and obtained her Doctor of Nursing Practice degree at the University of Illinois at Chicago in 2022. Throughout her career, Kelsey has had many opportunities to function in an education role by being a charge nurse, preceptor to new RNs and nursing students, as well as a Clinical Team Lead in charge of creating orientation programs and policies. Through these opportunities, Kelsey realized her ideal career path should focus on the education of nurses, nursing students, patients, families, and anyone else with a desire to learn. Kelsey serves as a manager on the Nursing Content team and has been able to work on various projects that fulfill her love of perpetual learning.

Reviewer

Lisa Miklush, PhD, RN, CNS, Senior Content Editor

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