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PoM II - Final Exam > 03. Menstruation > Flashcards

03. Menstruation Flashcards

1
Q

Two general phases of Menstrual & Ovulatory Cycles

A

Follicular phase & Luteal phase

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2
Q

Hormone surges during Follicular Phase (in order)

A

FSH & LH (minor surge); Estrogen surge; LH surge; FSH surge

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3
Q

Hormone surges during Luteal Phase (in order)

A

Progesterone (major) & Estrogen (minor surge)

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4
Q

Follicular Phase Characteristics

A

Begins at onset of menses; Ovarian follicle recruitment & maturation; Ends with pre-ovulatory surge of LH stimulating ovulation (24-36 hr at end)

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5
Q

Luteal Phase Characteristics

A

Begins with ovulation; Ends at onset of menses; Endometrium thickens in preparation for pregnancy; Ends in pregnancy or luteolysis

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6
Q

Estimated blood loss during menses

A

~30 cc

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7
Q

Excessive blood loss during menses

A

~80 cc

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8
Q

Period of heaviest blood loss during menses

A

First 2 days

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9
Q

FSH effects

A

Causes 15-20 eggs to begin maturing in each ovary; Follicles produce estrogen

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10
Q

Estrogen effects

A

Released by maturing follicles; when threshold is reached, follicle is mature and triggers LH surge

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11
Q

LH Effects

A

Triggered by high estrogen levels; Causes egg to burst from follicle; Stimulates ovary to produce progesterone after ovulation. Also stimulates follicles to produce androgens, which are converted to estrogen

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12
Q

Progesterone Effects

A

Produced by corpus luteum; Prevents release of all other eggs for that cycle; Causes thickening of endometrium & sustains life until corpus luteum distintegrates (12-16 days later); Causes changes in 3 fertility signs

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13
Q

What are the 3 fertility signs?

A

Change in temperature, cervical fluid, and cervical position

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14
Q

3 Major Components that Regulate the Menstrual Cycle

A

Hypothalamic/Pituitary Axis; Ovaries; Endometrium/Uterus

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15
Q

5 Small Peptides/Amines From Hypothalamus that affect Reproductive Cycle

A

GnRH; TRH; SRIF; CRF; PIF (Prolactin release-inhibitin factor)

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16
Q

GnRH Effects

A

Pulsatile release from hypothalamus; Increased during follicular phase; Decreased during luteal phase; Pulses q90min; To the ANTERIOR PITUITARY via portal circulation;

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17
Q

Negative Estrogen Feedback Mechanism

A

During early follicular phases, estrogen levels low

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18
Q

Positive Estrogen Feedback Mechanism

A

High concentrations at end of follicular phase trigger FSH & LH, which trigger increased estrogen release; Ensuring LH surge triggers ovulation

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19
Q

Follicle count of 20 week fetus

A

6 million

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20
Q

Follicle count of newborn

A

600,000

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21
Q

Follicle count at menarche

A

300,000

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22
Q

Follicle count at menopause

A

10,000

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23
Q

FSH & LH negative feedback

A

High levels of estrogen and progesterone during luteal phase suppress FSH & LH

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24
Q

What is the time span between the LH surge and ovulation?

A

24-36 hr

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25
Q

Days 1-4 of menstrual cycle

A

“Bleeding phase”; Estradiol & progesterone levels low; FSH begins to rise; LH begins rising days after FSH starts rising

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26
Q

Causes of uterine sx during menstruation

A

Corpus luteum involutes; Prog & est fall rapidly; Prostaglandins increase in myometrium to stimulate contraction

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27
Q

Days 4-14 of menstrual cycle

A

Follicular phase; Estradiol increases & peaks just before LH surge & ovulation; Progesterone stays low; FSH peak mid-cycle with LH, but in lesser surge; LH rapidly peaks mid-cycle & triggers ovulation

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28
Q

Day 12-14

A

Ovulation; mid-cycle between follicular & luteal phases

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29
Q

Uterine changes during luteal (secretory) phase

A

Progesterone stimulates glands to secrete mucus & glycogen; Glands become tortuous & dilated; Convoluted spiral arteries extend to superficial layer of endometrium;

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30
Q

Corpus luteum

A

Forms from the granulosa cells of the ruptured follicle; maintains pregnancy until placental progesterone production is adequate

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31
Q

What happens to the corpus luteum if pregnancy doesn’t occur?

A

It degenerates intoa corpus albicans, which causes regression of progesterone and estradiol levels.

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32
Q

Estrone

A

Hormone secreted by ovary & adrenal glands; converted to estrogen in peripheral fat to maintain vaginal tissue, minimize hot flashes/night sweats/mood swings

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33
Q

Which hormone remains elevated if pregnancy occurs?

A

Progesterone

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34
Q

What are negative effects of high prolactin levels?

A

Interfere with FSH/LH and may cause anovulation. This is why people think they can’t get pregnant while breast feeding.

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35
Q

How can hyperthyroidism cause infertility?

A

High TSH levels stimulate Prolactin production. High prolactin levels lead to anovulation, which results in infertility.

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36
Q

How can adrenal dysfunction lead to infertility?

A

High ACTH inhibits FSH & stimulates androgen production. In combo, this inhibits ovulation.

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37
Q

What hormonal dysfunctions occur in PCOS?

A

Ovary doesnﾒt make all hormones needed for fully mature egg. Follicles start to grow but ovulation doesn’t occur because ovaries make androgens instead. Progesterone isn’t made, which results in irregular or absent menstrual cycle.

38
Q

Functional zones of endometrium

A

Functionalis (outer); Basalis (inner)

39
Q

Functionalis

A

Outer portion of endometrium; Undergoes cyclic changes during menstrual cycle; Sloughed off with menstruation

40
Q

Basalis

A

Inner portion of endometrium; relatively UNCHANGED during cycle; Provides stem cells and blood supply for renewal of functionalis

41
Q

Endometrium - Menstrual phase

A

Day 1-4. Disruption & disintegration of endometrial gland & stroma; Leukocyte infiltration; RBC extravasation

42
Q

Endometrium - Proliferative phase

A

Days 5-14. Endometrial growth secondary to estrogen surge. High estrogen causes proliferation of epithelial lining, endometrial gland, and connective tissue of stroma

43
Q

Endometrium - Secretory phase

A

Days 15-28. Lining becomes stable & ready for implantation. Progesterone stimulates secretion of glycogen & mucus. Glands & vessels become tortuous. Lumens dilate and fill.

44
Q

Premenstrual syndrome

A

Cyclic recurrence of physical, psychological and behavioral changes that cause distress and interfere with normal ADLs or relationships

45
Q

APA diagnostic criteria for PMS

A

Must have one or more of the following: Affect lability (mood swings); Persistant/marked anger/irritability; Marked anxiety/tension; Markedly depressed/hopeless; AND
Must have a total of 5 symptoms (not all listed)

46
Q

Dietary mods that may help PMS

A

Increase protein. Decrease carbs & salt. Limit caffeine & EtOH. Eat 4-6 small meals/day.

47
Q

PMS pharmacologic tx

A

Serotonins (SSRIs) - Fluoxetine (Prozac) and Venlafaxine (Effexor)

48
Q

Primary dysmenorrhea

A

Painful menstruation without associated pelvic disease; Caused by increased PG release from endometrial cells at time of menstruation. This causes uterine contractions, pressure, and some degree of ischemia. Lasts 12-72 hr.

49
Q

Primary dysmenorrhea tx

A

NSAIDs- inhibition of PG production. Ibuprofen, naproxen, and ketoprofen preferred. Hormonal contraceptives 2nd line.

50
Q

Secondary Dysmenorrhea

A

Pelvic pain present at non-menstruating times d/t identifiable pelvic pathology; unrelated to actual onset of menses each month; May or may not have normal pelvic exam.

51
Q

Causes of Secondary Dysmenorrhea

A

Chronic PID; Endometriosis; Adhesions; Mullerian duct abnormalities; Adenomyosis; IUD; Tumor

52
Q

What is endometriosis?

A

Presence of endometrial-like cells appearing and flourishing outside the uterine cavity. Influenced and respond to hormonal changes. Worsens with menstrual cycle.

53
Q

What are common sites of endometriosis?

A

Ovaries (MC); Posterior cul-de-sace; Anterior cul-de-sac; Uterosacral ligaments; Broad ligament

54
Q

Dyschezia

A

Constipation d/t defective defecation reflex; sign of endometriosis

55
Q

Definitive endometriosis diagnosis

A

Requires direct visualization of endometriotic lesions via laparoscopy, laparotomy, or tissue bx.

56
Q

Endometriosis Pathophysiology/Etiology

A

Retrograde menstruation;
Peritoneal coelomic metaplasia (metaplastic tissue assumes characteristics of endometrial tissue);
Hematogenous/lymphatic spread (Spread by vascular and lymphatic pathways to various structures)

57
Q

Chocolate cysts

A

Invasive endometriotic lesions on the ovary filled with chocolate-colored blood. Can cause extensive pelvic adhesions, esp. peri-ovarian

58
Q

Endometriosis Tx - Medical

A 
Estrogen-progestin OCPs (inhibit ovulation)
Mini-pills (suppress endometrial stimulation)
Danazol ("anti-estrogen" to suppress endometrial growth)
GnRH AGONISTS (MOST DEFINITIVE MEDICAL MANAGEMENT; RESULTS IN MEDICAL MENOPAUSE!!! Eliminates ovarian estrogen)
59
Q

Endometriosis Tx - Surgical

A

Destruction of endometrial lesions; lysis of adhesions; Uterosacral ligament ablation or presacral neurectomy (relieve pelvic pain)

60
Q

Oligomenorrhea

A

Infrequent, irregular bleeding with intervals >40 days

61
Q

Polymenorrhea

A

Frequent, regular bleeding with intervals

62
Q

Hypomenorrhea

A

Regular bleeding that is very light

63
Q

Cryptomenorrhea

A

Outflow obstruction

64
Q

Menorrhagia (hypermenorrhea)

A

Excessive amount or duration with regular intervals

65
Q

Metrorrhagia

A

Regular periods with intermenstrual bleeding

66
Q

Menometrorrhagia

A

Heavy periods with intermenstrual bleeding

67
Q

2 Basic Etiologies of Abnormal Uterine Bleeding

A

Anatomic & Hormonal

68
Q

Anatomic causes of abnormal uterine bleeding

A

Uterine fibroids; Adenomyosis; Uterineor cervical polyps

69
Q

4 Main Categories of Abnormal Bleeding d/t Hormonal Dysorder

A

Estrogen withdrawal bleeding (Mid-cycle spotting)
Estrogen breakthrough bleeding (Missed menses followed by heavy bleeding x 10d)
Progesterone withdrawal bleeding (menstrual bleeding)
Progesterone breakthrough bleeding (Atrophic endometrium)

70
Q

DUB

A

Dysfunctional uterine bleeding; No longer a recommended term. Considered abnormal uterine bleeding in absence of an anatomic lesion)

71
Q

AUB

A

Abnormal uterine bleeding; Newer, preferred term. Replaces DUB.

72
Q

Most common times of DUB presentation

A

Shortly after menarche; Perimenopause

73
Q

Physical exam findings of DUB

A

No significant findings; R/O pregnancy, systemic dz, and obvious pathology.

74
Q

When performing a work up for a patient presenting with DUB, which imaging technique should be used?

A

Pelvic or trans-vaginal U/S

75
Q

What are the five general categories causing DUB?

A

Endocrine d/o; Structural lesions; Infections; Medications; Pregnancy

76
Q

3 Goals of DUB Tx

A

Prevent endometrial hyperplasia/CA; Treat/prevent anemia; Restore quality of life

77
Q

Progesterone Challenge & DUB

A

Give the progesterone missing due to lack of ovulation; Medroxyprogesterone acetate 10mg x 10 d, or Micronized progesterone 200mg x 10d; or progesterone 100mg IM. This is diagnostic & therapeutic if patient has withdrawal bleeding; reboots menstrual cycle.

78
Q

Advantages of Progesterone Tx of DUB

A

CAN beused in women who CANNOT take OCPs; Manages bleeding; Treats endometrial hyperplasia; Inexpensive; DepoMPA for contraception or menorrhagia (3-12 months to work)

79
Q

Disadvantages of Progesterone Tx of DUB

A

MPA 10mg x 10d; or Micronized progesterone 200 mg x 10d; or Progesterone 100mg IM have no protection against ovarian CA, may not help dysmenorrhea; offerno contraceptive protection

80
Q

High-dose Estrogen to Tx DUB

A

Stops bleeding but does not treat underlying cause; induces endometrial growth, stimulates productino of progesterone receptors; allows progestin to differentiate endometrium

81
Q

Recommended high-dose estrogen for DUB Tx

A

OCP qid x 5 d and/or followed by 1 QD for a total of 21 days

82
Q

AUB vs DUB

A

AUB (bleeding differs in quantity or timing from natural cycle; d/t various causes). DUB (related to hormonal changes directly affecting menstrual cycle; NL menstruation disrupted due to anovulation; UNRELATED TO ANOTHER ILLNESS)

83
Q

Amenorrhea Adverse Effects

A

Infertility, osteoporosis

84
Q

Primary Amenorrhea

A

No period by age 14 AND no growth or development of secondary sex characteristics; OR
No period by age 16 regardless of secondary sex traits

85
Q

Secondary Amenorrhea

A

Cessation of regular menstruation for >3 cycle intervals or >6 months total.

86
Q

MCC of Secondary Amenorrhea

A

Pregnancy

87
Q

Classifications of Amenorrhea

A

1) Primary/Secondary; or 2) Axes

88
Q

4 Axes of Amenorrhea

A

Disorders of outflow tract; Disorders of ovaries; Disorders of anterior pituitary; Disorders of CNS/Hypothalamus

89
Q

Functional hypothalamic amenorrhea

A

Common in female athletes

90
Q

Functional hypothalamic amenorrhea tx

A

Weight restoration through nutrition rehab and decreased exercise; OCPs do NOT improve bone density, and shouldn’t be used soley for this purpose

PoM II - Final Exam (12 decks)

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