2 - Reproductive Physiology Flashcards
Heavy menses occurring in the context of ovulatory cycles with no other etiology is most likely caused by what?
- Endometrial pathology
* diagnoses of exclusion
What is the difference between menorrhagia and metrorrhagia?
- menorrhagia = excessive flow/duration
- metrorrhagia = irregular intervals
If a childbearing age patient presents with acute abnormal bleeding they need to be ruled out for what?
- ectopic pregnancy
Ovulation follows the LH surge by how many hours?
24-36 hr
A surge in this hormone causes oocyte in the dominant follicle to complete the first meiotic division (ovulation).
- Luteinizing hormone (LH)
What non surgical treatment option for fibroids is available for patients of non child-bearing age?
- uterine artery embolization
Why can’t you diagnose PCOS within 2 years of menarche in adolescents?
- menstrual irregularities during adolescents are common and cycles are frequently anovulatory
A peak in this hormone leads to the LH surge causing ovulation.
- Estradiol (E2)
What is the ultrasound diagnostic criteria for PCOS?
- > 12 follicles 2-9mm in diameter
- ovarian volume > 10 ml
*need only 1 ovary for diagnosis
Anovulation is defined as an absence of bleeding for greater than how many months?
2 months
What is the medical treatment for hyperprolactinemia?
- dopamine agonists (e.g. bromocriptine, cabergoline)
Which of the following is the most common location for fibroids?
a. subserosal (in serosa)
b. intramural (within uterine wall)
c. submucosal (in endometrial cavity)
b. intramural
What is on the differential for abnormal menstrual bleeding? (hint: PALM-COEIN)
- Polyp
- Adenomyosis
- Leiomyoma
- Malignancy
- Coagulopathy
- Ovulatory Dysfx
- Endometrial
- Iatrogenic
- Not yet classified
What type of hyperplasia has the highest risk of malignant transformation?
a. simple
b. complex
c. atypical
atypical
For adenomyosis:
- what is the main symptom?
- what is the main diagnostic method?
- what is the main treatment?
- pelvic pain
- biopsy
- go through menopause or hysterectomy
What hormone induces the production of ovarian androgens and progesterone?
- Luteinizing hormone (LH)
What test is used to diagnose diabetes in patients with PCOS? What do the results mean?
- oral glucose tolerance test (75 gm)
- <140 = negative
- 140-199 = intolerant
- > 200 = diabetic
How is estrogen breakthrough bleeding treated?
- give progesterone
What time of day do you want to check prolactin levels?
- early morning
What hormone is used as a marker of ovarian health and aging?
- Anti-mullerian hormone
How is hirsutism secondary to PCOS best treated?
- OCs or anti-androgens (spironolactone)
What drug is well known to cause elevated prolactin levels?
- respiradone
What is the most common diagnosis for a hysterectomy?
- Leiomyomas (Fibroids)
How can excessive exercise result in anovulation?
- excessive exercise can decrease GnRH secretion
Depo-povera (progesterone>estrogen) can result in which of the following:
a. estrogen withdrawal bleeding
b. estrogen breakthrough bleeding
c. progesterone withdrawal bleeding
d. progesterone breakthrough bleeding
d. progesterone breakthrough bleeding
Normal ovulation occurs in which of the following:
a. estrogen withdrawal bleeding
b. estrogen breakthrough bleeding
c. progesterone withdrawal bleeding
d. progesterone breakthrough bleeding
c. progesterone withdrawal bleeding
When does the folllicular phase begin and end?
- begins at cycle day 1 and ends with LH surge
What are the 3 main characteristics of prolactinomas?
- galactorrhea
- amenorrhea/oligomenorrhea
- visual field defects
How is primary amenorrhea defined?
- no menses by 16 years
What is the most common solid pelvic tumors in women?
- Leiomyomas (Fibroids)
What causes oligomenorrhea and a hypoestrogenic state in patients with prolactinoma?
- prolactin suppresses GnRH secretion which suppress LH/FSH
What is the surgical treatment of hyperprolactinemia?
- transphenoidal resection
What is the most common cause of anovulation?
Polycystic ovarian syndrome (PCOS)
In adolescents within 2 years of menarche how should you treat suspected PCOS?
- treat individual manifestations
e. g. obesity, hirsutism, irregular menses
Polycystic ovarian syndrome (PCOS) is defined by these 3 findings.
- hyperandrogenism (hirsutism)
- ovulatory dysfunction (amenorrhea/ oligomenorrhea)
- polycystic ovaries
A hysterectomy for treatment of fibroids should only be performed after a patient has completed this stage in her life.
- child bearing stage
When does the luteal/secretory phase begin and end?
- begins with LH surge
- ends with onset of menses
How is the first day of menses defined?
- first day of previous period (not the last day)
What hormone increases the production of estrogen?
- Follicle stimulating hormone (FSH)
What surgical treatment is available for patients with fibroids who desire an option for future fertility?
- myomectomy (resection of fibroids by laparotomy/laparoscopy)
- pt will need C-section for delivery after this procedure
What is the most common gynecologic malignancy in women in the USA?
- Carcinoma
Hyperplasia results from an unopposed increase in this hormone.
- estrogen
ACOG now recommends testing for vWD in these 2 situations:
- adolescents with severe menorrhagia before hormonal treatment
- adult women with undiagnosed cause of menorrhagia
What is the main difference between menstruation in adults and adolescents?
- adolescent = occurs from negative feedback (E2/FSH cycling)
- adults = occurs from positive feedback (LH surge)
How is progesterone breakthrough bleeding (Depo-provera) treated?
- add estrogen or progestin that is testosterone derivative
Menses ensues when the corpus luteum stops making this hormone.
- progesterone
What is the most common bleeding disorder causing heavy menstrual bleeding?
- Von Willebrand’s disease
What is the hallmark sign of insulin resistance in patients with PICO?
- acanthosis nigricans
