5. Menstrual Cycle and Menstrual Disorders Flashcards

1
Q

Relationships between ovarian and uterine changes during the MC

A

Slide 5

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2
Q

Phases of endometrial cycle?

A

Menstrual, proliferative, secretory

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3
Q

Uterine changes during 1. menstrual phase of MC?

A

Day 1= First day of menstrual flow
Duration =3-5days
Epithelial lining of uterus (endometrium) degenerates
Part of ovarian follicular phase

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4
Q

Uterine changes during 2. proliferative phase of MC?

A

Menstrual flow ceases
Under influence of oestrogen, the endometrium thickens. The growth of the underlying smooth muscle (myometrium) also occurs.
Synthesis of receptors for progesterone in endometrium cells
Lasts for about 10days until ovulation
Still apart of ovarian follicular phase

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5
Q

Features of proliferative phase of MC

A
  • Repair of lining epithelium acer menstruation
  • Proliferation and thickening of stroma
  • Simple test tube shaped glands
  • Induction of synthesis of intracellular receptors for progesterone (i.e. it primes the uterus for later progesterone secre:on)
  • Contractility and excitability of the myometrium increases
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6
Q

The prolifera:ve phase of the uterine cycle is simultaneous with the ______ ____ of the ovarian cycle
Is dominated by ______

A

The prolifera:ve phase of the uterine cycle is simultaneous with the follicular phase of the ovarian cycle
Is dominated by estradiol 17β

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7
Q

Uterine changes during 3. secretory phase of MC?

A

Begins soon after ovulatiojn
Endometrium increases secretory activity under influence of progesterone. Acting on oestrogen primed tissue

Endometrial glands changes:

  • Become coiled and fill with glycogen
  • Blood vessels become more numerous
  • Enzymes accumulare in glands and connective tissue

Coincides with ovarian luteal phase

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8
Q

The secretory phase of the uterine cycle is simultaneous with the _____ phase of ovarian cycle
Dominated by _________

A

The secretory phase of the uterine cycle is simultaneous with the luteal phase of ovarian cycle
Dominated by Progesterone

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9
Q

Features of secretory phase?

A

• Proliferation/thickening of stroma
• Spiral arteries develop alongside complex,
hacksaw shaped glands
• Secretion in the glands is rich in glycoprotein sugars and amino acids
• Enlargement of myometrial cells but depressed overall excitability

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10
Q

What are the events to the endometrium that occur during the ischaemic phase? (i.e. loss of steroid support from follicle)

A

Between secretory and menstrual phases.

Constriction of spiral arteries
Ischemia and collapse of endometrium
Separation of basal and functional layers
Functional layer is shed as menstrual bleeding
Increase in neutrophils

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11
Q

Volume of menstruation

A

30-80mls

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12
Q

What is dysmenorrhoea?

A

Painful contraction during menstruation

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13
Q

the bleeding is due to…

A

Endogenous fibrinolytic activity

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14
Q

Menstrual cycle major events days 1-5

A

Oestrogen and progesterone levels low because the previous CL is regressing
Therefore:
-Endometrial lining sloughs
-Secretion of FSH and LH is released from inhibition and their plasma cones increase
–> Several growing follicles are stimulated to mature

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15
Q

Menstrual cycle major events day 7

A

A single follicle becomes dominant

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16
Q

Menstrual cycle major events days 7-12

A

Plasma oestrogen increases because of secretion by the dominant follicle
–>Endometrium is stimulated to proliferate

LH and FSH decrease due to oestrogen and inhibin negative feedback
–> Degeneration of non-dominant follicles occurs

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17
Q

Menstrual cycle major events days 12-13

A

LH surge by increasing plasma oestrogen

  • -> Oocyte is induced to complete its first meiotic division and undergo cytoplasmic maturation
  • ->Follicle is stimulates to secrete digestive enzymes and prostaglandins
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18
Q

Menstrual cycle major events day 14

A

Ovulation is mediated by follicular enzymes and prostaglandins

19
Q

Menstrual cycle major events days 15-25

A

CL forms and under influence of LH (Levels low but adequate) secretes oestrogen and progesterone
–> Secretory endometrium develops
–>Secretion of FSH and LH is inhibited, lowering their plasma concentration
Hence no new follicles develop

20
Q

Menstrual cycle major events days 25-28

A
CL degenerates (if implantation of the conceptus does not occur)
--> Plasma conc of oestrogen and progesterone decrease
Results in endometrium sloughs at day 28 and a new cycle begins
21
Q
Menstrual disorder terminology:
•  Meno?
•  Oligomenorrhoea ?
•  Metrorrhagia?
•  Dysmenorrhoea?
•  Polymenorrhoea?
•  Amenorrhoea?
A
  • Meno – menstruation
  • Oligomenorrhoea - infrequent light periods
  • Metrorrhagia - irregular bleeding
  • Dysmenorrhoea - painful periods
  • Polymenorrhoea – frequent periods
  • Amenorrhoea - no periods
22
Q

Main cause of dysmenorrhoea?

A

Oveproduction of prostaglandins produced by endometrium in response to decrease in plasma oestrogen and progesterone
Leads to excessive uterine contraction

23
Q

Why are there associated systemic effects with cramps?

A

Prostaglandins can affect smooth muscle elsewhere and may account form some of the systemic symptoms that sometimes accompany cramps eg nausea, vomiting, headache.

24
Q

What is PMS?

A

Prementrual syndrome

25
Q

What is PMDD?

A

Prementrual Dysphoric disorder
Order in 3-8%
E.g. anxiety, mood swings, depression, irritability

26
Q

Reasons for PMS and PMDD?

A

Progesterone has anxiolytic effect. Therefore may be due to falling progesterone levels at the end of the cycle.

27
Q

Primary and secondary causes for amenorrhoea?

A

Primary:

  • Anatomical/congenital abnormality e.g. underdevelopment or absnse of uterus/vagina
  • Genetic e.g. Turner’s syndrome

Secondary:

  • Pregnancy
  • Lactation
  • Exercise/nutrition
  • Menopause
  • Polycystic ovarian syndrome
  • Latrogenic
28
Q

Effects of amenorrhoea

A

Oestrogen deficiency symptoms:

  • Hot flushes
  • Vaginal dryness

Loss of bone mineralisation

  • Reduction in peak bone mass attained
  • Osteopenia/osteoporosis
29
Q

What is lactational amenorrhoea?

A

No periods when breast feeding

30
Q

Characteristics of polycystic ovary syndrome?

A
Hyperandrogenemia
Oligomenorrhea
Obesity
Hirsutism (hairiness)
Infertility
Enlarged cystic ovaries
31
Q

What is polycystic ovary syndrome (PCOS)?

A

Normal variation in ovarian morphology with multiple peripheral cysts

32
Q

Biochemical effects of PCOS?

A

Elevated oestrogen from peripheral aromatase
Elevated free testosterone
Insulin resistance
Elevated anti mullein hormone

33
Q

PCOS therapy?

A

– Weight control: difficult but effec:ve
– Cycle regulation e.g. oral contraceptive pill
– Anti androgen therapy e.g. cyproterone acetate
– Cosmetic hair removal
– Ovulation induction

34
Q

Where is prolactin secreted from?

A

Anterior pituitary gland

35
Q

Control of prolactin secretion?

A

Hypothalamic prolactin inhibitory factor (PIF)

  • Shown to be dopamine
  • Stress inhibits dopamine release which allows prolactin levels to rise
36
Q

Role of dopamine as a PIF

A

Dopamine is carried from neurosecretory cells in the arcuate nucleus via the hypophyseal portal system to the anterior lobe of the pituitary where it modulates the secretion of prolactin

37
Q

Consequences on hyperprolactinaemia?

A

Inhibit FSH and LH leading to the secondary amenorrhea

Inappropriate lactation, libido loss

38
Q

Something that can constrict the blood supply to pituitary, hence interfering with prolactin control?

A

Pituitary tumour
or
Tumours affecting the population of cells secreting prolactin are prolactinomas – these secrete excessive prolactin

39
Q

Treatment of prolactinomas

A

Dopamine agonist BROMOCRIPTINE or CABERGOLINE to both relieve amenorrhoea and shrink the tumour.

40
Q

What is menopause

A

The exhaustion of primordial follicles

Lack of follicular development leads to low oestrogen and elevated FSH owing to lack of negative feedback

41
Q

What is POF?
Causes?
Treatment?

A
Premature ovarian failure
Menopause can occur in women under 40
Due to:
-Idiopathic
-Auto immune disease
-Genetic disorders such as fragile X
-Chemo
-Radiation 

Treatment: Oestrogen replacement (HRT)

42
Q

What is the cause for the menarche occurring?

A

Maturation of GnRH pulsatility so primarily hypothalamic

43
Q

What is the female athlete triad?

A

when the energy availability is low

  • -> Osteoporosis
  • -> Functional hypothalamic amenorrhea