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3002 > 80 Menstrual cycle and menstrual disorders > Flashcards

80 Menstrual cycle and menstrual disorders Flashcards

1
Q

What occurs in a menstrual cycle?

A

• In each cycle, the uterus prepares for gamete transport and implantation
In absence of implantation the tissues regress and the cycle repeats

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2
Q

How long is each menstrual cycle and how many years does it last for?

A
  • Mean 28 days

* For ~ 40 years

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3
Q

When does menarche occur?

A
  • Occurs towards end of puberty and marks the beginning of potential fertility
  • Maturation of GnRH pulsatility so primarily hypothalamic
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4
Q

When does menopause occur?

A
  • Occurs at 51 years
  • Marks the end of natural fertility
  • Exhaustion of primordial follicles so primarily ovarian
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5
Q

What is the difference between most mammals and human females in regards to being sexually receptive?

A
  • Most mammals show oestrus behaviour at the time of ovulation when females become sexually receptive to males (‘on heat’)
  • Human females are sexually receptive throughout their cycles; menstruation is only obvious sign of a woman’s reproductive state and this is not related to the timing of ovulation
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6
Q

Relationships between ovarian and uterine changes during the MC

A

Slide 5

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7
Q

Uterine phases of the endometrial cycle?

A
  1. Menstrual: Day 1-5 (ovarian phase - follicular)
  2. Proliferative: Day 5-15 (ovarian phase - follicular)
  3. Secretory: Day 15-28 (ovarian phase - luteal)

(Ischaemic phase)

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8
Q

What occurs in uterus in menstrual phase?

A 
• Day 1 = first day of menstrual flow
• Duration ≈ 3-5 days
(in typical 28 day cycle)
• Epithelial lining of uterus (endometrium) degenerates.
• Is part of ovarian follicular phase
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9
Q

What occurs in uterus in proliferative phase?

A

• Menstrual flow ceases
• Under influence of oestrogen, endometrium
thickens
– Growth of underlying smooth muscle (myometrium) also occurs
• Synthesis of receptors for progesterone in endometrial cells also occurs
• Lasts for ~10 days until ovulation
• Is part of ovarian follicular phase

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10
Q

Histology and features of proliferative phase?

A

• Dominated by estradiol 17β

  • Repair of lining epithelium after 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 secretion)
  • Contractility and excitability of the myometrium increases
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11
Q

What occurs in the uterus in secretory phase?

A

• Begins soon after ovulation
• Endometrium increases secretory activity under influence
of progesterone
– acting on the oestrogen-primed tissue
• Endometrial glands:
– become coiled, filled with glycogen, blood vessels become more numerous, enzymes accumulate in glands and connective tissue
– All to make endometrium hospital environment for implantation and nourishment of developing embryo

• Coincides with ovarian luteal phase

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12
Q

Histology and features of secretory phase?

A

• Dominated by Progesterone
• 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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13
Q

Histology and features of ischaemic phase (loss of steroid support)?

A
  • Constriction of spiral arteries
  • Ischaemia and collapse of endometrium
  • Seperation of basal and functional layers
  • Functional layer is shed as menstrual bleeding
  • Increase in neutrophils
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14
Q

Histology and features of menstrual phase?

A
  • Repeats 28 days
  • ~40 years/ 450 cycles in well nourished women
  • 2-7 days
  • Bleeding without clotting: endogenous fibrinolytic activity
  • 30-80mls
  • Dysmenorrhoea - painful contractions (155 seek analgesia)
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15
Q

Menstrual cycle major events: Days 1-5?

A

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

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16
Q

Menstrual cycle major events: Day 7?

A

A single follicle becomes dominant

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17
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 + FSH decrease due to oestrogen and inhibin -ve feedback
–-> Degeneration (atresia) of non-dominant follicles occurs

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18
Q

Menstrual cycle major events: Days 12-13?

A

• LH surge is induced by increasing plasma oestrogen
–-> Oocyte is induced to complete its 1st meiotic division and undergo cytoplasmic maturation
–-> Follicle is stimulated to secrete digestive enzymes and prostaglandins

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19
Q

Menstrual cycle major events: Day 14?

A

Ovulation is mediated by follicular enzyme and prostaglandins

20
Q

Menstrual cycle major events: Days 15-25?

A

• Corpus luteum forms and under the influence of low but adequate levels of LH, secretes oestrogen and progesterone, increasing their plasma concs.
––> Secretory endometrium develops
––> Secretion of FSH + LH is inhibited, lowering their plasma concs.
––> No new follicles develop

21
Q

Menstrual cycle major events: Days 25-28?

A

• Corpus luteum degenerates (if implantation of the conceptus doesn’t occur)
––> Plasma oestrogen and progesterone concs. decrease
––> Endometrium beings to slough at conclusion of day 28, and a new cycle begins

22
Q

What uterine phase is penetrable by sperm?

A
  • Proliferative phase - oestrogen causes the cervical mucus to be readily penetrable by sperm
  • (Secretory phase - progesterone makes the cervical mucus relatively impenetrable to sperm)
23
Q 
Menstrual disorder terminology?
• Meno -
•  Oligomenorrhoea
• Metrorrhagia
• Dysmenorrhoea
• Polymenorrhoea
• Amenorrhoea
A
  • Meno - menstruation
  • Oligomenorrhoea - infrequent light periods
  • Metrorrhagia - irregular periods
  • Dysmenorrhoea - painful periods
  • Polymenorrhoea - frequent periods
  • Amenorrhoea - no periods
24
Q

Main cause of dysmenorrhoea (menstrual cramps)?

A
  • Overproduction of prostaglandins produced by endometrium in response to decrease in plasma oestrogen and progesterone
  • Leads to excessive uterine contractions
25
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

26
Q

What is PMS?

A

Premenstrual Syndrome

27
Q

What is PMDD?

A
  • Premenstrual dysphoric disorder
  • 3-8%
  • Causes: anxiety, mood swings, tiredness, irritability, depression, a loss in confidence, clumsiness, headaches, feeling bloated, a change in appetite, joint pain, tender enlarged breasts, abdominal pain
28
Q

Reasons for PMS and PMDD?

A
  • Progesterone has anxiolytic effect

* May be due to falling progesterone levels at the end of the cycle

29
Q

Primary and secondary causes of amenorrhoea (no periods)?

A
  1. Primary
    • Anatomical/ congenital abnormality e.g. underdevelopment or absence of uterus/vagina
    • Genetic e.g. Turner’s syndrome
2. Secondary
• Pregnancy
• Lactation
• Exercise/ Nutrition
• Menopause
• Polycystic Ovarian Syndrome
• Iatrogenic (surgery, medication)
30
Q

Effects of amenorrhoea

A
  1. Ostrogen deficiency symptoms
    • Hot flushes (flashes)
    • Vaginal dryness
  2. Loss of bone mineralisation
    • Reduction in peak bone mass attained
    • Osteopenia/ osteoporosis
31
Q

What is the female athlete triad?

A
  • Exercise
  • Nutrition
  • Amenorrhoea
32
Q

What is lactational amenorrhoea?

A

Women who breast feed ‘naturally’ (feeding ad lib and with baby sleeping with mother and feeding through the night) may experience lactational amenorrhoea which decreases likelihood of pregnancy until weaning occurs

33
Q

Characteristics of polycystic ovary syndrome?

A

• ~10% of reproductive age women (most common reproductive problem)

  • Hyperandrogenemia
  • Oligomenorrhea
  • Obesity
  • Hirsutism
  • Infertility
  • Enlarge cystic ovaries
34
Q

What is polycystic ovary syndrome (PCOS)?

A

• Normal variation in ovarian morphology – Multiple peripheral follicular cysts <5 mm
• Clinical spectrum can include none or all of:
– Secondary amenorrhoea / oligomenorrhoea – Subfertility anovulatory cycles
– Obesity
– Hairiness (hirsuitism) and acne

35
Q

Biochemical spectrum of PCOS?

A
  • Elevated oestrogen from peripheral aromatase, or low from anovulation
  • Elevated free testosterone
  • Insulin resistance
  • Elevated anti Müllerian hormone
36
Q

PCOS therapy?

A

Directed to relevant part of clinical spectrum
• Weight control
• Cycle regulation e.g. oral contraceptive pill
• Anti androgen therapy e.g. cyproterone acetate
• Cosmetic hair removal
• Ovulation induction

37
Q

Where is prolactin secreted from?

A

Normally synthesised and released from anterior pituitary gland

38
Q

Control of prolactin secretion?

A

• Controlled by hypothalamic prolactin inhibitory factor (PIF)
– PIF is shown to be dopamine
– Stress inhibits dopamine release which allows prolactin levels to rise
• Reaches pituitary via blood supply

39
Q

Role of dopamine as a PIF

A

Dopamine inhibits the release of prolactin from the anterior pituitary

40
Q

Consequences of hyperprolactinaemia?

A

Without PIF, prolactin levels rise causing hyperprolac:naemia
• Inhibit FSH & LH leading to 2° amenorrhea
• Inappropriate lactation, libido loss

41
Q

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

A
  • Pituitary tumours (macroadenoma) may constrict the blood supply to the pituitary
  • Without PIF, prolactin levels rise causing hyperprolac:naemia
42
Q

How to fix pituitary tumours (macro adenoma) that constricts the blood supply to the pituitary?

A

Surgical approach via the nasal cavity and sphenoid air sinus

43
Q

What are prolactinomas and how are they treated?

A

• Tumours affecting the population of cells secreting prolactin - these secrete excessive prolactin
• Treated with dopamine agonist:
1. Bromocriptine
2. Cabergoline
- relieve amenorrhoea and shrink the tumour

44
Q

What is menopause?

A
  • Between 45-55 years (average 51yrs)
  • Exhaustion of primordial follicles
  • Lack of follicular development leads to low oestrogen and elevated FSH owing to lack of -ve feedback
45
Q

What is POF?
• Causes?
• Treatment?

A
  • Premature Ovarian Failure (POF)
  • Menopause can occur in women <40 y (idiopathic, autoimmune disorders, genetic disorders such as Fragile X, chemotherapy, radiation)
  • Symptoms treated with oestrogen replacement (HRT)

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