Block 2 Lecture 1 -- Menstrual Cycle

Question 1

How long does menses last?

Answer 1

3-5 days (2-7 is normal)

Question 2

When is normal onset of menses?

Answer 2

12 yo

Question 3

What is the other name for aromatase?

Answer 3

CYP19

Question 4

What causes the LH surge?

Answer 4

estradiol ≥ 200 pg/mL x 48 hours

Question 5

When does the LH surge occur relative to ovulation?

Answer 5

10-16 hours prior

Question 6

What is the best predictor of ovulation?

Answer 6

LH surge

Question 7

When is [progesterone] greater than [estrogen]?

Answer 7

ONLY during luteal phase of menstrual cycle

Question 8

What is the time period over which the CL degenerates?

Answer 8

9-11 days if no fertilization

Question 9

When is hCG detectable?

Answer 9

6-8 days post-fertilization

Question 10

When does the luteal-placental shift occur?

Answer 10

12 weeks post-fertilization

Question 11

What hormones are produced by the placenta?

Answer 11

progesterone and estriol

Question 12

When is hCG produced?

Answer 12

immediately following blastocyst implantation in the endometrium

Question 13

Describe the structures of FSH and LH.

Answer 13

• • 36kDa heteromeric glycoproteins
• • secreted by AP
• • common alpha, unique beta subunits

Question 14

What is the half-life of FSH?

Answer 14

3-4 h

Question 15

What is the half-life of LH?

Answer 15

20 minutes

Question 16

What is the E# designation for estrone?

Answer 16

E1

Question 17

What is the E# designation for estradiol?

Answer 17

E2

Question 18

What is the E# designation for estriol?

Answer 18

E3

Question 19

What is E1

Answer 19

estrone

Question 20

What is E2

Answer 20

estradiol

Question 21

What is E3

Answer 21

estriol

Question 22

When is E1 most abundant?

Answer 22

estrone most abundant…

– post menopause

Question 23

Where is E1 primarily produced

Answer 23

estrone produced …

– primarily from fat

Question 24

When is E2 most abundant?

Answer 24

estradiol most abundant…

– in repro women

Question 25

When is E3 most abundant?

Answer 25

estriol most abundant... | -- during pregnancy (and only detectable during pregnancy)

Question 26

Where is E2 produced?

Answer 26

ovaries

Question 27

Where is E3 produced?

Answer 27

in placenta from E2 or E1, or from circulating DHEA

Question 28

What is the most abundant steroid in circulation?

Answer 28

DHEA

Question 29

What are the non-menstrual effects of estrogens?

Answer 29

1) secondary sex characteristics 2) increased bone formation 3) improved lipids 4) opposition of aldosterone 5) positive mood 6) neuroprotection 7) softer skin 8) increased liver protein synthesis

Question 30

What is the concentration of progesterone in the follicular phase?

Answer 30

less than 2 ng/mL

Question 31

What is the concentration of progesterone in the luteal phase?

Answer 31

5+ ng/mL (normally 10-15)

Question 32

What is the concentration of progesterone in pregnancy?

Answer 32

100-200 ng/mL

Question 33

What are the progestogens?

Answer 33

1) progesterone | 2) 17-alpha-hydroxyprogesterone

Question 34

Where is progesterone formed?

Answer 34

corpus luteum | adrenals

Question 35

Where is 17-alpha-hydroxyprogesterone formed?

Answer 35

adrenals

Question 36

What is the principle circulating progestogen?

Answer 36

progesterone

Question 37

What is the concnetration of progesterone in the luteal phase?

Answer 37

10-15 ng/mL

Question 38

What is the concentration of 17-alpha-hydroxyprogesterone in the luteal phase? 3rd trimester?

Answer 38

1-5 mg/mL | 30 ng/mL

Question 39

When is 17-alpha-hydroxyprogesterone concentration elevated?

Answer 39

pregnancy | CAH

Question 40

Describe the structure of inhibin

Answer 40

peptide dimer

Question 41

What is the function of hCG?

Answer 41

maintain CL | maintain progesterone production

Question 42

What are the functions of progesterone?

Answer 42

1) suppress uterine contractility, maternal immune response to fetus, inhibit lactation, promote preparation of lactation 2) sperm attractant via activating Ca channels 3) prepares endometrium for implant 4) forms thick cervical mucous to inhibit sperm movement 5) used by embryo to make glucocorticoids and sex steroids

Question 43

Where are the targets of progesterone?

Answer 43

1) uterus 2) breast 3) CNS -- neuromodulator, neuroprotector

Question 44

What is the function of FSH?

Answer 44

- - stimulate granulosa cells to produce estrogen by upregulating aromatase - - stimulate inhibin production - - in males: spermatogenesis

Question 45

How long is menses?

Answer 45

21-40 days; (u=28)

Question 46

Which phase of the cycle is most likely to vary in length?

Answer 46

follicular, esp. after menarche and before menopause

Question 47

What is non-pharm tx for dysmenorrhea?

Answer 47

- - topical heat up to 12h - - exercise - - low-fat diet

Question 48

When is the usual onset of PMS?

Answer 48

1-2 weeks prior to menses

Question 49

What is non-pharm tx for PMS?

Answer 49

1) decrease caffeine, EtOH, sugar, salt 2) increase exercise 3) vitamin b6 (50-100 mg/day) + Calcium

Question 50

What is the incidence of PMS?

Answer 50

75%, most common between 25-35 yo

Question 51

What are the symptoms of dysmenorrhea?

Answer 51

-- crampy pelvic pain 1-3 days before menses +/- menorrhagia +/- nausea/vomiting +/- headache

Question 52

What percentage of women experience recurrent dysmenorrhea?

Answer 52

25%

Question 53

What are the causes of secondary dysmenorrhea? Most common?

Answer 53

most common = endometriosis | others: uterine polyps, pelvic infections, cervical stenosis

Question 54

What percentage of PMS patients develop PMDD?

Answer 54

3-8%

Question 55

What is the primary target of estrogens?

Answer 55

ER-alpha | -- primarily ovary, uterus, breast