disorders of the menstrual cycle Flashcards by lynne nguyen

What does LH stand for

Luteinising hormone

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What does FSH stand for

Follicle-stimulating hormone

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What is the hypothalamic-pituitary feedback system that leads to endometrial changes and cervical mucus changes?
Hint: involves the release of E, P, LH, FSH

Hypothalamus releases GnRH, which stimulates the anterior pituitary to release LH and FSH, which stimulates the ovaries to release E and P, which stimulates the uterus to cause endometrial and cervical mucus changes, before going into a negative feedback loop

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What happens to the body when E stimulates LH surge?

Ovulation

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Stimulation and development of follicle is due to the surge of what hormone?

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What does E/estradiol thicken?

Endometrium lining

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What does P/progestogen thicken?

Cervical mucous

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Define dysmenorrhea

Period pain - chronic, cyclical, pelvis spasmodic (cramp) pain in absence of other pathologies

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Which of these is NOT a risk factor for dysmenorrhoea?
A. Low BMI
B. Smoker
C. Earlier menarche
D. Being an athlete
E. Sexual abuse

D - exercise lowers the chances of getting it, so not a risk factor

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Which of these DO NOT help with dysmenorrhoea?
A. No previous childbirth
B. First childbirth at younger age
C. Exercise
D. Contraceptives

A - no child is a risk factor actually, having a kid young makes pain better

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Difference between primary and secondary dysmenorrhoea

Primary - getting cramps after onset of normal menstrual cycle with normal pelvic exam
Secondary - not just normal periods cramp, referral needed as something else is going on, some pelvic patholgy

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How does primary dysmenorrhoea happen?

Secreted E and P stimulate prostaglandin (PGF2 alpha), which stimulates nerve endings that cause pain, ultimately causing myometrial contractions

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How is prostaglandin (PGF2 alpha) associated with pain?

PGF2 alpha mediates and potentiates pain sensations and stimualtes smooth muscle contractions

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MOA if NSAIDs in dysmenorrhoea

Inhibits synthesis and activity of uterine prostaglandins

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Reason for COCP in dysmenorrhoea?

Stops ovulation, so it minimises sx they get with a period

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Drugs indicated for dysmenorrhoea (3)

NSAIDs, COCP, paracetamol

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When does secondary dysmenorrhoea occur?

Later in life

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What does PMS stand for

Pre-menstrual syndrome

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When does pre-menstrual syndrome (PMS) happen?

10 days before menstruation

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Which of these is NOT a physical sx of PMS?
A. Abnormal bloating from fluid retention
B. Loss of libido
C. Acne
D. Breast tenderness and fullness
E. Diarrhoea

E - in PMS you get fluid retention, opposite to diarrhoea

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Which of these is NOT a psychological sx?
A. Anger issues
B. Mood swings
C. Tension and anxiety
D. Food cravings, binge eating

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Another word for period?

Menses

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If using an OCP for PMS, what ingredient needs to be in it for it to work?

Drosperonine

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What does PMDD stand for

Premenstrual dysphoric disorder

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What are the 4 stages of menses?

1. Menstrual phase 2. Follicular (pre-ovulatory) phase 3. Ovulatory phase 4. Luteal (post-ovulatory) phase

Define premenstrual dysphoric disorder (PMDD)

Severe form of PMS

Most common drug for PMDD, and when to take it?

SSRI - can take everyday or cyclically when px knows when period/sx will occur

Define menorrhagia

Heavy menstrual bleeding (HMB)

What are the types of menorrhagia and which is the most common? (4)

- Ovulatory - Anovulatory - Complication of pregnancy - Coagulation disorder (most common)

Which of these is NOT a type of menorrhagia? A. Ovulatory B. Anovulatory C. Trauma D. Complications of pregnancy E. Coagulation disorder

What occurs due to excessive fibrinolytic activity and increase in PG production in the endometrium?

Ovulatory HMB

What hormone causes anovulatory HMB

the lack of P

What are 2 common causes of anovulatory HMB?

PCOS and perimenopausal dysfunction uterine bleeding

What is the goal of tranexamic acid in HMB?

Decrease blood loss in menstrual cycle

What is the first-line treatment in HMB management?

Levonorgestrel IUD

What are the 2 POP medications indicated for HMB?

Norethisterone or IM medroxyprogesterone

MOA of POP in HMB

Reduces endometrial thickness, reduce bleeding by 30%

Define amenorrhoea

Absence of periods

True/False POP used for HMB can cause amenorrhoea

True - can cause amenorrhoea in 70% of women

What drug class is tranexamic acid?

Antifibrinolytics

MOA of antifibrinolytics

Inhibits local fibrinolysis and inhibits clot breakdown by preventing activation of plasminogen and plasmin

MOA of COCP used in HMB

Thins the endometrium

MOA of COCP used in HMB

Thins the endometrium

API of Ponstan?

Mefenamic acid

When should you start using NSAIDs for HMB?

Onset or 3-5 days prior to bleeding

MOA of NSAIDs indicated for HMB

Decrease PG conc. in the endometrium, ultimately reducing blood loss and reduces inflammation/pain

MOA of levonorgestrel-releasing intra-uterine system (the IUD) used for HMB

Slowly release progestin that thins the endometrium

What are the 2nd line treatments for HMB after the IUD

Tranexamic acid, NSAIDs, COCP

Why is the IUD the most effective for HMB?

Avoids the systemic ADR of po or inj progestins

What happens when endometrial cells implant and grow outside of the uterus?

Endometriosis

What does endometriosis cause? (2)

- Irregular bleeding - Problems falling pregnant

What disorder of the menstrual cycle is a cause of infertility?

Endometriosis

Which one is the immune theory on why endometriosis occurs? A. Altered immune response allows endometrial cells to avoid destruction B. Metaplasia near pelvic floor

Which one is Meyer's theory on why endometriosis occurs? A. Altered immune response allows endometrial cells to avoid destruction B. Metaplasia near pelvic floor

Which is NOT a sx of endometriosis? A. Pain/severe dysmenorrhoea B. Bleeding C. Bowel and bladder sx D. Chronic fatigue, nausea, depression, infertility E. Early onset of menopause

What can be used for pain suppression in endometriosis? (5)

Analgesics, OCP, vaginal contraceptive ring (Nuvaring), contraceptive implant (Implanon), IUD (Mirena)

MOA of GnRH agonist in endometriosis

Reduce activity of the hypothalamic-pituitary axis in order to decrease FSH and LH secretion, consequently suppressing E which shrinks ectopic endometrium

SE of GnRH agonist (2)

Menopausal sx or loss of bone mineral density

What drug class do these belong to? Nafarelin, goserelin

GnRH agonist

MOA of aromatase inhibitors in endometriosis

Inhibits the conversion of androgen to E (less E)

SE of aromatase inhibitors in endometriosis

Menopausal sx or loss of bone mineral density

What do drugs used for endometriosis aim for?

Aim to shrink ectopic endometrium by suppressing E