disorders of the menstrual cycle Flashcards
What does LH stand for
Luteinising hormone
What does FSH stand for
Follicle-stimulating hormone
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
What happens to the body when E stimulates LH surge?
Ovulation
Stimulation and development of follicle is due to the surge of what hormone?
P
What does E/estradiol thicken?
Endometrium lining
What does P/progestogen thicken?
Cervical mucous
Define dysmenorrhea
Period pain - chronic, cyclical, pelvis spasmodic (cramp) pain in absence of other pathologies
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
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
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
How does primary dysmenorrhoea happen?
Secreted E and P stimulate prostaglandin (PGF2 alpha), which stimulates nerve endings that cause pain, ultimately causing myometrial contractions
How is prostaglandin (PGF2 alpha) associated with pain?
PGF2 alpha mediates and potentiates pain sensations and stimualtes smooth muscle contractions
MOA if NSAIDs in dysmenorrhoea
Inhibits synthesis and activity of uterine prostaglandins
Reason for COCP in dysmenorrhoea?
Stops ovulation, so it minimises sx they get with a period
Drugs indicated for dysmenorrhoea (3)
NSAIDs, COCP, paracetamol
When does secondary dysmenorrhoea occur?
Later in life
What does PMS stand for
Pre-menstrual syndrome
When does pre-menstrual syndrome (PMS) happen?
10 days before menstruation
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
Which of these is NOT a psychological sx?
A. Anger issues
B. Mood swings
C. Tension and anxiety
D. Food cravings, binge eating
A
Another word for period?
Menses
If using an OCP for PMS, what ingredient needs to be in it for it to work?
Drosperonine
What does PMDD stand for
Premenstrual dysphoric disorder
What are the 4 stages of menses?
- Menstrual phase
- Follicular (pre-ovulatory) phase
- Ovulatory phase
- 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
C
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
A
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
B
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
E
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
