Exam 1 Flashcards
1
Q
What is menarche and when does it usually occur?
A
onset of menstruation that usually occurs between ages 8 and 16
2
Q
length of complete cycle
A
28-29 days
3
Q
How much does the average woman bleed during menstruation?
A
1-2 oz OR 25-80mL
this varies from person to person and can be more in women with heavier flows
4
Q
average length of menstrual cycle (days bleeding)
A
4-8 days
5
Q
perimetrium
A
outer layer of uterus (aka peritoneum)
6
Q
myometrium
A
middle muscle layer of uterus
7
Q
endometrium
A
inner mucosal layer of uterus
8
Q
Which layer of the uterus sheds during menses?
A
the endometrium
9
Q
What is the purpose of “ligature” for the uterus?
A
ligature are fibers that help the uterus clamp down and return to normal size after pregnancy
10
Q
What does ligature help prevent after pregnancy?
A
post partum hemorrhage
11
Q
Functions of the cervix:
A
- lubrication of the vagina (helps to wash away microorganisms)
- acts as a bacteriostatic environment, which protects from microorganisms
- provides an alkaline environment for sperm
12
Q
What are the three parts of the fallopian tubes?
A
isthmus, ampulla, and fimbria
13
Q
Location and function of isthmus
A
located closest (proximal) to the uterus and is the site of tubal ligation
14
Q
location and function of ampulla
A
the “middle” part of the tube where fertilization occurs
15
Q
What is the fimbria?
A
The fimbria is the distal end of the fallopian tube, which possess “finger-like” projections that need to be free moving for normal function to occur.
16
Q
What helps move the ovum through the fallopian tubes to the uterus?
A
Tubal peristalsis and ciliary (hairs)
17
Q
What is present in the fallopian tubes and uterus that helps provide a nourishing environment for the ovum?
A
serous fluid
18
Q
What complication arises involving the fallopian tubes when recurrent infections are present?
A
Difficulty conceiving.
Rationale: With recurrent infections, the structures are constantly inflamed. This constant state of inflammation means the structures have a harder time transporting the ovum to the ampulla and supporting it once there, making it more difficult to conceive.
19
Q
How do healthy tubes move and support the ovum?
A
Serous fluid, ciliary, and tubal peristalsis
Rationale: Healthy tubes have plenty of fluid and ciliary to move the ovum towards the ampulla to unite with the sperm.
20
Q
Function of ovaries
A
- store and develop follicles
2. secrete estrogen and progesterone
21
Q
Estrogen’s function in development
A
helps in the development of secondary female sex characteristics ie. breasts and pubic hair
22
Q
Estrogen’s function in pregnancy
A
considered “growth hormone of pregnancy” - encourages the growth of the uterus and fetus
23
Q
Estrogen’s function in the ovarian cycle
A
helps the follicle to mature so it can release a mature ovum during ovulation
24
Q
Progesterone’s function in pregnancy
A
helps keep you pregnant!!
- decreases uterine motility and contractility (quiets the uterus and calms contractions)
- causes a relaxation effect during pregnancy (ie. more tired, decreased GI motility –> constipation)
25
Source of progesterone during ovarian cycle
the corpus luteum
26
Source of progesterone in pregnancy
the placenta
27
As the level of progesterone decreases, what increases?
the risk of miscarriage
28
What are the first 14ish days of the ovarian cycle called?
The follicular phase
29
What occurs during the follicular phase?
the oocyte matures into an ovum
30
When does the graafian follicle appear?
by day 14
31
What is the function of the graafian follicle?
acts as a shell around the oocyte
32
What hormone do graafian follicle cells release?
estrogen
33
Where is the ovum released from during ovulation?
the graafian follicle
34
What is the luteal phase?
days 14-28 of the ovarian cycle, begins directly after ovulation
35
What occurs during the luteal phase?
the corpus luteum forms and begins to release progesterone (prepares for PG - if not, menses starts)
36
What happens to hormone levels during the luteal phase?
Estrogen levels decrease and progesterone levels increase
37
When does the luteal phase end?
when menses begins
38
Where is FSH release from?
the pituitary gland
39
FSH target organ
the ovaries
40
FSH function
stimulates the maturation of the follicle or oocyte
41
High levels of estrogen stimulate
the release of LH from the pituitary gland
42
The peak of which hormone triggers ovulation?
LH (ovulation occurs approx. 24hrs after surge)
43
Prostaglandin E main function
helps to stimulate labor
44
Pg E two specific functions
1. relaxes smooth muscle (opens the cervix)
| 2. vasodilator
45
Prostaglandin F main function
helps to stop post partum hemorrhage
46
Pg F specific function
strong vasoconstrictor, increases contractility of muscles and arteries
47
Duration of menstrual phase
day 1 to approx. day 5
48
duration of proliferative phase
approx. day 5 (end of menses) through ovulation
49
How does the uterus change during the proliferative phase?
1. the lining of the uterus thickens (with the help of estrogen)
2. cervical mucus becomes fertile mucus
50
duration of secretory phase
ovulation to approx. 3 days before menses
51
Characteristics of the uterine lining during secretory phase
the lining of the endometrium is thick and at the peak of vascularity (ready for implantation of zygote)
52
Job of LH
Helps with the formation of the corpus luteum after ovulation occurs
53
Hormone levels during menstrual phase
estrogen levels are low
54
Hormones levels during secretory phase
estrogen levels drop and progesterone increases
55
Hormone levels during ischemic phase
estrogen and progesterone levels are low
56
Endometrial changes during ischemic phase
Necrosis of the lining occurs and the tissue begins to slough off (bleeding begins)
57
Signs of ovulation
1. the amount of mucus increases
2. appears thin, watery, and clear
3. Spinnbarkeit (very stretchy and stringy)
4. ferning pattern appears under microscopic examination
5. basal body temp increases by 10ths of a degree (post-ovulation)
58
Ovulation mucus
abundant, thin, watery
59
Saliva testing for fertility
ferning pattern will appear on microscope slide
60
Why does ferning occur during ovulation?
Increased levels of estrogen --> increased levels of salt, which causes ferning
61
amenorrhea
absence of menses
62
primary amenorrhea
menstruation has yet to be established by 16yrs
63
secondary amenorrhea
established menses (longer than 3-6 months) ceases
64
Common causes for secondary amenorrhea
#1 is pregnancy
others: lactation, hormonal imbalances, poor nutrition, low body fat ratios (extreme athletes)
65
dymenorrhea
painful menstruation that typically occurs before onset of menstrual cycle
66
primary dysmenorrhea
cramps present without disease state
67
most common cause of primary dysmenorrhea
prostaglandin release (cause cramping)
68
what else causes cramping with primary dysmenorrhea
increased uterine contractility and ischemia (the body is shedding the uterine lining so cramping is needed)
69
secondary dysmenorrhea
associated with a disease
70
things that cause secondary dysmenorrhea
endometriosis, pelvic inflammatory disease (PID), cysts, tumors, presence of IUD, fibroids
71
When are fibroids most prevalent? Why?
during childbearing years (onset of puberty to menopause) r/t estrogen levels
72
What can fibroids (benign uterine tumors) cause?
infertility
73
What is the common cause of PID?
often caused by an infection that was not resolved or controlled, then spread to the pelvis
74
Treatment of primary dysmenorrhea
OCPs, NSAIDs, self care
75
Why are OCPs used for tx of primary dysmenorrhea?
OCPs inhibit ovulation, which decreases dysmenorrhea sx and cramping
76
Why are NSAIDs used to tx of primary dysmenorrhea?
NSAIDs inhibit the release (or synthesis) of prostaglandins, which cause cramping
77
When should NSAIDs be taken for primary dysmenorrhea?
NSAIDs should be taken at the start of menses or 2-3 days prior to menses
78
What are 3 self care measures that can be used to decrease primary dysmenorrhea?
1. regular exercise and pelvic rocking (reduces pelvic congestion)
2. application of heat
3. yoga to decrease homocysteine levels and pain
79
Nutritional care for dysmenorrhea
1. increase intake of complex carbs and proteins
2. restriction of methylxanthine-containing foods ie. chocolate, coffee, cola
3. restriction of ETOH, nicotine, red meat, animal fats
80
What foods should be avoided the week before menses?
Salty foods and refined sugars
81
What nutritional supplements help with dysmenorrhea?
- Vitamin B6 (bloating and irritability)
- Vitamin E (mild prostaglandin inhibitor)
- natural diuretics ie. watermelon, cranberry juice, asparagus
82
What is premenstrual syndrome and when does it occur?
distressing physical, psychological, and behavioral symptoms that reoccur cyclically during 2nd half of cycle (luteal phase) in 3+ consecutive cycles
83
When is PMS most prominent?
the week before menses and typically subsides at the start of menstruation
84
Ages most affected by PMS
20s-30s
85
Factors that contribute to PMS
- cyclical hormonal changes
- serotonin insufficiency
- stress
- depressions
- poor nutrition (lots of salt, caffeine, ETOH)
86
Common psychological symptoms of PMS
- mood swings
- crying episodes
- anxiety
- poor concentration
87
Common physical symptoms of PMS
- fluid retention and wt. gain
- muscle aches
- breast tenderness
- insomnia
- palpitations
- fatigue
- acne
(basically everything that happens to you)
88
Self-care tx for PMS
- increase physical exercise
| - modify diet (reduce salt, refined sugar, red meat, caffeine, chocolate)
89
Supplement tx for PMS
- calcium 1200mg
- magnesium
- vitamin B6 (tx of anxiety and depression)
- vitamins D and E
90
Medications for PMS
- SSRIs (if depressions is serotonin related)
| - NSAIDs (antiprostaglandins)
91
If suffering from depressions r/t serotonin levels (PMS), what class of medications is recommened?
SSRIs (selective serotonin reuptake inhibitors) - they increase levels of serotonin in the brain
92
What is premenstrual dysphoric disorder (PMDD)?
a more severe form of PMS, but women experience more mood symptoms
93
How common is PMDD?
3-8% of women affected
94
Does PMDD continue during pregnancy or menopause?
No. PMDD will not occur without ovarian function.
95
Symptoms of PMDD
- severe depression
- panic attacks
- feelings of worthlessness
- suicidal thoughts
- trouble concentrating or sleeping
96
Women with PMDD will...
show no interest in relationships or ADLs, often feel out of control, tired/fatigued, and severely depressed
97
What is YAZ?
YAZ is an OCP that is only approved for the treatment of PMDD
98
How is PMDD treated?
prescribed by psychiatric consultant - often given SSRI (Prozac, Zolaf)
99
Do PMS sx become more severe or less severe during menopause?
more severe
100
Definition of menopause
absence of menstruation for 1 full year and thereafter
101
What is perimenopause?
refers to the transition from ovulatory cycles to amenorrhea (starting to s/s of menopause but haven't fully achieved menopause)
102
What is important to note during perimenopause?
Irregular menses coincides with irregular ovulation - tracking and being cautious can help prevent unwanted pregnancies during perimenopause
remember: perimenopause = PAUSE and use PROTECTION
103
When does menopause occur in most women?
ages 39-51*
*should be postmenopausal by 59
104
Onset of menopause is affected by...
- overall health
- weight and nutrition
- lifestyle and ethnicity
- genetics
105
How long does perimenopause last?
approx. 4-8 years
106
Which ethnicities experience perimenopause earlier than others?
African American and Hispanic
107
What happens to FSH levels during menopause?
FSH levels increase in an attempt to stimulated estrogen release from the ovaries
108
What happens to estrogen levels during menopause?
Estrogen levels steadily decrease, causing the cessation of ovarian follicle production
109
What happens to female reproductive organs/ tissues during menopause?
- endometrium thins
| - myometrium, fallopian tubes, and ovaries atrophy
110
Secondary sex changes during menopause
- vaginal mucosa dries and thins
- vaginal pH increases
- pubic hair thins and turns grey
- breasts become pendulous
- labia shrink and lose pigmentation
111
What happens to pelvic fascia and muscles during menopause? What complications arise as a result?
The pelvic fascia and muscles atrophy, meaning support has now been lost for uterus.
Increases the risk for uterine prolapse, cystoceles, etc.
112
Why are post menopausal women more susceptible to urinary frequency and incontinence?
the urethra shortens
113
Are postmenopausal women more at risk for UTIs? Why?
yes!! r/t the shortened urethra
114
Post menopausal women are at a higher risk for which four diseases?
1. hypertension
2. CAD
3. stroke
4. osteoporosis
115
What is the rationale behind why postmenopausal women are at higher risk for osteoporosis?
The formation of new bone is directly r/t the synthesis of estrogen, which is steadily decreasing as the ovaries atrophy. So while bone reabsorption is occurring, bone reformation cannot keep up r/t decreasing levels of estrogen. This results in the bones slowly thinning and becoming more brittle.
116
Hormone therapy is recommended for how long?
1-3 years and at the lowest possible dose
117
Risks of hormone replacement therapy
- breast cancer
- stroke
- thromboembolic disease
118
Who can be on estrogen-only HRT?
women who have had a hysterectomy
119
Who is prescribed estrogen-progesterone HRT?
women who still have a uterus
120
Why is estrogen-progesterone HRT ideal for women with uteruses?
The progesterone does not allow the endometrium to build up (hyperplasia). It helps shed the lining, which decreases the risk of uterine cancer.
121
How is osteoporosis assessed?
Bone mineral density (BMD) testing
122
Who is the targeted group for bone mineral density (BMD) testing?
all postmenopausal women:
- 65yr+
- w/ fractures
- or <65, but with multiple risk factors
123
Why are height checks done on postmenopausal women?
They detect bone loss leading to vertebra compression.
124
What is Dowager's Hump?
The cervical vertebrae are no longer able to support the upper body and the woman appears slumped.
125
What are 5 ways to prevent osteoporosis?
1. increase calcium intake
2. weight-bearing exercise ie. walking, stairs
3. vitamin D supplements
4. limit ETOH and caffeine
5. if a smoker, stop smoking
126
How much daily calcium should postmenopausal women on HRT take?
1200mg
127
How much daily calcium should postmenopausal NOT on HRT take?
1500mg
128
Types of drug treatments for osteoporosis
- bisphosphonates
- selective estrogen receptor modulators (SERMs)
- parathyroid hormone
- salmon calcitonin
- prolia
129
Why are bisphosphonates used for the tx of osteoporosis?
They are calcium regulators and increase bone mass.
130
Examples of bisphosphonates
Fosamax and Boniva: oral
| Zometa: IV yearly
131
Why are selective estrogen receptor modulators (SERMs) used for the tx of osteoporosis?
SERMs do not stimulate the breast or uterine tissues.
They also preserve the beneficial effects of estrogen.
132
Example of a selective estrogen receptor modulator
ralaxifene PO - Evista
133
How does parathyroid hormone benefit women with osteoporosis?
Increases bone formation
taken SQ daily for up to 2 years
134
Salmon calcitonin and osteoporosis
Calcium regulator
nasal spray
135
Prolia and osteoporosis
increases bone mass and strength
taken SQ every 6 months
136
What are phytoestrogens?
plants with estrogen properties
ex. carrots, wild yams, cherries, black beans, SOY products (increase mineral density in bone)
137
What does acupuncture do for postmenopausal women?
helps with hot flashes
138
How long does an egg live after being released?
24hrs
139
How long does the corpus luteum stay in place if fertilization occurs?
8 weeks, then placenta takes over
