EXAM #1: NORMAL MENSTRUAL CYCLE Flashcards
What are the three “ovarian phases” of the menstrual cycle?
1) Follicular Phase
2) Ovulation
3) Luteal Phase
*The average cycle is roughly 28 days
When the menstrual cycle is irregular, where in the cycle does the irregularity happen?
Follicular phase
Lluteal phase remains constant; follicular phase will change
What is the normal volume of menstrual flow?
30 mL
What is an abnormal volume of menstrual flow?
Greater than 80 mL
When in the life of a female will she have the greatest number of oocytes?
Weeks 16-20 gestation
What does follicular development result in?
Single mature follicle that will go on to ovulation
Where are granulosa cells located in the follicle?
This is a layer that surrounds that maturing oocyte
Where is the zona pellucida in the follicle?
This layer surrounds the granulosa cells
Where are FSH receptors located?
Granulosa cells
Where are the theca cells located in the follicle?
Outside the zona pellucida
What receptors to theca cells have?
LH
What hormonal balance has to exist for the follicle to develop?
High FSH and low LH
What is the “success” of the follicle in becoming the dominant follicle dependent on?
Ability to converty androgen into estrogen
What is ovarian steroidogenesis dependent on?
LH
What must granulosa cells acquire to be able to respond to the LH surge mid-cycle with ovulation?
LH receptors
What hormone stimulates the LH surge that is necessary for ovulation?
Estrogen
After ovulation, what does the follicle become?
Corpus luteum
After ovulation, what do the granulosa cells surrounding the follicle become?
Luteal cells
What is Mittleschmerz pain?
Pain experienced with ovulation
What is the time from LH surge to menses?
14 days; this is constant
After ovulation and formation of the corpus luteum, what happens to the corpus luteum?
Luteal regression
What hormone can “rescue” the corpus luteum?
hCG
What are the three endometrial phases of the menstrual cycle?
1) Menstrual endometrium/ proliferative
2) Ovulation
3) Secretory
What produces contractions/ uterine cramping during menstruation?
Prostaglandins
What induces endometrial healing and cessation of menstruation?
Rising estrogen levels from the follicular phase of the menstrual cycle
After ovulation, what hormones influence the endometrium?
Estrogen
Progesterone
What is the role of progesterone in the menstrual cycle after ovulation? How does this impact the influence of estrogen?
Progesterone= limits endometrial growth
Estrogen= continued growth within a confined space–produces “tortuous” blood vessels
What is primary amenorrhea?
Amenorrhea= lack of menstruation for six months
- Primary=
1) girl that has not menstruated by 13 without secondary sex characteristics
2) 15 with secondary sex characteristics
What is secondary amenorrhea?
Previously menstruating woman has not menstruated for 3-6 months
What is polymenorrhea?
Menstrual bleeding occurring regularly but less than every 21 days
What is oligomenorrhea?
Menstrual cycle frequency between 40 days to 6 months
What is menorrhagia?
Prolonged (more than 7 days) or excessive bleeding (greater than 80 mL)
What is hypomenorrhea?
Cycle length that is less than 2 days
What is intermenstrual bleeding?
Bleeding between periods
What is metorrhagia?
Bleeding at irregular but frequent intervals
What is menometorrhagia?
Bleeding at irregular but frequent intervals AND large amounts
What is the most common cause of amenorrhea?
Pregnancy
What are the causes of HPA dysfunction leading to amenorrhea?
1) Functional
2) Drug-induced
3) Neoplasia
4) Psychogenic
5) Head injury
What is the most common cause of HPA dysfunction leading to amenorrhea?
Functional
How labs are used to diagnose HPA dysfunction leading to amenorrhea?
1) Low FSH/LH
2) Prolactin
What are the expected findings if ovarian dysfunction is causing amenorrhea?
High FSH/LH that the ovaries are NOT responding to
What is the most common cause of ovarian dysfunction leading to amenorrhea?
Turner’s Syndrome
What is the most frequent anatomic cause of amenorrhea?
Asherman Syndrome i.e. scarring of the uterine cavity
What is the utility of the progesterone challenge test in amenorrhea?
This will determine if the patient is anovulatory OR has hypoestrogen/anatomic problem
So,
- Patient bleeds with progesterone= ANOVULATORY
- No bleeding= hypoestrogen/ anatomic etiology
What would lead you to think that a prolactinoma is causing amenorrhea?
Amenorrhea + GALACTORRHEA
What is the treatment for a prolactinoma?
Bromcriptine
If a patient has amenorrhea and desires to become pregnant, what is the treatment?
Induction of ovulation with:
1) Clomiphene citrate
2) Pulsatile GnRH (Leuprolide)
3) Aromatase inhibitors
What can abnormal uterine bleeding lead to?
Endometrial hyperplasia and increased risk of endometrial cancer b/c of unopposed estrogen
How is AUB treated?
1) Progestin for 10-14 days
2) Combination oral contraceptives
How is abnormal heavy abnormal bleeding treated?
1) High dose estrogen/ progestin
2) Follow with progestin prophylaxis or oral contraceptives
How is heavy bleeding that is unresponsive to medical management treated?
1) D/C
2) Endometrial ablation
3) Hysterectomy
What patients are good candidates for D/C?
1) Patients with hypovolemia
2) Older patients at risk of endometrial hyperplasia
What is a contraindication for endometrial ablation?
Woman that wants to maintain reproductive status
What is the indication for a hysterectomy?
Failure of all other medical and surgical interventions
