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OB/GYN > EXAM #1: NORMAL MENSTRUAL CYCLE > Flashcards

EXAM #1: NORMAL MENSTRUAL CYCLE Flashcards

1
Q

What are the three “ovarian phases” of the menstrual cycle?

A

1) Follicular Phase
2) Ovulation
3) Luteal Phase

*The average cycle is roughly 28 days

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2
Q

When the menstrual cycle is irregular, where in the cycle does the irregularity happen?

A

Follicular phase

Lluteal phase remains constant; follicular phase will change

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3
Q

What is the normal volume of menstrual flow?

A

30 mL

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4
Q

What is an abnormal volume of menstrual flow?

A

Greater than 80 mL

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5
Q

When in the life of a female will she have the greatest number of oocytes?

A

Weeks 16-20 gestation

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6
Q

What does follicular development result in?

A

Single mature follicle that will go on to ovulation

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7
Q

Where are granulosa cells located in the follicle?

A

This is a layer that surrounds that maturing oocyte

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8
Q

Where is the zona pellucida in the follicle?

A

This layer surrounds the granulosa cells

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9
Q

Where are FSH receptors located?

A

Granulosa cells

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10
Q

Where are the theca cells located in the follicle?

A

Outside the zona pellucida

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11
Q

What receptors to theca cells have?

A

LH

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12
Q

What hormonal balance has to exist for the follicle to develop?

A

High FSH and low LH

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13
Q

What is the “success” of the follicle in becoming the dominant follicle dependent on?

A

Ability to converty androgen into estrogen

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14
Q

What is ovarian steroidogenesis dependent on?

A

LH

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15
Q

What must granulosa cells acquire to be able to respond to the LH surge mid-cycle with ovulation?

A

LH receptors

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16
Q

What hormone stimulates the LH surge that is necessary for ovulation?

A

Estrogen

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17
Q

After ovulation, what does the follicle become?

A

Corpus luteum

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18
Q

After ovulation, what do the granulosa cells surrounding the follicle become?

A

Luteal cells

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19
Q

What is Mittleschmerz pain?

A

Pain experienced with ovulation

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20
Q

What is the time from LH surge to menses?

A

14 days; this is constant

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21
Q

After ovulation and formation of the corpus luteum, what happens to the corpus luteum?

A

Luteal regression

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22
Q

What hormone can “rescue” the corpus luteum?

A

hCG

23
Q

What are the three endometrial phases of the menstrual cycle?

A

1) Menstrual endometrium/ proliferative
2) Ovulation
3) Secretory

24
Q

What produces contractions/ uterine cramping during menstruation?

A

Prostaglandins

25
Q

What induces endometrial healing and cessation of menstruation?

A

Rising estrogen levels from the follicular phase of the menstrual cycle

26
Q

After ovulation, what hormones influence the endometrium?

A

Estrogen

Progesterone

27
Q

What is the role of progesterone in the menstrual cycle after ovulation? How does this impact the influence of estrogen?

A

Progesterone= limits endometrial growth

Estrogen= continued growth within a confined space–produces “tortuous” blood vessels

28
Q

What is primary amenorrhea?

A

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
29
Q

What is secondary amenorrhea?

A

Previously menstruating woman has not menstruated for 3-6 months

30
Q

What is polymenorrhea?

A

Menstrual bleeding occurring regularly but less than every 21 days

31
Q

What is oligomenorrhea?

A

Menstrual cycle frequency between 40 days to 6 months

32
Q

What is menorrhagia?

A

Prolonged (more than 7 days) or excessive bleeding (greater than 80 mL)

33
Q

What is hypomenorrhea?

A

Cycle length that is less than 2 days

34
Q

What is intermenstrual bleeding?

A

Bleeding between periods

35
Q

What is metorrhagia?

A

Bleeding at irregular but frequent intervals

36
Q

What is menometorrhagia?

A

Bleeding at irregular but frequent intervals AND large amounts

37
Q

What is the most common cause of amenorrhea?

A

Pregnancy

38
Q

What are the causes of HPA dysfunction leading to amenorrhea?

A

1) Functional
2) Drug-induced
3) Neoplasia
4) Psychogenic
5) Head injury

39
Q

What is the most common cause of HPA dysfunction leading to amenorrhea?

A

Functional

40
Q

How labs are used to diagnose HPA dysfunction leading to amenorrhea?

A

1) Low FSH/LH

2) Prolactin

41
Q

What are the expected findings if ovarian dysfunction is causing amenorrhea?

A

High FSH/LH that the ovaries are NOT responding to

42
Q

What is the most common cause of ovarian dysfunction leading to amenorrhea?

A

Turner’s Syndrome

43
Q

What is the most frequent anatomic cause of amenorrhea?

A

Asherman Syndrome i.e. scarring of the uterine cavity

44
Q

What is the utility of the progesterone challenge test in amenorrhea?

A

This will determine if the patient is anovulatory OR has hypoestrogen/anatomic problem

So,

  • Patient bleeds with progesterone= ANOVULATORY
  • No bleeding= hypoestrogen/ anatomic etiology
45
Q

What would lead you to think that a prolactinoma is causing amenorrhea?

A

Amenorrhea + GALACTORRHEA

46
Q

What is the treatment for a prolactinoma?

A

Bromcriptine

47
Q

If a patient has amenorrhea and desires to become pregnant, what is the treatment?

A

Induction of ovulation with:

1) Clomiphene citrate
2) Pulsatile GnRH (Leuprolide)
3) Aromatase inhibitors

48
Q

What can abnormal uterine bleeding lead to?

A

Endometrial hyperplasia and increased risk of endometrial cancer b/c of unopposed estrogen

49
Q

How is AUB treated?

A

1) Progestin for 10-14 days

2) Combination oral contraceptives

50
Q

How is abnormal heavy abnormal bleeding treated?

A

1) High dose estrogen/ progestin

2) Follow with progestin prophylaxis or oral contraceptives

51
Q

How is heavy bleeding that is unresponsive to medical management treated?

A

1) D/C
2) Endometrial ablation
3) Hysterectomy

52
Q

What patients are good candidates for D/C?

A

1) Patients with hypovolemia

2) Older patients at risk of endometrial hyperplasia

53
Q

What is a contraindication for endometrial ablation?

A

Woman that wants to maintain reproductive status

54
Q

What is the indication for a hysterectomy?

A

Failure of all other medical and surgical interventions

OB/GYN (19 decks)

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