EXAM #1: NORMAL MENSTRUAL CYCLE Flashcards by Jonathan Kallevang

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

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

Follicular phase

Lluteal phase remains constant; follicular phase will change

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What is the normal volume of menstrual flow?

30 mL

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What is an abnormal volume of menstrual flow?

Greater than 80 mL

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

Weeks 16-20 gestation

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What does follicular development result in?

Single mature follicle that will go on to ovulation

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Where are granulosa cells located in the follicle?

This is a layer that surrounds that maturing oocyte

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Where is the zona pellucida in the follicle?

This layer surrounds the granulosa cells

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Where are FSH receptors located?

Granulosa cells

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Where are the theca cells located in the follicle?

Outside the zona pellucida

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What receptors to theca cells have?

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

High FSH and low LH

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

Ability to converty androgen into estrogen

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What is ovarian steroidogenesis dependent on?

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

LH receptors

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

Estrogen

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After ovulation, what does the follicle become?

Corpus luteum

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

Luteal cells

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What is Mittleschmerz pain?

Pain experienced with ovulation

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What is the time from LH surge to menses?

14 days; this is constant

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

Luteal regression

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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