Exam 3 Intro to Women's Health

Question 1

What happens to GnRH levels during the menstrual cycle?

Answer 1

during the follicular phase it starts to increase and hits the max before ovulation and then rapidly declines during the luteal phase and remains low until it starts to increase during the follicular phase

Question 2

How do FSH levels and LH levels differ during the menstrual cycle?

Answer 2

FSH levels are higher during the first part of the follicular phase and spikes up a bit before ovulation and then remains lower than LH levels during the luteal phase

LH levels are first lower than FSH levels until it massively spikes at ovulation and then remains higher than FSH levels for the rest of the luteal phase until the follicular phase begins

Question 3

What are the follicular stages during the menstrual cycle?

Answer 3

the follicle begins to grow during the follicular phase and then ovulation occurs at day 14 in which the egg is released and if no fertilization happens, the corpus luteum becomes the corpus albicans and will shrivel and die

Question 4

What are estrogen levels like during the menstrual cycle?

Answer 4

estrogen levels steadily increase until it peaks at ovulation then declines and increases again before declining and remaining low

Question 5

What are inhibin levels like during the menstrual cycle?

Answer 5

they remain low during the follicular phase and has a small peak around ovulation and then surges up during the luteal phase and comes back down

Question 6

What are progesterone levels like during the menstrual cycle?

Answer 6

they remain low (lower than inhibin levels) and then have a large surge in the middle of the luteal phase and then comes back down

Question 7

What are the phases of the uterine cycle and how does that translate to the endometrial changes that are happening?

Answer 7

1. menses (days 1-7) → the endometrial lining is shedding
2. proliferative (days 8-14) → the endometrial lining is being regenerated
3. ovulation (day 14)
4. secretory (days 14-28) → secretion of endometrial glands in which the endometrial lining is thickening and growing (then to be shed during menses)

Question 8

What is the overall summary of the hormones being produced that regulate the menstrual cycle?

Answer 8

1. hypothalamus secretes GnRH → stimulates the anterior pituitary to secrete FSH/LH → stimulates the ovaries to produce estrogens and progesterones → have physiological functions
2. follicular phase → ovarian follicle → estradiol
3. luteal phase → corpus luteum → progesterone

Question 9

What are some important things to know about estrogens?

Answer 9

1. commonly seen in the form of estradiol and estrone
2. produced by the ovary
3. target: many tissues
4. at menarche (first occurrence of menstruation): stimulate breast development, fat deposition, increase growth hormone and height
5. throughout the reproductive years: maintain female sexual physical characteristics, related behaviors, and reproductive organs + stimulates cyclic uterine lining growth and repair
6. levels fluctuate throughout the menstrual cycle

Question 10

As an example, estradiol is available as what products?

Answer 10

Estrace, Climara, Depo-Estradiol, Femring, Vivelle-Dot (and many more)

Question 11

What are some contraindications to estradiol?

Answer 11

1. undiagnosed abnormal vaginal bleeding
2. DVT or PE (current or history)
3. active or history of arterial thromboembolic disease (stroke, MI)
4. breast cancer
5. hypercoagulable disorder
6. pregnancy

Question 12

What are some therapeutic uses of estrogen?

Answer 12

1. breast cancer palliation
2. uremic bleeding (IV)
3. prevention of post-menopausal osteoporosis
4. menopause (moderate to severe vasomotor symptoms)
5. vulvar and vaginal atrophy
6. female hypogonadism
7. ovarian failure
8. abnormal uterine bleeding
9. contraception

Question 13

What are some things to know about progesterone?

Answer 13

1. levels begin to rise and peak around cycle day 22
2. produced by the ovary and corpus luteum
3. main target: uterus
4. during pregnancy: prepares the endometrium for pregnancy, inhibits contraction of the uterus, inhibits development of a new follicle
5. endometrial lining cannot be maintained without high progesterone levels

Question 14

What are some things to know about medroxyprogesterone as an example of progesterone?

Answer 14

1. available as Depo-Provera, Provera
2. contraindications: history of or current VTE, severe hepatic dysfunction, breast cancer, undiagnosed vaginal bleeding
3. reduces the risk of endometrial cancer with unopposed estrogen treatment
4. warning: prolonged use of contraceptive injection may result in loss of bone mineral density (BMD)

Question 15

What are some therapeutic uses of progestins?

Answer 15

1. long term prevention of pregnancy
2. treatment of heavy menstrual bleeding
3. emergency contraception
4. amenorrhea
5. endometriosis

Question 16

What are GnRH agonists (GnRH-A’s)?

Answer 16

1. synthetic analogs of GnRH → leuprolide, buserelin, nafarelin, goserelin, triptorelin
2. mechanism: pseudomenopausal state
3. side effects: hot flashes, vaginal dryness, insomnia, osteoporosis

Question 17

What are some therapeutic uses of GnRH agonists?

Answer 17

1. menorrhagia (heavy or prolonged menstrual bleeding)
2. endometriosis
3. premenstrual dysphoric disorder (PMDD)