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OB/GYN original > Female Physiology > Flashcards

Female Physiology Flashcards

1
Q

What hormones are responsible for regulating the menstrual cycle?

A 
Gonadotropic releasing hormone (GnRH)
Follicle stimulating hormone (FSH)
Luteinizing hormone (LH)
Estrogen
Progesterone
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2
Q

What is GnRH secreted by? When is it secreted?

A

By the hypothalamus

When serum estradiol levels fall below a given concentration

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3
Q

GnRH signals the _______ _______ _______ to secrete _______ _______ _______ and _______ _______.

A

anterior pituitary gland

follicle stimulating hormone (FSH) 
luteinizing hormone (LH)
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4
Q

What does FSH stimulate?

A

The growth and development of ovarian follicles

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5
Q

What does LH stimulate? What does this then cause?

A

The maturation of follicle and is responsible for Graafian follicular rupture causing ovulation

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6
Q

Which organ in the reproductive system secretes estrogen and progesterone? Specify what secretes these in this organ.

A

Ovary

Estrogen = secreted by developing follicles (and in lesser amounts the corpus luteum)

Progesterone = secreted by the corpus luteum

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7
Q

What are the pituitary gonadotropins?

A

FSH and LH

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8
Q

Any “-tropic” hormone signals what?

A

Another organ to function or secrete

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9
Q

What cells within the follicles produce estrogen? What does this then stimulate?

A

Theca cells

Stimulates endometrial growth

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10
Q

What stimulates progesterone production? When does progesterone peak?

A

Rupture of the Graafian follicle which causes ovulation

Peaks after ovulation in secretory phase

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11
Q

When the fertilized ovum implants into the endometrium, _____ signals _______ _______ to continue secreting _______ to prevent shedding of the endometrial lining.

A

hCG
corpus luteum
progesterone

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12
Q

What happens to progesterone and the endometrium if implantation does not occur?

A

Levels decrease and the uterine lining sheds

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13
Q

Define menarche.

A

The onset of menses, usually occurring between 11-14 years of age

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14
Q

When does menopause usually occur? What age is considered premature menopause?

A

44-55 years of age = menopause

prior to age 40 = premature menopause

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15
Q

When do FSH and LH peak?

A

Mid-cycle, ovulation

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16
Q

When does estrogen peak?

A

Proliferative phase, before ovulation

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17
Q

Sonographic findings of a dominant follicle:

A
  • any follicle measuring >11mm will most likely ovulate
  • grows linearly (approximately 2-3mm/day)
  • maximum diameter varies between 15 and 30mm
  • line of decreased reflectivity around follicle suggests ovulation will occur within 24 hours
  • presence of cumulus oophorus (mural nodule within follicle) suggests ovulation will occur within 36 hours
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18
Q

Describe the follicular phase: what days does it occur? What is it stimulated by? When does the dominant follicle appear and what will it measure?

A

Days 1-14
Stimulate by FSH
Several follicles develop, but the dominant follicle may be identified by about day 8 when it measures 10mm

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19
Q

Define Mittelschmerz.

A

Unilateral pelvic pain occurring mid-cycle, associated with ovulation.

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20
Q

When does ovulation occur?

A

MID-CYCLE (~day 14)

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21
Q

Describe ovulation and the sonographic findings.

A

A surge of LH secretion causes rupture of follicular membrane (usually within 24-36 hours after surge)

Sonographic findings:

  • sudden decrease in follicular size
  • free fluid in posterior cul-de-sac
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22
Q

Describe the luteal phase: what days does this occur? What is secreting progesterone and for what reason? What happens if there is no pregnancy?

A

Days 15-28
The corpus luteum is secreting progesterone to prepare and maintain the endometrium for implantation

If there is no pregnancy:

  • absence of hCG
  • corpus luteum regresses and atrophies and becomes corpus albicans
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23
Q

What are the sonographic findings during the luteal phase?

A
  • replacement of dominant cystic follicle with an echogenic structure representing thrombus (corpus albicans)
  • small irregular cystic mass with irregular thick borders and low-level echoes
  • Doppler findings of a hyper vascular corpus luteum with low resistance flow (ring of fire - CL is performing a vital to life function)
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24
Q

Describe the menstrual phase: include what days.

A

Days 1-5

Sloughing of the superficial layer of endometrial tissue and blood cells (menses)

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25
Q

Describe the sonographic findings of beginning and end of menstrual phase.

A

Beginning of menses:

  • endometrium thickened
  • might see fluid in endo
  • complex appearance

End of menses:

  • endometrium thinned, slightly irregular
  • endo max diameter of 2mm
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26
Q

Describe the proliferative phase: include what days/how long does it last/when does it end?

A

Days 6-14

  • Regeneration/proliferation of endometrium is stimulated by estrogen and secreted by the developing follicles
  • lasts about 10 days and ends at ovulation
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27
Q

Sonographic findings of the proliferative phase

A

Early proliferative:
- endometrium = hypoechoic area around prominent midline echo

Late proliferative (peri-ovulatory):
- tri-layered endometrium (3 line sign) with a hyper echoic basalis, hyperechoic functionalis and a hyperechoic line indicating the cavity
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28
Q

When you see the three line sign, about what day in the phase are they at?

A

About day 14

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29
Q

Describe the secretory phase: what days/what happens to the endometrium/what happens in the absence of fertilization?

A

Days 15-28
Endometrium becomes edematous and spongy due to progesterone
In absence of fertilization/implantation:
- no hCG production so the endometrial glands fragment and undergo autolysis to start the cycle again

30
Q

Describe the sonographic findings of the secretory phase.

A

Endometrium appearance:

  • homogeneous
  • hyperechoic
  • obscured midline echo
  • may have posterior acoustic enhancement
  • max diameter 14-16mm
31
Q

Define hypermenorrhea. What is another name for it?

A

Excessive volume during cyclic menstrual bleeding

AKA menorrhagia

32
Q

Define hypomenorrhea.

A

An abnormally small amount of menstrual bleeding

33
Q

Define polymenorrhea.

A

Frequent menstrual bleeding occurring less than 21 days apart

34
Q

Define oligomenorrhea.

A

Menstrual bleeding occurring more than 35 days apart

35
Q

Define metrorrhagia. What population does this most frequently occur with?

A

Irregular, frequent bleeding

Especially in patients near menopause

36
Q

Define menometrorrhagia.

A

Bleeding that is irregular in both frequency and volume

37
Q

Define intermenstrual bleeding.

A

Bleeding that occurs between normal cycles

38
Q

Define breakthrough bleeding.

A

Intermenstrual bleeding in OCP or HRT

39
Q

Define postcoital bleeding.

A

Bleeding after vaginal intercourse

40
Q

Define dysmenorrhea

A

Painful bleeding

41
Q

Define amenorrhea and the two types.

A

Absence of menstrual flow

Primary: patient has never had a period

Seconday: patient had periods but they stopped

42
Q

Define post-menopausal bleeding.

A

Bleeding occurring 1 year after menopause or at unanticipated times in HRT

43
Q

Define dysfunctional uterine bleeding (DUB).

A

Abnormal bleeding from an essentially normal uterus

Causes may be functional or organic, and may include endocrine disorders and many others

44
Q

What is the endometrial thickness in each phase: menses, proliferative, secretory.

A 
menses = 1-4mm
proliferative = 4-8mm
secretory = 8-16mm
45
Q

Name the dominant hormones of each phase: menses, proliferative, secretory.

A 
menses = FSH, estrogen
proliferative = FSH, estrogen --- LH at ovulation
secretory = progesterone
46
Q

What do OCP’s prevent? What is the most common regimen in the US?

A

Prevent conception by inhibiting ovulation

Pills with a combination of estrogen and progesterone

47
Q

What will be different sonographically with patients who are on OCP’s?

A
  • Won’t develop a dominant follicle (bc they don’t ovulate)
  • May have smaller follicles (5-19mm)
  • Endometrial growth suppressed - can’t go by normal measurements
48
Q

What is the general lifespan of an IUD? What are the most common types?

A

5-10 years

Copper-coated (Paraguard, Copper-T)
Lippes Loop
Hormonal (Mirena, Progestasert, Skyla, Liletta, Kyleena)

49
Q

What commonly happens with the uterus during insertion of an IUD?

A

Uterine perforation

50
Q

Describe the sonographic appearance of an IUD.

A
  • hyperechoic to the endometrium (could appear isoechoic)
  • posterior acoustic shadow or other artifact
  • positioned in fundus or mid portion of uterine body
51
Q

How is sonography used with the placement of IUD’s?

A

Sonography is used to confirm IUD position in the uterus or evaluate for myometrial perforation. 3D is useful in determining exact location.

52
Q

Define infertility.

A

The inability of a man and woman to achieve pregnancy after at least a year of having regular intercourse without any type of birth control.

53
Q

How many couples does infertility affect? Approximately how many are due to female factors, male factors, both partners and how many are unexplained?

A

1 in 7 couples

Female factors = 40%
Male factors = 40%
Both = 5-10%
Unexplained = 5-10%

54
Q

What do the female factors for infertility include?

A
  • an ovulation and abnormal ovulation
  • tubal and transport factors (ie adhesions, hydrosalpinx)
  • endometriosis
  • uterine factors (ie myoma, congenital anomalies)
  • polycystic ovarian syndrome
  • cervical factors
55
Q

How is sonography used in in-vitro fertilization programs?

A
  • Establishes normal uterine anatomy and evaluates endocrine indicators (ie: thickness, texture of endo and presence of intracavitary lesions or fluid)
  • Monitors the development of growing follicles and determine the timing of injection of hCG to trigger ovulation
  • Confirms ovarian response to various drugs (ie Clomid, Pergonal), or identify hyperstimulated ovaries
  • Guide oocyte retrieval from ovaries
56
Q

What are the ovulation induction medications?

A
  • Clomiphene Citrate
  • Gonadotropins
  • Glucophage (metformin)
  • hCG
  • Parlodel and dostinex
57
Q

What does clomiphene citrate used for?

A

Tablet used for women who have infrequent periods for long menstrual cycles

58
Q

What are gonadotropins(med) used for?

A

Injectible medication used to induce the release of the egg once the follicles are developed and the eggs are mature

59
Q

What is glucophage used for? What population is it typically given to and what are the effects of that?

A

Given to patients as an insulin lowering medication, commonly used in PCOS patients

Will reverse PCOS endocrine abnormalities in 2-3 months

60
Q

What is hCG(med) used for?

A

Used with other drugs to trigger ovulation

61
Q

What are parlodel and dostinex used for?

A

Used to lower prolactin levels and will reduce pituitary tumor size, should one be present

62
Q

How big are follicles when they are typically aspirated for IVF?

A

18-24mm

63
Q

What is the IVF sonographic protocol?

A
  • baseline TA sonogram
  • preliminary TV evaluation of follicles
  • daily TV to monitor dominant follicles
64
Q

Describe in vitro fertilization (IVF).

A

Consists of:

  • ovarian stimulation
  • needle aspiration of oocytes
  • incubation of oocytes with sperm
  • catheter delivery of typically 2-4 embryos into the uterus
65
Q

Describe zygote intrafallopian tube transfer (ZIFT).

A

Embryo (or zygote) is placed into the fallopian tube (rather than the uterus, as with IVF)

66
Q

Describe gamete intrafallopian tube transfer (GIFT).

A

Sperm and ova are placed into the Fallopian tube

67
Q

Describe intrauterine insemination (IUI). In what cases is this used?

A

Catheter placement of a sperm preparation into the uterine fundus

Used in cases of male factor infertility

68
Q

What is ovarian hyperstimulation syndrome (OHSS)?

A

A condition resulting from excessive stimulation of the ovaries in women taking fertility drugs

69
Q

What are the sonographic findings of OHSS?

A
  • large simple cysts with an ovarian diameter of >5cm
  • bilateral
  • resemble theca lutein cysts
  • may have ascites and pleural effusion
70
Q

When/how does OHSS usually resolve?

A

Mild cases usually resolve spontaneously following the next menstrual cycle

More severe cases are associated with a high mortality rate (50%) and may require hospitalization to correct fluid and electrolyte imbalances
- more severe in patients who conceive

71
Q

The incidence of ______ ______ increased with successful fertility treatment.

A

multiple gestations

OB/GYN original (2 decks)

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