Female Physiology Flashcards
Define menarche.
onset of menses, usually occurring between 11-14 years of age
Define menopause.
termination of regular menses, usually occurring between 45-55 years of age
Define premature menopause.
termination of regular menses prior to age 40
The endometrium and ovaries respond to _______ and ________ levels in the blood. These levels are determined by a feedback mechanism between the ______ and the ________/________ complex.
- estrogen
- progesterone
- ovaries
- hypothalamus/pituitary
When serum estradiol levels fall below a given concentration, the _________ produces ____________.
- hypothalamus
- gonadotropic releasing hormone (GnRH)
The production of GnRH signs the _________ to produce gonadotropins: ________ and _______.
- pituitary
- FSH and LH
A “-tropic” hormone signals an organ to _______ or ______.
function or secrete
What does FSH do?
stimulates the growth and development of follicles
Which cells within the follicles produce estrogen and stimulate endometrial growth?
theca cells
As follicles grow, ______ levels increase and help them respond to _____ with eventual ________.
- estradiol
- LH
- ovulation
What does luteinizing hormone do?
stimulates maturation of follicle and is responsible for Graafian follicular rupture causing ovulation
Once the Graafian follicle ruptures, _________ is stimulated and ____ after ovulation. When the fertilized ovum implants into the endometrium, ______ production signals the ________ to continue secreting progesterone to prevent _______ of the endometrium.
- progesterone
- peaks
- hCG
- corpus luteum
- shedding
If implantation does not occur, _________ __________ levels permit sloughing of the uterine lining.
decreasing progesterone
Any follicle measuring _____ will most likely ovulate.
<11 mm
Follicles grow _______ (approximately _____ mm/day).
- linearly
- 2-3mm/day
What suggests ovulation will occur within 24 hours?
line decreased reflectivity around follicle
What suggests ovulation will occur within 36 hours?
presence of cumulus oophorus (mural nodule within follicle)
What is mittelschmerz?
unilateral pelvic pain occurring mid-cycle, associated with ovulation
When does ovulation occur?
mid-cycle (ie: 32 day cycle = ovulates day 16)
Define hypermenorrhea (menorrhagia).
excessive volume during cyclic menstrual bleeding
Define hypomenorrhea.
an abnormally small amount of menstrual bleeding
Define polymenorrhea.
frequent menstrual bleeding occurring less than 21 days apart
Define oligomenorrhagia.
menstrual bleeding occurring more than 35 days apart
Define metrorrhagia.
irregular, frequent bleeding
Define menometrorrhagia.
bleeding that is irregular in both frequency and volume
Define intermenstrual bleeding.
bleeding that occurs between normal cycles
Define breakthrough bleeding.
intermenstrual bleeding in OCP or HRT
Define postcoital bleeding.
bleeding after vaginal intercourse
Define dysmenorrhea.
painful bleeding
Define amenorrhea, including primary and secondary.
absence of menstrual flow
- primary: patient has never had a period
- secondary: patient had periods but they stopped
Define post-menopausal bleeding.
bleeding occurring 1 year after menopause or at unanticipated times in HRT
Define dysfunctional uterine bleeding (DUB). What are the causes?
abnormal bleeding from an essentially normal uterus
- causes may be functional or organic, and may include endocrine disorders
The follicular phase happens in days _____, when the dormant _____ is stimulated by ______ and the fluid-filled _____ moves to the ovarian surface.
- egg
- FSH
- follicle
The dominant follicle may be identified by about day ___ when it measures ______.
- 8
- 10mm (size begins to exceed other follicles)
What is the maximum diameter of a Graafian follicle?
15-30mm
Around day ___, ovulation occurs and a surge of _____ causes rupture of the follicular membrane, usually within ______ hours after the surge.
- 14
- LH
- 24-36 hours
What are 2 sonographic findings that indicate that ovulation has occurred?
- sudden decrease in follicular size
2. free fluid in posterior cul-de-sac
The luteal phase occurs between days ______ and is when the expulsion of the ovum becomes the __________. This manufactures and secretes __________ (and smaller amounts of _______). to prepare and maintain the endometrium for _________.. In the absence of hCG, the corpus luteum regresses and atrophies, becoming the __________.
- 15-28
- corpus luteum
- progesterone
- estrogen
- implantation
- corpus albicans
What does the corpus albicans look like sonographically?
small, rounded hyperechoic area
Describe the sonographic findings in the luteal phase.
- replacement of dominant cystic follicle with an echogenic structure representing thrombus
- 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)
The _________ changes in thickness depending on the uterine phase.
functionalis
What days is the menstrual phase?
days 1-5
In the menstrual phase, during the final _____ days of the secretory phase, the _______________ is absorbed. Desquamation and sloughing of the _______ layer of endometrial tissue and blood cells occurs and is expelled as menses. Menstrual bleeding patterns vary, but typically begin with _____ hours of _____ flow followed by _____ days of _____ flow.
- 2-3 days
- endometrial intracellular edema
- superficial
- 12-24 hours of heavy flow
- 4-7 days of scanty flow
What are sonographic findings during the menstrual phase?
- thickened, echogenic endometrium prior to the start of menses (might see fluid in endometrium)
- complex appearance at the beginning menses
- thin, slightly irregular endometrium after shedding of tissue
- maximum AP diameter (post menses) 2mm
When is the proliferative phase?
days 6-14
In the proliferative phase, the regeneration and proliferation of the endometrium is stimulated by _________ secreted by the developing ________. The phase begins the _______ day after menses and lasts for about _____ days, ending at ________.
- estrogen
- follicles
- 4th or 5th day
- 10 days
- ovulation
Describe the sonographic features during the proliferative phase.
- hypoechoic area around prominent midline echo (early phase)
- tri-layered endometrium (late phase)
What is the peri-ovulatory endometrium referred to as?
three line sign
When is the secretory phase?
days 15-28
When is the endometrium at max thickness?
secretory phase
Beginning at ovulation in the secretory phase, the endometrium prepares for the possible implantation of a _______. Under the influence of ________, the endometrium becomes grossly ______ and ______. In the absence of fertilization, implantation and ____ production, the endometrial glands _______ and undergo ______, starting the cycle again.
- fertilized ovum
- progesterone
- edematous and spongy
- hCG
- fragment
- autolysis
What are the sonographic features during the secretory phase?
- hyperechoic endometrium with obscured midline echo (might not see cavity anymore), often with posterior acoustic enhancement
- max AP diameter up to 14-16mm
When are the hormones FSH and estrogen the dominant ones?
- days 1-5 – menses – follicular phase
- days 6-14 – proliferative phase – follicular phase
When is the hormone LH dominant?
- day 14
- proliferative phase (end of)
- ovulation
When is the hormone progesterone dominant?
- days 15-28
- secretory phase
- luteal phase
What is the most common OCP regimen in the US?
a combination of pills with both estrogen and progesterone
taken every day for 20-21 days
Most patients on OCPs will not develop ____________ and will not ________. However, TV imaging may reveal ____________ in these patients, measuring _______.
a dominant follicle and will not ovulate
smaller follicles, 5-19mm
What is suppressed in those on OCPs?
endometrial growth
What may the endometrial appearance assist in with those on OCPs with dysfunctional uterine bleeding?
evaluating an appropriate therapeutic dosage
What is the lifespan of most IUDs?
5-10 years, depending on type
Name the 3 most common types of IUDs and their brand names (one doesn’t have any brand names).
- Copper-coated – Paragard, Copper-T
- Lippes Loop –
- Hormonal – Mirena, Progestasert, Skyla, Liletta, Kyleena
What is a sonogram used for in evaluating an IUD?
- confirm IUD position in uterus
- document myometrial penetration
- 3D to determine exact location
When is uterine perforation most common?
at time of insertion of IUD
If IUD is not seen in the endometrial cavity or if peroration is suspected, _____ may help locate the device in the peritoneum.
x-ray
Describe the sonographic appearance of IUDs.
- hyperechoic to endometrium (sometimes may appear isoechoic)
- posterior acoustic shadow or other artifact
- positioned in fundus or mid portion of uterine body
Infertility affects how many American couples?
1 out of 7
___% of fertility issues are due to female factors, ___% to male factors and ____% related to both partners and _____% are unexplained.
40% = female factors 40% = male factors 5-10% = both partners 5-10% = unexplained
What are the female factors for infertility?
- an ovulation and abnormal ovulation
- tubal and transport factors (ie: adhesions, hydrosalpinx)
- endometriosis
- uterine factors (ie: myoma, congenital anomalies)
- polycystic ovarian syndrome
- cervical factors
What is sonography used for in in-vitro fertilization programs?
- Establish: normal uterine anatomy and evaluate endocrine indicators, such as thickness and texture of endometrium and presence of intracavitary lesions/or fluid.
- Monitor: the development of the growing follicles, determine the timing of injection of hCG to trigger ovulation
- Confirm: ovarian response to various drugs (ie: Clomid, Pergonal), or identify hyper stimulated ovaries
- Guide: oocyte retrieval from ovaries
Name the medications that are used for ovulation induction.
- Clomiphene Citrate
- Gonadotropins
- Glucophage
- hCG
- Parlodel and Dostinex
Clomiphene Citrate
Clomid, Serophene
- tablet form
- used for women who have infrequent periods or long menstrual cycles
Gonadotropins
Repronex, Follistim, Pergonal, Bravelle, Fertinex, Metrodin, Gonal-F
- injectable medication
- used to induce the release of the egg once the follicles are developed and eggs are mature
Glucophage
Metformin
- insulin lowering medication
- most commonly used in PCOS patients
- shown to reverse endocrine abnormalities seen with PCOS in 2-3 months
hCG
Pregnyl, Novarel, Ovidrel, Profasi
- used with other drugs to trigger ovulation
Parlodel and Dostinex
- used to lower prolactin levels and will also reduce pituitary tumor size if one is present
What is the IVF sonographic protocol?
- baseline TA sonogram
- preliminary TV evaluation of follicles
- daily TV to monitor dominant follicle
- medial to lateral usually best, be consistent
When are follicles typically aspirated for IVF?
18-24mm
Describe IVF.
- consists of ovarian stimulation
- needle aspiration of oocytes
- incubation of oocytes with sperm
- catheter delivery of typically 2-4 embryos into the uterus
Describe zygote intrafallopian tube transfer (ZIFT).
- embryo (or zygote) is placed into the Fallopian tube (rather than uterus)
Describe gamete intrafallopian tube transfer (GIFT).
- sperm and ova are placed into the Fallopian tube
Describe intrauterine insemination (IUI).
in cases of male factor infertility, u/s used to guide catheter placement of sperm preparation into the uterine fundus
What is ovarian hyper stimulation syndrome (OHSS)? What happens with mild cases vs severe cases?
a condition resulting from excessive stimulation of the ovaries
- mild cases usually resolve spontaneously following the next menstrual cycle
- severe cases are associated with a high mortality rate (up to 50%) and may require hospitalization for correction of fluid and electrolyte imbalances
In who does OHSS most commonly occur in? Who is it most severe in?
- women taking fertility drugs
- those who conceive
Describe the sonographic findings of OHSS.
- large simple cysts with an ovarian diameter >5cm
- bilateral
- resemble theca lutein cysts
- may have ascites and pleural effusion
