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OB/GYN > Female Physiology > Flashcards

Female Physiology Flashcards

1
Q

Define menarche.

A

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

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2
Q

Define menopause.

A

termination of regular menses, usually occurring between 45-55 years of age

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3
Q

Define premature menopause.

A

termination of regular menses prior to age 40

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4
Q

The endometrium and ovaries respond to _______ and ________ levels in the blood. These levels are determined by a feedback mechanism between the ______ and the ________/________ complex.

A
  • estrogen
  • progesterone
  • ovaries
  • hypothalamus/pituitary
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5
Q

When serum estradiol levels fall below a given concentration, the _________ produces ____________.

A
  • hypothalamus

- gonadotropic releasing hormone (GnRH)

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6
Q

The production of GnRH signs the _________ to produce gonadotropins: ________ and _______.

A
  • pituitary

- FSH and LH

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7
Q

A “-tropic” hormone signals an organ to _______ or ______.

A

function or secrete

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8
Q

What does FSH do?

A

stimulates the growth and development of follicles

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9
Q

Which cells within the follicles produce estrogen and stimulate endometrial growth?

A

theca cells

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10
Q

As follicles grow, ______ levels increase and help them respond to _____ with eventual ________.

A
  • estradiol
  • LH
  • ovulation
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11
Q

What does luteinizing hormone do?

A

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

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12
Q

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.

A
  • progesterone
  • peaks
  • hCG
  • corpus luteum
  • shedding
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13
Q

If implantation does not occur, _________ __________ levels permit sloughing of the uterine lining.

A

decreasing progesterone

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14
Q

Any follicle measuring _____ will most likely ovulate.

A

<11 mm

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15
Q

Follicles grow _______ (approximately _____ mm/day).

A
  • linearly

- 2-3mm/day

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16
Q

What suggests ovulation will occur within 24 hours?

A

line decreased reflectivity around follicle

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17
Q

What suggests ovulation will occur within 36 hours?

A

presence of cumulus oophorus (mural nodule within follicle)

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18
Q

What is mittelschmerz?

A

unilateral pelvic pain occurring mid-cycle, associated with ovulation

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19
Q

When does ovulation occur?

A

mid-cycle (ie: 32 day cycle = ovulates day 16)

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20
Q

Define hypermenorrhea (menorrhagia).

A

excessive volume during cyclic menstrual bleeding

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21
Q

Define hypomenorrhea.

A

an abnormally small amount of menstrual bleeding

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22
Q

Define polymenorrhea.

A

frequent menstrual bleeding occurring less than 21 days apart

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23
Q

Define oligomenorrhagia.

A

menstrual bleeding occurring more than 35 days apart

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24
Q

Define metrorrhagia.

A

irregular, frequent bleeding

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25
Q

Define menometrorrhagia.

A

bleeding that is irregular in both frequency and volume

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26
Q

Define intermenstrual bleeding.

A

bleeding that occurs between normal cycles

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27
Q

Define breakthrough bleeding.

A

intermenstrual bleeding in OCP or HRT

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28
Q

Define postcoital bleeding.

A

bleeding after vaginal intercourse

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29
Q

Define dysmenorrhea.

A

painful bleeding

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30
Q

Define amenorrhea, including primary and secondary.

A

absence of menstrual flow

  • primary: patient has never had a period
  • secondary: patient had periods but they stopped
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31
Q

Define post-menopausal bleeding.

A

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

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32
Q

Define dysfunctional uterine bleeding (DUB). What are the causes?

A

abnormal bleeding from an essentially normal uterus

- causes may be functional or organic, and may include endocrine disorders

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33
Q

The follicular phase happens in days _____, when the dormant _____ is stimulated by ______ and the fluid-filled _____ moves to the ovarian surface.

A
  • egg
  • FSH
  • follicle
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34
Q

The dominant follicle may be identified by about day ___ when it measures ______.

A
  • 8

- 10mm (size begins to exceed other follicles)

35
Q

What is the maximum diameter of a Graafian follicle?

A

15-30mm

36
Q

Around day ___, ovulation occurs and a surge of _____ causes rupture of the follicular membrane, usually within ______ hours after the surge.

A
  • 14
  • LH
  • 24-36 hours
37
Q

What are 2 sonographic findings that indicate that ovulation has occurred?

A
  1. sudden decrease in follicular size

2. free fluid in posterior cul-de-sac

38
Q

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 __________.

A
  • 15-28
  • corpus luteum
  • progesterone
  • estrogen
  • implantation
  • corpus albicans
39
Q

What does the corpus albicans look like sonographically?

A

small, rounded hyperechoic area

40
Q

Describe the sonographic findings in the luteal phase.

A
  • 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)
41
Q

The _________ changes in thickness depending on the uterine phase.

A

functionalis

42
Q

What days is the menstrual phase?

A

days 1-5

43
Q

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.

A
  • 2-3 days
  • endometrial intracellular edema
  • superficial
  • 12-24 hours of heavy flow
  • 4-7 days of scanty flow
44
Q

What are sonographic findings during the menstrual phase?

A
  • 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
45
Q

When is the proliferative phase?

A

days 6-14

46
Q

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 ________.

A
  • estrogen
  • follicles
  • 4th or 5th day
  • 10 days
  • ovulation
47
Q

Describe the sonographic features during the proliferative phase.

A
  • hypoechoic area around prominent midline echo (early phase)
  • tri-layered endometrium (late phase)
48
Q

What is the peri-ovulatory endometrium referred to as?

A

three line sign

49
Q

When is the secretory phase?

A

days 15-28

50
Q

When is the endometrium at max thickness?

A

secretory phase

51
Q

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.

A
  • fertilized ovum
  • progesterone
  • edematous and spongy
  • hCG
  • fragment
  • autolysis
52
Q

What are the sonographic features during the secretory phase?

A
  • hyperechoic endometrium with obscured midline echo (might not see cavity anymore), often with posterior acoustic enhancement
  • max AP diameter up to 14-16mm
53
Q

When are the hormones FSH and estrogen the dominant ones?

A
  • days 1-5 – menses – follicular phase

- days 6-14 – proliferative phase – follicular phase

54
Q

When is the hormone LH dominant?

A
  • day 14
  • proliferative phase (end of)
  • ovulation
55
Q

When is the hormone progesterone dominant?

A
  • days 15-28
  • secretory phase
  • luteal phase
56
Q

What is the most common OCP regimen in the US?

A

a combination of pills with both estrogen and progesterone

taken every day for 20-21 days

57
Q

Most patients on OCPs will not develop ____________ and will not ________. However, TV imaging may reveal ____________ in these patients, measuring _______.

A

a dominant follicle and will not ovulate

smaller follicles, 5-19mm

58
Q

What is suppressed in those on OCPs?

A

endometrial growth

59
Q

What may the endometrial appearance assist in with those on OCPs with dysfunctional uterine bleeding?

A

evaluating an appropriate therapeutic dosage

60
Q

What is the lifespan of most IUDs?

A

5-10 years, depending on type

61
Q

Name the 3 most common types of IUDs and their brand names (one doesn’t have any brand names).

A
  1. Copper-coated – Paragard, Copper-T
  2. Lippes Loop –
  3. Hormonal – Mirena, Progestasert, Skyla, Liletta, Kyleena
62
Q

What is a sonogram used for in evaluating an IUD?

A
  • confirm IUD position in uterus
  • document myometrial penetration
  • 3D to determine exact location
63
Q

When is uterine perforation most common?

A

at time of insertion of IUD

64
Q

If IUD is not seen in the endometrial cavity or if peroration is suspected, _____ may help locate the device in the peritoneum.

A

x-ray

65
Q

Describe the sonographic appearance of IUDs.

A
  • hyperechoic to endometrium (sometimes may appear isoechoic)
  • posterior acoustic shadow or other artifact
  • positioned in fundus or mid portion of uterine body
66
Q

Infertility affects how many American couples?

A

1 out of 7

67
Q

___% of fertility issues are due to female factors, ___% to male factors and ____% related to both partners and _____% are unexplained.

A 
40% = female factors
40% = male factors
5-10% = both partners
5-10% = unexplained
68
Q

What are the female factors for infertility?

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
69
Q

What is sonography used for in in-vitro fertilization programs?

A
  • 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
70
Q

Name the medications that are used for ovulation induction.

A
  • Clomiphene Citrate
  • Gonadotropins
  • Glucophage
  • hCG
  • Parlodel and Dostinex
71
Q

Clomiphene Citrate

A

Clomid, Serophene

  • tablet form
  • used for women who have infrequent periods or long menstrual cycles
72
Q

Gonadotropins

A

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
73
Q

Glucophage

A

Metformin

  • insulin lowering medication
  • most commonly used in PCOS patients
  • shown to reverse endocrine abnormalities seen with PCOS in 2-3 months
74
Q

hCG

A

Pregnyl, Novarel, Ovidrel, Profasi

  • used with other drugs to trigger ovulation
75
Q

Parlodel and Dostinex

A
  • used to lower prolactin levels and will also reduce pituitary tumor size if one is present
76
Q

What is the IVF sonographic protocol?

A
  • baseline TA sonogram
  • preliminary TV evaluation of follicles
  • daily TV to monitor dominant follicle
  • medial to lateral usually best, be consistent
77
Q

When are follicles typically aspirated for IVF?

A

18-24mm

78
Q

Describe 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
79
Q

Describe zygote intrafallopian tube transfer (ZIFT).

A
  • embryo (or zygote) is placed into the Fallopian tube (rather than uterus)
80
Q

Describe gamete intrafallopian tube transfer (GIFT).

A
  • sperm and ova are placed into the Fallopian tube
81
Q

Describe intrauterine insemination (IUI).

A

in cases of male factor infertility, u/s used to guide catheter placement of sperm preparation into the uterine fundus

82
Q

What is ovarian hyper stimulation syndrome (OHSS)? What happens with mild cases vs severe cases?

A

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
83
Q

In who does OHSS most commonly occur in? Who is it most severe in?

A
  • women taking fertility drugs

- those who conceive

84
Q

Describe the sonographic findings of OHSS.

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

OB/GYN (6 decks)

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