Gynecology- Menstruation & Contraception

Question 1

Mechanism of normal menstruation

Answer 1

Ovulation–> corpus luteum(CL) produced progesterone –> differentiates the proliferative endometrium into secretory endometrium.

CL degenerates, ↓ progesterone –> ↓ endometrial blood supply –> shedding

Question 2

Diagnosis: 15yo, 1yr since menachry, heavy irregular cycles, anemic

Answer 2

Anovulatory cycles due to immature hypothalamic pituitary axis

Question 3

Mechanism of anovulatory heavy menstruation

Answer 3

Anovulation= no progesterone and no differentiation into secretory endometrium.

Unopposed estrogen stimulation –> uncontrolled proliferation of endometrium –> breakthrough bleeding when too thick& unstable

Question 4

Treatment for teen with heavy irregular cycles

Answer 4

oral Progesterone therapy

Question 5

Oral contraceptive hypertension

Answer 5

OCP commonly cause mild elevation in BP and in 5% HTN. Risk of HTN increases with duration of OCP use.

Question 6

management of hypertensive pts on OCP

Answer 6

Dont use combination estrogen-progestin OCPP in women with OCP. Discontinue and monitor BP.

If doesn’t correct offer lifestyle mods and meds.