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Y5 Gynae & Obstetrics > Hormonal Control of the Menstrual Cycle > Flashcards

Hormonal Control of the Menstrual Cycle Flashcards

1
Q

What hormone does the hypothalamus secrete for the menstrual cycle? In what manner?

A

GnRH

In pulses

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2
Q

Which hormones does GnRH trigger secretion of?

A

LH, FSH in pituitary

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3
Q

Which other hormones regulate LH, FSH release?

A

oestrogen

progesterone

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4
Q

How does oestrogen regulate LH, FSH

A

High oestrogen causes INCREASE in LH

Low oestrogen causes DECREASE in LH

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5
Q

How does progesterone regulate LH, FSH

A

High progesterone causes DECREASE in LH, FSH

Low progesterone causes INCREASE in LH, FSH

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6
Q

How does the COCP work on the menstrual cycle?

A

It maintains a constant serum oestrogen level that is in the negative feedback range
So there never is a surge in LH

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7
Q

What are the three stages in the uterine cycle?

A

Maria Prefers SAM

Menstruation
Proliferation
Secretory

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8
Q

What are the stages in the ovarian cycle?

A

Maria Forgets Of Laura

Menstruation
Follicular
Ovulation
Luteal

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9
Q

What stage of meiosis are oocytes stuck at from birth to puberty?

A

Prophase I

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10
Q

Describe the follicular stage

A

FSH rises
This stimulates some follicles to grow
The follicles produce androgens (from theca cells) which are then converted to oestrogen (from granulosa cells)

Oestrogen starts increasing, but it has a negative feedback effect on FSH, so FSH decreases

This causes follicular atresia except for the DOMINANT Follicle

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11
Q

What cells produce inhibin?

A

Granulosa cells

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12
Q

What does inhibit do?

A

further reduces FSH

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13
Q

What occurs in the ovulatory phase?

A

The dominant follicle keeps producing oestrogen until it switches to POSITIVE FEEDBACK on the pituitary

Oestrogen positive feedback on the pituitary causes LH surge (and smaller FSH surge)

Surge of LH and FSH stimulates resumption of meiosis and rupture of the ovarian follicle, so the oocyte is released

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14
Q

What occurs in the luteal phase?

A

The remaining theca cells and granulosa cells form the corpus luteum

The corpus luteum secretes lots of progesterone (and some oestrogen)

Progesterone inhibits FSH, LH

Ion the absence of beta hCG, corpus luteum regresses by luteolysis

Corpus luteum regresses to a corpus albicans, that does not make hormones

As there is a progesterone withdrawal, this results in menstruation

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15
Q

What occurs in the menstruations phase in the uterine cycle?

A

The endometrium is shedded (the stratum compactum and spongiosum)

The stratum basalts (deepest) remains through out the cycle

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16
Q

What occurs to the endometrium in the proliferative stage=

A

High oestrogen levels stimulate:

  • thickening of the endometrium
  • growth of endometrial glands
  • formation of spiral arteries
  • Thickening of cervixal mucous
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17
Q

How does the endometrial epithelium change during the proliferative phase?

A

From single columnar to pseudo stratified

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18
Q

Who does thickness of the endometrium change during the proliferative phase?

A

From 0.5mm to 3.5mm

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19
Q

What occurs to the endometrium in the secretly phase=

A 
Progesterone forms the decidua 
Pinopodes appear (apical membrane projections of epithelial cells) making the endometrium receptive for implantations)

Endometrial glands become tortuous, spiral arteries grow, uterine glands secrete mucous

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20
Q

What is the role of leptin in puberty?

A

PERMISSIVE
So it is required for puberty to occur
Lack of leptin e.g. if very underweight means no puberty

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21
Q

What is the mean age of menarche?

A

12.8 years

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22
Q

What are physical changes in secondary sex characteristics?

A

Breast development
Pubic and axillary hair growth
Growth spurt
Menarche

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23
Q

What staging describes pubertal development?

A

Tanner staging

24
Q

What is precocious puberty?

A

Puberty before the age of 9 in boys, 8 in girls

25
Q

What is delayed puberty?

A

Lack of signs of secondary sex characteristics by the age of 14

26
Q

What are causes of delayed puberty?

A

Central (due to no GnRH response)

  • anorexia nervosa, excessive exercise
  • chronic illness
  • Kallmanns

Peripheral

  • gonadal failure
  • Turners
27
Q

What is Kallmans syndrome?

A

Lack of GnRH production

28
Q

What is the genotype in Turner’s

A

45X

29
Q

What are presenting features of Turner’s

A

Short stature
Webbing of neck
Wide carrying angle

30
Q

What conditions is Turners associated with

A

Aortic coarctation
IBS
Sensorineural/conduction deafness
Renall anomalies

31
Q

What is 46XY gonadal dysgenesis due to

A

SRY gene mutation

32
Q

What is swyer syndrome?

A

Complete gonadal dysgenesis - gonads remain as streak, do not produce any hormones

In absence of anti-mullarian hormone, mullein structures develop normally
Absence of testosterone means foetus does not virile
BUT GONADS DO NOT FUNCTION, so patient presents with delayed puberty

33
Q

What s the most common cause of 46XY DSD?

A

Complete androgen insensitivity

34
Q

What is primary amenorrhoea?

A

Failure to menstruate by the age of 16

35
Q

What is secondary amenorrhoea?

A

Absence of menstruation for MORE THAN 6 MONTHS in a female of reproductive age that is not due to pregnancy, lactation or menopause

36
Q

What is oligomenorrhoea?

A

Irregular periods at intervals >35 days with only 4-9 periods a year

37
Q

What are key investigations for oligomenorrhoea?

A 
pregnancy test 
Bloods - hormone levels (LH, FSH, prolactin, testosterone, TFT)
TVUS 
MRI 
Karyotyping ...
38
Q

What criteria are used to diagnose PCOS?

A

Rotterdam consensus criteria

39
Q

Explain the Rotterdam consensus criteria

A

Must have 2 of the 3:

  • Amenorrhoea/oligomenorrhoea
  • clinical or biochemical hyperandrogegism m
  • PCO on USS (12+ follicular cysts)
40
Q

What diseases is PCOS associated with

A

T2DM

CV events

41
Q

How can you manage PCOS?

A

Lifestyle advice, weight reduction

COCP - regulates menstruation
or cyclical oral progesterone (to induce bleeds)b

Ovarian drilling (may destroy ovarian storm, prompt ovulatory cycles)

42
Q

How do you treat PCOS if sub fertility is an issue?

A

Clomiphene (SERM)

43
Q

What is the function of FSH?

A

Recruitment and maturation of oocyte

Production of oestrogen

44
Q

What is the function of LH?

A

Release of oocyte (ovulation)

Production of androgens

45
Q

What is the function of oestrogen?

A

Thicken the endometrial lining

46
Q

What is the function of progesterone?

A

Maintain the endometrial lining

47
Q

How can you classify causes of amenorrhoea?

A

Hypothalamic
Pituitary
Ovarian
Endometrial

48
Q

What are hypothalamic causes of amenorrhoea?

A

KALLMAN’S syndrome
Excessive exercise / weight loss / stress
Head injury
Hypothalamic lesion (craniopharyngioma, glioma)
Drugs (progestogens, HRT, dopamine agonist)
Systemic disorders (Sarcoid, TB)

49
Q

What are pituitary causes of amenorrhoea?

A
  • Adenoma (prolatinoma)
  • Pituitary necrosis (Sheehan’s)
  • Iatrogenic (surgery, radiotherapY)
  • Congenital pituitary development failure
50
Q

Why does Sheehan’s cause pituitary necrosis?

A

Because the pituitary increases in size during pregnancy
However the blood supply to it remains the same
So excessive blood loss (e.g. PPH) may cause infarction of the pituitary and therefore necrosis

51
Q

What ovarian disorders cause amenorrhoea?

A

PCOS

52
Q

What endometrial disorders cause amenorrhoea’

A
  • Primary amenorrhoea: Haematocolpos (vagina filled with blood) if imperforate hymen/ malarian duct anomaly
  • Secondary amenorrhoea: Asherman’
53
Q

What investigations can be done for amenorrhoea?

A

Pregnancy test
Hormone levels (FSH, testosterone raised > PCOS)
Prolactin (Prolactinoma)
Thyroid
TVUSS, MRI
Hysteroscopy (Asherman’s, cervical stenosis)
Karyoptyping (e.g. Turner’s)

54
Q

What are LH and FSH like in PCOS patients?

A

LH > FSH

This causes excess androgen production

55
Q

What are complications of PCOS?

A

T2DM
CVD
Infertility
Endometrial hyperplasia

56
Q

Why is endometrial hyperplasia in PCOS occurring and why is it dangerous?

A

Endometrial hyperplasia occurs because increased oestrogen levels in PCOS maintain a thickened endometrium. No bleeds mean that the endometrium is not shed
Ensure that there is at least 4 periods per year or induce them
This will prevent endometrial cancer

57
Q

What are management options for PMS?

A

CONSERVATIVE:

  • encourage healthy lifestyle
  • improved nutrition
  • regular exercise
  • alcohol, caffeine limitation
  • Exercise
MEDICAL: 
- COCP (bicycle/tricycle)
- Transdermal oestrogen 
- GnRH analogue 
- SSRI
- CBT for depression 
HYSTERECTOMY last reserve

Y5 Gynae & Obstetrics (34 decks)

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