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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
What is delayed puberty?
Lack of signs of secondary sex characteristics by the age of 14
26
What are causes of delayed puberty?
Central (due to no GnRH response) - anorexia nervosa, excessive exercise - chronic illness - Kallmanns Peripheral - gonadal failure - Turners
27
What is Kallmans syndrome?
Lack of GnRH production
28
What is the genotype in Turner's
45X
29
What are presenting features of Turner's
Short stature Webbing of neck Wide carrying angle
30
What conditions is Turners associated with
Aortic coarctation IBS Sensorineural/conduction deafness Renall anomalies
31
What is 46XY gonadal dysgenesis due to
SRY gene mutation
32
What is swyer syndrome?
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
What s the most common cause of 46XY DSD?
Complete androgen insensitivity
34
What is primary amenorrhoea?
Failure to menstruate by the age of 16
35
What is secondary amenorrhoea?
Absence of menstruation for MORE THAN 6 MONTHS in a female of reproductive age that is not due to pregnancy, lactation or menopause
36
What is oligomenorrhoea?
Irregular periods at intervals >35 days with only 4-9 periods a year
37
What are key investigations for oligomenorrhoea?
``` pregnancy test Bloods - hormone levels (LH, FSH, prolactin, testosterone, TFT) TVUS MRI Karyotyping ... ```
38
What criteria are used to diagnose PCOS?
Rotterdam consensus criteria
39
Explain the Rotterdam consensus criteria
Must have 2 of the 3: - Amenorrhoea/oligomenorrhoea - clinical or biochemical hyperandrogegism m - PCO on USS (12+ follicular cysts)
40
What diseases is PCOS associated with
T2DM | CV events
41
How can you manage PCOS?
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
How do you treat PCOS if sub fertility is an issue?
Clomiphene (SERM)
43
What is the function of FSH?
Recruitment and maturation of oocyte | Production of oestrogen
44
What is the function of LH?
Release of oocyte (ovulation) | Production of androgens
45
What is the function of oestrogen?
Thicken the endometrial lining
46
What is the function of progesterone?
Maintain the endometrial lining
47
How can you classify causes of amenorrhoea?
Hypothalamic Pituitary Ovarian Endometrial
48
What are hypothalamic causes of amenorrhoea?
KALLMAN'S syndrome Excessive exercise / weight loss / stress Head injury Hypothalamic lesion (craniopharyngioma, glioma) Drugs (progestogens, HRT, dopamine agonist) Systemic disorders (Sarcoid, TB)
49
What are pituitary causes of amenorrhoea?
- Adenoma (prolatinoma) - Pituitary necrosis (Sheehan's) - Iatrogenic (surgery, radiotherapY) - Congenital pituitary development failure
50
Why does Sheehan's cause pituitary necrosis?
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
What ovarian disorders cause amenorrhoea?
PCOS
52
What endometrial disorders cause amenorrhoea'
- Primary amenorrhoea: Haematocolpos (vagina filled with blood) if imperforate hymen/ malarian duct anomaly - Secondary amenorrhoea: Asherman'
53
What investigations can be done for amenorrhoea?
Pregnancy test Hormone levels (FSH, testosterone raised > PCOS) Prolactin (Prolactinoma) Thyroid TVUSS, MRI Hysteroscopy (Asherman's, cervical stenosis) Karyoptyping (e.g. Turner's)
54
What are LH and FSH like in PCOS patients?
LH > FSH This causes excess androgen production
55
What are complications of PCOS?
T2DM CVD Infertility Endometrial hyperplasia
56
Why is endometrial hyperplasia in PCOS occurring and why is it dangerous?
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
What are management options for PMS?
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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