Lecture 11: Menstrual Disorders

Question 1

Between estradiol and progesterone which is the most prominent in each of the ovarian cycle phases?

Answer 1

Follicular phase = estradiol

Luteal phase = progesterone (estradiol too just more progesterone)

Question 2

When do estrogen levels generally reach a maximum in the ovarian cycle?

Answer 2

1 day before the midcycle LH peak

After the peak and before ovulation there is a marked and precipitous fall

• During the luteal phase, estradiol rises to a maximum 5-7 days after ovulation and returns to baseline before menstruatiion

Question 3

When does secretion oof progesterone by the corpus luteum reach a maximum?

Answer 3

5-7 days after ovulation and returns to baseline before menstruation

• Prior to ovulation the unruptured luteinizing Graafian follicle begins to produce increasing amounts of progesterone

Question 4

Primary amenorrhea is defined as absence of menarche by age _______ without secondary sexual development OR by the age of _____ with secondary sexual development

Answer 4

13;15

Question 5

Most normal cycles range from ____ to ____ days even in first gynecologic year. By the third year after menarche approximately 80% of menstrual cycles are ____ to _____ days long, as is typical of adults

Answer 5

2-45 days; 21-35 days

**Median length of first cycle after menarche was 34 days and most females bled 2-7 days during first menstruation

Question 6

Secondary amenorrhea is defined as the absence of menstruation for _____ months. It is rare for girls and adolescents to remain amenorrheic for more than ____ months

Answer 6

6; 3

**If >90 days further workup is indicated

Question 7

Menorrhegia is defined as menstrual flow of greater than ___cc

Answer 7

80

• changing a pad every 1-2 hrs is excessive especially if the bleeding is lasting >7 days

Question 8

What are uterine Leiomyomas “fibroids” (AUB-L)?

Answer 8

Benign tumors derived from smooth muscle cells of the myometrium

• rarely malignant
• most are asymptomatic
• Sx = Excessive uterine bleeding, pelvic pressure and pain, infertility
• Risk factors = increasing age during reproductive years, african american, nulliparity, Fx

Question 9

What is the most common neoplasm of the uterus?

Answer 9

Uterine leiomyomas “fibroids” (AUB-L)

Question 10

What causes endometrial hyperplasia (AUB-M)?

Answer 10

Represents an over abundance growth of the endometrial lining usually as a result of persistent unopposed estrogen possibly due to things such as PCOS, granulosa theca cell tumors-estrogen producing tumors, obesity-secondary to peripheral conversion of androgens to estrogens in adipose cells, exogenous estrogens without Progestins or tamoxifen

Endometrial hyperplasia is a precursor to endometrial cancer

Question 11

What are the 4 possible endometrial hyperplasia malignancy precursors?

Answer 11

Simple without atypia -> 1% chance

Complex without atypia -> 3% chance

Simple with atypia -> 9% chance

Complex with atypia -> 27% chance

Rules of 3

Question 12

Define primary oocyte

Answer 12

Cells that have begun 1st meiotic division, arrested at prophase 1

Question 13

Define follicular cells

Answer 13

Angle layer of cells that surround a primordial follicle, associated with a basement membrane

Question 14

Define granulosa cells

Answer 14

Follicular cells that proliferate and become stratified

• will eventually segregate into cumulus oophorous, mural granulosa cells and corona radiata

Question 15

Define zona pellucida

Answer 15

Coat of glycoproteins that encases primary oocyte, involved with sperm recognition (ZP1-4)

Question 16

Ovarian stromal cells differentiate and form outer covering (theca) surrounding the follicle. What are the general roles of the theca interna versus externa?

Answer 16

Theca interna = steroid producing

Theca externa = fibroblasts and smooth muscle

Question 17

Defne secondary oocyte

Answer 17

Cells that complete 1st meiotic division (with LH stimulation), enter meiosis II but arrest at metaphase II