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Gynaecology > Menstrual Cycle > Flashcards

Menstrual Cycle Flashcards

1
Q

Primary amenorrhea

A

No menarche at 15 yrs despite nrml 2nd sexual characteristics

Or

No menarche at 13 plus no 2nd sexual characteristics

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2
Q

FSH stimulates?

A

Granulosa cells to prod progesterone & androstenedione

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3
Q

FSH inhibition by?

A

(Negative feedback) -Inhibin B & estradiol

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4
Q

In the menstrual cycle LH surge due to?

A

Positive feedback (estradiol secreted by maturing follicle)

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5
Q

Normal menstrual cycle length

A

24 - 38 days

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6
Q

Menses duration and blood loss?

A

3-7 days

35 - 50 ml

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7
Q

Follicular phase?

A

Day 1 - 14

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8
Q

Fate of Graffian follicle

A

Corpus Luteum

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9
Q

Length of Luteal phase

A

14-15 days

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10
Q

Primary dysmenorrhea

A

Lower abdominal/before or during menses

Absence of pathological findings

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11
Q

Primary dysmenorrhea diagnosis?

A

Diagnosis of exclusion

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12
Q

1mry dysmenorrhea treatment?

A
  • NSAIDS

- hormonal contraceptives (COCP, IUD w/levonorgestrel)

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13
Q

Uterine causes of 2ndry dysmenorrhea?

A

-PID
-IUD
-Adenomyosis
•Leiomyoma
•Cervical Polyps

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14
Q

Extrauterine causes of 2ndry dysmenorrhea?

A

-ENDOMETRIOSIS
- Adhesions
- functional ovarian cyst
•IBD

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15
Q

Causes of Primary Amenorrhea

A
  • Constitutional Growth delay
  • Hypogonadotrophic hypogonadism
  • Hypergonadotrophic hypohonadism
    •Anatomic anomalies
    •receptor enzyme abnormalities
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16
Q

Deficient GnRH syndromes

A

• Kallmann syndrome (anosmia)
• Prader willi syndrome (hyperphagia)
• Stress/sports eating disorders
-CNS tumors (craniopharyngioma)

17
Q

Most common cause of 1ry amenorrhea

A

Gonadal dysgenesis

  • Turner syndrome 45X0
  • Swyer syndrome
  • 46XY gonadal dysgen
18
Q

Anatomic anomalies causing 1mry amenorrhea?

A

-Mulerian agenesis
- Imperforate Hymen
-Vaginal atresia
•Transverse vaginal Hymen

19
Q

Receptor enzyme abnormalities causing 1mry amenorrhea?

A
  • Complete androgen insensitivity syndrome
  • 5 alpha reductase deficiency
  • Congenital adrenal hyperplasia (17alpha hydrolase deficiency)
20
Q

Abnormal lab result in primary ovarian insufficiency (hypergonadotrophic)

A

Elevated FSH

21
Q

Lab finding in androgen secreting tumor?

A

Elevated dehydroepiandrosterone sulfate (DHEA-S)

22
Q

Congenital adrenal hyperplasia clinical finding?

A

High blood pressure

23
Q

2ndry amenorrhea definition

A

Regular cycle: Absent menses for > 3 months

Irregular cycle: Absent menses for > 6 months

24
Q

Most common cause of 2ndry amenorrhea?

A

Pregnancy

25
Q

Medications causing amenorrhea?

A
  • antipsychotics
  • chemo
  • OCP
26
Q

Pathology of hypothyroid amenorrhea?

A

dec. T3/T4 — ^TRH — ^Prolactin — dec. GnRH — dec. Estrogen

27
Q

Syndromes causing 2ndry amenorrhea?

A

• Sheehan syndrome (ischemia)
• Asherman syndrome
• Cushing syndrome
- Adrenal insufficiency

28
Q

Functional hypothalamic amenorrhea?

Etiologies?

A

Dysfunction in pulsatile secretion of GnRH

  • excess exercise
  • reduced calorie intake
  • stress
  • Female athlete triad syndrome*
29
Q 
Cause of..
• Menstrual dysfunction
• Decreased bone density 
• Calorie deficit 
in Athletic adolescent?
A

Female athlete triad syndrome

(dec. Leptin / increased Cortisol)

30
Q

Medical tax for prolactinoma?

Mechanism of drug?

A
  • Bromocriptine
  • Cabergoline

D2 agonist

31
Q

Structural causes of AUB

A
  • Polyps
  • Adenomyosis
  • Leiomyomas
  • Malignancy and hyperplasia
32
Q

Non-structural causes of AUB

A
  • Coagulopathies
  • Ovulation disorders
  • Endometrial disorders
  • Iatrogenic
  • Not otherwise classified
33
Q

Chronic AUB definition

A

Uterine bleed of abnormal frequency, regularity and or volume for > 6 months

34
Q

Initial laboratory tests in AUB and reason

A

•CBC (rule out anemia)
•Beta hCG (r/o pregnancy)
•PT, PTT (r/o coauglopathy)
-TFT’s

35
Q

Indications for endometrial biopsy in AUB

A
  • Endometrial thickness >4mm
  • > 45y with freq. heavy/ prolonged bleed
  • < 45y, freq. heavy/prolonged bleed + risk of endometrial Ca.
  • Obesity
  • T2 DM
  • PCOS
  • tamoxifen therapy
  • Lynch syndrome
36
Q

Tx of acute AUB

Hemodynamically stable

A

High dose IV conjugated estrogen

Or

OCP, progestin, tranexamic acid (2nd line)

37
Q

Non surgical tx of ovulatatory bleeding

A
  • OCP’s, progestin
  • NSAID
  • Transxamic acid
38
Q

Surgical tx options for AUB

A
  • D&C
  • Endometrial Ablation
  • Transcatheter uterine artery embolizatiom (first line in AVM)
  • Hysteroscopy (polyps)
  • Hysterectomy
39
Q

First line tx of PMS

A

NSAIDS (napronex)

OCP’s

Gynaecology (7 decks)

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