Menstrual Cycle Flashcards
1
Q
Reservoir of follicles
A
Ovary
2
Q
Cortex of ovary contains
A
Primordial follicle and granulosa cell
3
Q
Medulla of ovary contains
A
Blood vessels and Theca cells.
4
Q
When does H-P-O axis become functional
A
@ puberty
5
Q
Pathway of FSH
A
Hypothalamus produces GnRH which acts on Anterior pituitary which produces FSH.
6
Q
Role of FSH
A
FSH acts on Granulosa cells which produce Estrogen and Inhibin B
7
Q
Function of Estrogen
A
Negative feedback on FSH and Positive feedback on LH
Proliferates endometrium.
8
Q
Role of Inhibin B
A
Negative feedback on FSH
9
Q
FSH receptors are present on
A
Granulosa cells
10
Q
Granulosa cell tumor AKA
A
Feminizing tumor
11
Q
Tumor marker for Granulosa cell or feminizing tumor is
A
Inhibin B
12
Q
Types of Estrogen - E1
A
Estrone
13
Q
E2
A
Estradiol
14
Q
E3
A
Estriol
15
Q
E4
A
Estetrol
16
Q
Role of LH
A
Due to positive feedback from Estrogen - LH level inc - Called as LH surge - 200 pg for 48 hrs = LH Surge
LH acts on theca cells to produce Androgens which are converted to Estrogen in granulosa and adipose tissue .
Acts on granulosa cell and small amounts of progesterone is produced before ovulation.
17
Q
LH surge
A
LH levels above 200 pg for 48 hrs
Leads to Completion of meiosis 1 and conversion of follicle to Corpus luteum. this is called OVULATION.
18
Q
What is ovulation.
A
Conversion of 1 primary to secondary oocyte and follicle to corpus luteum.
19
Q
Two Cell Two Gonadotropin Theory
A
both Theca and Granulosa cell are required for production of Estrogen
Theca cells produce Androgens which are then converted to estrogen in granulosa cells
20
Q
Aromatase enzyme is absent in _____ cell
A
Theca cells
21
Q
Aromatase enzyme is present in ____ cell
A
Granulosa cell
22
Q
CYP17 is present in _____ cell
A
Theca cell
23
Q
CYP17 is absent in _____ cell
A
Granulosa cell
24
Q
Role of LH on granulosa cell
A
Luteinisation happens - Small amounts of progesterone is produced before ovulation.
This progesterone has positive feedback on LH and FSH.
25
Follicular or proliferative phase
Day 1 - 14
Starts with FSH release from Anterior pituitary and ends with ovulation on Day 14
Pre antral - antral to graafian follicle to corpus luteum
primary to secondary oocyte.
Main Hormone - Estrogen
26
Ovarian cycle is initiated by
FSH
27
Size of Follicle before ovulation
18-20 mm
28
Time btw LH surge and Ovulation
32-36 hrs or 24-36 hrs
29
Time between LH peak and Ovulation
10-12 hrs.
30
Time between Estrogen peak and LH peak
14-24 hrs
31
Time between Estrogen peak and ovulation.
24-26 hrs.
32
LH surge is maintained by
Estrogen and progesterone
33
LH surge is initiated by
Estrogen
34
Meiosis 1 is resumed by
LH surge
35
Cumulus oophorus
Granulosa cells surrounding primary oocyte in antral follicle
36
Anovulation - Pathogenesis
Appearance of LH in antral cavity fluid early in the cycle instead of mid cycle leading to atesia of the follicle and decreased mitotic activity of granulosa cell.
37
Maintenance of Corpus luteum in a non pregnant female is by
LH
38
Corpus Luteum grows cos of which hormone
LH
39
Corpus luteum attains maximum size on which day
D22 of the cycle or 8 days post fertilisation.
40
Hormones produced by corpus luteum
Progesterone, Estrogen and Inhibin B
41
Function of Progesterone
Negative feedback on LH
Secretory action
Supports Uterus
42
Relaxin
Produced by Corpus luteum in pregnancy
43
At low concentration, Progesterone
Inc FSH and LH
44
At high concentration, Progesterone
Dec LH and FSH
45
Corpus luteum degeneration.
Due to dec in LH levels, Support to CL ends and it degenerates leading to dec in levels of Progesterone, estrogen, and Inhibin A.
Dec Progesterone leads to Endometrial shedding and Dysmenorrhoea.
Dec Estrogen - inc levels of FSH cos of dec negative feedback.
FSH again acts on granulosa cells leading to inc estrogen levels and proliferation of endometrium for next cycle.
46
Enzyme responsible for Endometrial shedding
Enz Metalloproteinase
47
Menstruation
Endometrial shedding
48
Dysmenorrhoea
Pain at time of menses due to myometrial contraction due to inc PGF2 Alpha due to vasoconstriction
49
Which layer of endometrium is shed during menstruation
Superficial layer
50
Layer of endometrium responsible for regeneration of entire endometrium for next cycle
Deep layer
51
2nd half of Menstrual cycle is called
Luteal or secretory phase
52
DOC for Luteal phase defect
Progesterone.
53
Main hormone in 1 st phase of menstrual cycle
Estrogen
54
Main hormone in 2nd phase of menstrual cycle
Progesterone
55
Which part of the menstrual cycle is fixed
Luteal Phase - 14 days
56
How to calculate Day of Ovulation
Count 14 days backwards from Day of menstruation.
57
Lifespan of corpus luteum in non pregnant female
10-12 days
58
Lifespan of corpus luteum in pregnant females
10-12 weeks.
59
Which hormone prevents Corpus luteum from undergoing Luteolysis in a pregnant female
HCG
60
LH and FSH peak at
Time of ovulation
61
Estrogen peaks at
32-34 hrs before ovulation.
62
Progesterone peaks at
D22 of cycle.
63
all tests for ovulation are done on
Day 22 of cycle
64
Minimum level of FSH and LH found in which phase
Secretory phase.
65
MId- Cycle Pain in abdomen
Mittelschmerz syndrome.
66
Pain in abdomen at the time of ovulation
Mittelschmerz syndrome.
67
Basal body temperature increased at
time of ovulation.
68
Most important hormone needed for menstruation
Progesterone
69
Priming of endometrium is done by
Estrogen
70
Postponing or preponing the menses
Start progesterone 2-3 days before the expected date
| 5mg Primolut - N -TDS
71
Female complains of delayed menses - how to manage
If UPT is negative -
Give Progesterone for 3-5 days and stop.
3 days after stoppage - menses should occur
Meprate - BD / TDS
72
Irregular, painless, heavy bleeding
Anovulatory cycles.
73
Females with complains of anovulation - Pathogenesis
No corpus luteum - dec progesterone
Inc levels of estrogen - Endometrium excessive proliferation leads to Estrogen breakthrough bleeding.
Anovulatory cycles.
74
Dysmenorrhoea
Pain at time of menstruation
75
Types of Dysmenorrhoea
Primary or secondary
76
Primary Dysmenorrhoea
Normal physiologic dysmenorrhoea - no pelvic pathology
| Due to PGF2 alpha
77
Spasmodic dysmenorrhoea
Primary dysmenorrhoea
78
Secondary dysmenorrhoea
Pain due to pelvic pathology
| Congestive dysmenorrhoea
79
Congestive dysmenorrhoea
secondary dysmenorrhoea
80
Pain that subsides with onset of menses
Primary dysm.
81
Pain that does not subside with onset of menses
Secondary dysm.
82
Mx of primary dysmenorrhoea
NSAIDS - Mefenamic acid or OCP which leads to Anovulatory cycles
83
Mx of secondary dysmenorrhoea
Treat underlying pathology
84
OCP's -
Synthetic estrogen and synthetic progesterone
85
DOC in irregular menstrual cycle
OCP
86
Low dose estrogen in OCP
30-35 mcg
87
Very low dose estrogen in OCP
< 20 mcg
88
OCP's are protective in
Hyperestrogenic conditions
89
Hyperestrogenic conditions
Endometriosis
Endometrial Cancer
Endometrial Hyperplasia
Fibroids
90
Mx of Excessive bleeding at time of menses
Tranexamic acid > OCP's > Progesterone.
91
Normal length of a cycle
24- 38 days
92
Average length of a cycle
28 days
93
Number of days of bleeding in a cycle
2-7 days
94
Average days of bleeding in a cycle
4-6 days
95
Normal blood loss in a cycle
5 - 80 ml
96
Average blood loss in a cycle
30 > 35 > 50 ml
97
Atypical uterine bleeding is
Any deviation from the normal characteristics of a normal cycle.
98
Menorrhagia
Excessive bleeding at regular cycle
> 85 ml or > 7 days
Seen in fibroids
99
Hypomenorrhoea
Reduced bleeding at regular cycles
< 5ml or< 2 days
Seen in asherman syndrome
100
Oligomenorrhea
Longer duration of cycles
| Infrequent menstruation
101
Polymenorrhea
Shorter duration of cycles
| Frequent menstruation
102
Metrorrhagia
Irregular bleeding or intermenstrual bleeding
| seen in polyps
103
Menometrorrhagia
excessive bleeding at irregular intervals
| seen in fibroid polyp and anovulatory cycles,
104
Abnormal uterine bleeding
Pelvic pathology causing excessive bleeding
105
Dysfunctional uterine bleeding
No pelvic pathology involved
106
Causes of AUB
```
PALMCOEIN
P- Polyps
A- Adenomyosis
L- Leiomyoma - fibroid
M - Malignancy
C- Coagulation disorder
O-Ovulatory dysfunction
E- Endometrial dysfunction
I- Iatrogenic
N- Not yet classified
```
107
Mx of excessive bleeding
TVS to be done .
Check for endometrial thickening
In premenopausal women - > 12 mm
In menopausal >5mm
Indication for Biopsy
If uniformly thickened - Endometrial aspiration biopsy using Pipelle device and vibra aspirator
If Localised or focal thickening - Hysteroscopy and biopsy
108
Gold standard for Excessive bleeding
Fractional curettage > DnC
109
MCC of DUB in young females
Puberty or menarche -
| Check TSH, Bleeding disorders , and TVS
110
Causes of DUB in reproductive females
Thyroid disorders ,
Bleeding disorders,
Pregnancy complications
premalignant conditions
111
Mx of Mild to Moderate DUB
Non hormonal - Tranexamic acid / mefenamic acid
| OCP's > Progesterone ( 5mg * 21 days) >Mirena (progesterone IUD)
112
Mx of Severe DUB
If vitals stable - High dose of oral Estrogen for 24 hrs - followed by OCP's or progesterone
If vitals unstable - D n C then put patient on IV estrogen or OCP or Progesterone.
113
Uncontrollable DUB - MX
if above 40 years - TAH or TCRE / endometrial ablation.
114
TCRE
Transcervical resection of endometrium
115
what does high dose of estrogen do in DUB
leads to over proliferation - filling gaps in the layer .
116
Menstrual blood is
Arterial
