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Gynae > Menstrual Cycle > Flashcards

Menstrual Cycle Flashcards

1
Q

Which phase of the varian cycle remains constant and for how long?

A

Luteal phase- 14 days

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2
Q

What 3 things are fundamental to a normal menstrual cycle?

A

Intact hypothalamo-pituitary-ovarian endocrine axis, presence of responsive follicles in the ovaries, and a functional uterus.

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3
Q

What is released by the hypothalamus?

A

GnRH- a decapeptide that is secreted in a pulsatile manner

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4
Q

When does GnRH act on?

A

It acts on the anterior pituitary, to stimulate synthesis and release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH)

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5
Q

What 2 things does FSH do?

A

It simulates follicular maturation during the follicular phase of the cycle. It also, along with LH, stimulates steroid hormone secretion (predominantly oestrogen) from granulosa cells of mature ovarian follicles.

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6
Q

What 3 things does LH do?

A

It contributes to steroidogenisis in follicle with FSH and it plays a role in ovulation. (this is dependant upon the mid-cycle surge of LH). Also production of progesterone by the corpus luteum is under the influence of LH.

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7
Q

When are polymenorrhea and IMB most common?

A

At extremes of reproductive age.

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8
Q

How do you assess for mennorrhagia?

A

Amount and timing, flooding and passage of clots, contraception, dysmenorrhea?

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9
Q

What is adenomyosis?

A

Ectopic endometrial tissue found in the muscular wall of the myometria (uterus).

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10
Q

When is an USS indicated in a patient with polymenorrhoea?

A

If >35 years with irregular or IMB or if <35 years and medical treatment has failed.

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11
Q

When is an endometrial biopsy indicated?

A

If the endometrium is thickened, polyp suspected or ablative surgery or the IUS are to be used.

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12
Q

When is a diagnostic laparoscopy indicated?

A

If endometriosis or chronic pelvic infection are suspected

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13
Q

What is the medical treatment for polymenorrhoea?

A

COCP- can induce regular and lighter menstruation. Cyclical progestogens- they cause amenorrhea but withdrawal can mimic normal menstruation. HRT may regulate erratic DUB during menopause. The mirena could can cause lighter periods and anti-fibrinolytics and NSAIDS (transexamic acid and mefenamic acid)

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14
Q

What is primary amenorrhoea?

A

When menstruation has not started by the age of 16

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15
Q

What is secondary amenorrhea?

A

Previously normal mentruation ceases for 6+ months

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16
Q

What is the definition or oligomenorrhea?

A

When menstruation occurs less frequently than every 35 days

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17
Q

Which drugs can cause amenorrhea?

A

Progestogens, GnRH analogues and sometimes major tranquillisers. THYROID

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18
Q

Which acquired disorders can cause amenorrhea?

A

Premature menopause, polycystic ovary syndrome and hyperprolactinaemia.

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19
Q

Hypothalamic hypogonadism can cause amenorrhoea, what is this?

A

Impaired secretion of GnRH, leading to impaired release and synthesis of FH and LSH by the anterior pituitary.

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20
Q

What are the usual causes of hypothalamic hypogonadism?

A

Anorexia nervosa or athleticism

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21
Q

What causes hyperprolactinaemia, leading to amenorrhoea?

A

Usually caused by pituitary hyperplasia or benign adenomas. (associated with PCOS and use of psycotropic drugs)

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22
Q

What is the treatment for hyperprolactinaemia?

A

Bromocriptine, cabergoline (dopamine agonists), or occassionally surgery.

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23
Q

What rare syndrome caused by severe post-patrum haemorrhage can lead to pituitary necrosis and this amenorrhea?

A

Sheehan’s syndrome

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24
Q

How can CAH cause amenorrhea?

A

Congenital adrenal hyperplasia, this causes excess androgen secretion and is seen in secondary amenorrhea.

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25
Q

Which acquired diseases of the ovary can cause amenorrhea?

A

PCOS, premature menopause (1 in 100), virilising tumours.

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26
Q

What are the congenital causes of amenorrhea?

A

Turners and gonadal dysgenesis (ovary os imperfectly formed due to mosaic abnormalities of the X chromosomes)

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27
Q

Which features can cause primary amenorrhea with secondary sexual characteristics?

A

imperforate hymen and transverse vaginal septum.

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28
Q

What is a haematocolpos/ haemotometra?

A

Menstruation accumulates in the vagina/ in the uterus. (surgical treatment)

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29
Q

Which acquired problems can cause secondary amenorrhea?

A

Cervical stenosis causing a haematometra or ashermans syndrome

30
Q

What causes Ashermans syndrome and what are the symptoms?

A

Consequence of accidental excessive D&C. (endometiral resection or ablation produces this effect intentioally). Symptoms are infertility, recurrent miscarriage and hypo or amenorrhea.

31
Q

What is the definition of menorrhagia?

A

More than 80mL menstrual loss or subjectively unacceptable loss to the woman

32
Q

What is irregular bleeding more commonly associated with?

A

Anovulatory causes and is more commonly associated with malignancy (especially in older women).

33
Q

What is the most common cause of menorrhagia?

A

DUB (60%)

34
Q

Name some systemic causes of menorrhagia.

A

Thyroid disease, haamostatic disorder e.g. von willebrands, anticoagulant therapy

35
Q

Anatomical causes of menorrhagia?

A

Fibroids, cervical and uterine polyps, adenomyosis and endometriosis.

36
Q

What are the rare causes of menorrhagia and more likely to cause irregular bleeding?

A

Chronic pelvic infection, ovarian tumours and endometrial and cervical malignancies.

37
Q

What is a lieomyomata?

A

It is a benign tumour of the myometrium (fibroid)

38
Q

How common are fibroids?

A

occur in 25% of women

39
Q

Who are fibroids most commonly seen in?

A

Women approaching the menopause, afro-caribbean women and those with a family history.

40
Q

Which qualities are protective for fibroids?

A

Parous women and the COCP

41
Q

Fibroid growth is oestrogen and probably progesterone dependent, so when would growth increase?

A

During pregnancy and with the combined contraceptive.

42
Q

In what types of fibroids is intermenstrual loss likely to occur?

A

If the fibroid is submucosal or polypoid.

43
Q

What percentage of fibroids are asymptomatic?

A

50%

44
Q

Can fibroids cause dysmennorhea?

A

YES- only seldom due to torsion or red degeneration

45
Q

What other symptoms do fibroids cause?

A

Frequency, retention, if they press on the ureters they can cause hydronephrosis, fertility can be impaired if the tubal ostia are blocked or submucosal fibroids prevent implantation.

46
Q

When do fibroids enlarge?

A

Mid pregnancy, pedunculated fibroids occasionally undergo torsion, causing pain.

47
Q

What is degeneration?

A

Normally the result of an inadequate blood supply.

48
Q

What is red degeneration characterised by?

A

pain and uterine tenderness

49
Q

What is a leiomyosarcomatoma?

A

This is a malignant fibroid and it occurs in 0.1-0.5% (VEYR RARE)

50
Q

What complications can fibroids cause in pregnancy?

A

Premature labour, malpresentations, transverse lie, obstructed labour and PPH.

51
Q

Should fibroids be removed at c-section?

A

No, as heavy bleeding can occur

52
Q

What complication can pedunculated fibroids undergo postpartum?

A

They may tort.

53
Q

What is the difference between a polyp and fibroid?

A

Polyps are made of endometrial tissue whereas fibroids are made of muscle.

54
Q

How does HRT affect fibroids?

A

HRT can cause continued fibroid growth after menopause

55
Q

What investigations are needed for suspected fibroids?

A

USS is helpful, laparoscopy can distinguish the fibroid from an ovarian mass. Hysteroscopy is used to assess distortion of the uterine cavity

56
Q

What signs may indicate a malignant fibroid?

A

Pain and rapid growth, growth in postmenopausal women not on HRT, poor response to GnRH agonists.

57
Q

How do GnRH agonists affect the levels of oestrogen and progestogen?

A

They reduce these, causing the fibroid to shrink.

58
Q

How does esmia work?

A

It blocks the effect of progesterone (this has a role in development of fibroids)

59
Q

How do GnRH agonists work in fibroids?

A

They cause temporary amenorrhea and fibroid shrinking by inducing a temporary menopausal state.

60
Q

What is a side effect of GnRH agonists?

A

They cause a loss in bone density and treatment is recommended for no longer than 9 months. (oestrogen could be added in to prevent this)

61
Q

What percentage of hysterectomies are carried out for fibroid problems?

A

20%

62
Q

When is hysteroscopic resection of fibroids indicated?

A

In a fibroid polyp or a small submucosal fibroid. (obvs useless for sub-serosal ones)

63
Q

What is a myomectomy and when is it indicated?

A

Removal of fibroids (fibroidectomy) and is used if medical treatment has failed but reproductive function is needed.

64
Q

What is the medical treatment of fibroids?

A

Transexamic acid, NSAIDs, or progestogens.

Radical: 3 months treatment with GnRH analogue

65
Q

What is an alternative to hysterectomy for fibroids?

A

Embolization- uterine artery embolised by radiologists. 80% success rate

66
Q

There is a rise in core body temperature early in the luteal phase following ovulation (between 0.5%-1%), what hormone is this mediated by?

A

Progesterone secretion

67
Q

Which blood test can a dr carry out to confirm ovulation and what does this show?

A

a blood test to detect the level of progesterone, this is because following ovulation the corpus luteum is formed and this secretes progesterone. These levels rise mid-luteal phase and is therefore suggestive of ovulation (fertility can be confirmed by this). SO confirming that she has periods cycles……

68
Q

An ovulation prediction test kit are based on the detection of which surge of hormone?

A

LH

69
Q

Which hormone is associated with the amount and consistency of clear cervical mucus which is cohesive ‘spinnbarkeit’?

A

Oestrogen/oestradiol. In the luteal phase this mucus becomes thicker, white and clumpy.

70
Q

The symptoms of breast tenderness, lethargy and bloating in the week coming up to menstruation are due to which hormone?

A

Progesterone

71
Q

What is the most common cause of irregular and heavy periods in adolescents?

A

Anovulation- common at the extremes of reproductive age (perimenopausal women too)

Gynae (15 decks)

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