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Semester 2 > Menstrual cycle > Flashcards

Menstrual cycle Flashcards

1
Q

What three things must a woman have to have a normal menstrual period?

A

Normal HPO axis

Responsive endometrium

Patent outflow tract

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2
Q

When is the clinical dating of the menstrual cycle?

A

From the first day of the last period

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3
Q

What happens in the preparation phase of the menstrual cycle?

A

Follicles grow in the ovary

The cervix prepares to allow sperm in (opens)

Uterus proliferates Sexual interaction facilitated

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4
Q

Describe the events of the early follicular phase

A

Begins as menstrual shedding starts. Oestrogen returns to basal levels Hypothalamus and pituitary free from negative feedback. FSH and LH begin to rise in the absence of negative feedback from oestrogen (FSH raised more due to lack of inhibin). FSH stimulates granulosa cells, and LH stimulates theca cells. Follicles begin to grow

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5
Q

Which hormone is dominant in the mid-follicular phase?

A

Oestrogen Released by the follicle as it develops and grows

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6
Q

Describe the events of the mid-follicular phase

A

As follicles grow they secrete oestrogen and inhibin. This exerts negative feedback on FSH and LH. FSH is selectively depressed by inhibin, which means that no more follicles are recruited to mature. FSH falls more than LH. One follicle becomes dominant and matures (antral follicle/ Graafian follicle).

Motility of the oviduct and myometrium increase to encourage movement of the ova towards the ampulla.

The endometrium begins to proliferate and the cevix secretes a thin alkaline mucus when open which creates a favourable environment for the sperm.

Changes occur in vagina secretions, skin, hair and metabolism

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7
Q

What are the three layers of the uterus?

A

Endometrium (inner)

Myometrium (outer)

Perimetrium (outer coat)

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8
Q

What are the layers of the endometrium?

A

Strata functionalis (has compact and spongy layers)

Bastalis

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9
Q

What are the key events at the end of the follicular phase?

A

One follicle has become dominant (Graafian follicle) and levels of oestrogen rise rapidly, resulting in positive feedback on LH.

This produces the LH surge required for ovulation

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10
Q

What happens to the uterus in the follicular phase?

A

It begins to proliferate (endometrium layers grow in preparation for the conceptus)

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11
Q

Describe the changes that occur in ovulation

A

After the LH surge the Graafian follicle ruptures and the ova is released into the peritoneum (causes mid-cycle pain). Some fluid is also released which can irritate the peritoneum.

Mid-cycle can occur due to a temporary drop in oestrogen post-ovulation.

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12
Q

Describe the events of the luteal phase

A

THe disrupted follicle forms teh corpus luteum. This secretes oestrogen and progesterone.

LH, FSH and GnRH are suppressed by negative feedback.

The corpus luteum lasts 14 days and then regresses. This is the least variable part of the cycle.

The myometrium becomes quiescent and continues to proliferate.

Cervix secretes a thick acidic mucus which kills any sperm in the vaginal tract.

There is decreased libido, an increase in temperature, water retention and bloating due to testosterone.

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13
Q

Describe the events at the end of the luteal phase if the ova is not fertilised

A

The corpus luteam undergoes apoptosis if fertilisation fails to take place.

Levels of oestrogen and progesterone fall and the endometerium begins to shed (menstruation)

The pituirary and hypothalamus are freed from feedback inhibition.

LH anf FSH begin to rise to start a new cycle.

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14
Q

Describe the events at the end of the luteal phase if there is fertilisation

A

The conceptus implants into the endometrium and forms trophoblast layers which secretes hCG.

hCG maintains the corpus luteum to continue to secrete progesterone and oestrogen until the placenta has developed (10-12 weeks)

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15
Q

What are the three classic symptoms of the menopause?

A

Hot flushes

Sweats

Vaginal dryness

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16
Q

What is the menopause?

A

Cessation of the menses.

Normally occurs between 45-60. Decline is gradual as ovarian oestrogen levels are progressively reduced. Periods space out and cease.

Symptoms are primarily due to falling oestrogen levels

17
Q

Name four other symptoms a women may experience when going through the menopause?

A

Non-specific: Headaches, migranes, palpitations, disturbed sleep

Urogenital symptoms: vaginal dryness, cystitis, urinary frequency, urinary incontinence

Psychological: Loss of concentration, poor memory, irritability, loss of libido

Atrophy of connective tissue: skin thinning, hair loss, brittle nails, aches and pains, osteoporosis

18
Q

What is the normal onset of menarche?

A

11-15 years

19
Q

What is the average length of a normal menstrual cycle?

A

21-42 days

20
Q

How much blood is lost during menstrual flow?

A

30-120ml

21
Q

What are the important things to ask a patient who presents with menstrual problems

A

Menstrual history:
What is the normal cycle period?
Has there been an increase or decrease in normal flow?
ICE
Symptoms of anaemia

22
Q

Metrorrhagia

A

Heavy irregular periods

23
Q

What are the categories of abnormal bleeding?

A

No bleeding

Abnormal uterine bleeding

Early pregnancy complications

24
Q

Causes of dysmenorrhea

A

Painful periods

Primary: no pathology, due to increased release of prostaglandins. Treated with NSAIDs, time. Common in adolescents

Secondary: occurs in middle reproductive years, pathological e.g. endometriosis

25
Q

Endometriosis

A

Caused by ectopic endometrial glands and stroma.

Causes a cyclical pain due to the action of hormones regulating the menstrual cycle.

Symptoms include dysmenorrhoea, dyspareunia, irregular periods.

26
Q

Causes of amenorrhea

A

Primary amenorrhoea - no menarche by age 16

Secondary - over 3-6 months with no period.

Can be physiological or pathologic

27
Q

Name four physiological causes of amenorrhoea

A

Pre-puberty

Pregnancy

Lactation

Menopause

Puerperium

28
Q

Name four pathologic causes of amenorrhoea

A

Hypothalamic control (altered in anorexia and stress)

Pituitary tumor

Dysgenesis ot damage to the ovary

Damage to the uterus

Imperforate hymen

29
Q

What tests would you do in a patient who is amenorrheic?

A

Pregnancy test

Oestrogen levels

FSH levels

Hb/Hct levels

Thyroid hormone levels

Karyotype

30
Q

Name three causes of abnormal uterine bleeding

A

Endometrial cancer

Cervical cancer

Fibroids

Endometrial polyps

31
Q

What are fibroids?

A

The common name for uterine leiomyomas (benign smooth muscle neoplasms) which occur in the myometrium.

Leiomyomas are well defined, round, firm, gray-white tumors surrounded in a pseudocapsule. Can be submucosal, intramural or subserosal. May be asymptomatic even if extensive.

Can cause abnormal bleeding, compression of the bladder (causing urinary frequency), pain and impaired fertility.

32
Q

Name three causes of bleeding in early pregnacy

A

Implantation bleeding

Miscarriage

Molar pregnacy

Ectopic pregnancy.

33
Q

How would you evaluate abnorma bleeding in a patient?

A

History: general, menstrual

Physical examination, pelvic examination

Blood tests: hCG, Hb levels

Possible pelvic ultrasound and endometrial sampling

34
Q

What are the effects of oestrogen in the follicular/proliferative phase?

A

steadily rising titres of oestrogen stimulates:

secretion and muscular contraction in the fallopian tube, and the growth and motility of fallopian cilia

growth and motility of the myometrium

thickening of the endometrium, and secretion a watery fluid to help transport of sperm

secretion of thin alkaline cervical mucus

increased mitotic activity in the vaginal epithelium

mildly anabolic metabolic changes, depress appetite and affects the cardiovascular system

35
Q

What are the actions of progesterone in the luteal/secretory phase?

A

the action of progesterone on oestrogen primed cells:

Reduces fallopian tube motility, secretion and cilia activity

Stimulates further thickening of the myometrium, but reduces motility

Stimulates further thickening of the endometrium, increased secretion and the development of spiral arteries

Stimulates thickening and acidity f cervical mucus, to prevent sperm transport

Stimulate a mildly catabolic metabolic change and increases basal body temperature

36
Q

How would you evaluate abnorma bleeding in a patient?

A

History: general, menstrual

Physical examination, pelvic examination

Blood tests: hCG, Hb levels

Possible pelvic ultrasound and endometrial sampling

Semester 2 (70 decks)

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