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Clin Med III > menstrual cycle > Flashcards

menstrual cycle Flashcards

1
Q

menarche

A
  • first menstruation
  • avg age 12-13
  • abnormal if < 8 or > 15
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2
Q

when do pubertal changes occur in relation to menarche

A
  • 2-3 years before menarche
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3
Q

thelarche

A
  • breast development
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4
Q

pubarche

A
  • pubic hair development
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5
Q

how long is the normal menstrual cycle

A
  • avg is 28 days
  • normal is 21-35 days
  • duration of bleeding is avg 4 days but can be 1-8 days
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6
Q

menorrhagia

A
  • abnormal heavy bleeding at regular intervals
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7
Q

metorrhagia

A
  • bleeding at irregular intervals
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8
Q

menometorrhagia

A
  • abnormal heavy bleeding at irregular intervals
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9
Q

intermenstrual bleeding

A
  • occurs between normal menstrual cycles
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10
Q

polymenorrhea

A
  • < 21 day cycle
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11
Q

oligomenorrhea

A
  • > 35 day cycle
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12
Q

hypomenorrhea

A
  • extremely light menstrual flow
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13
Q

mittelschmerz

A
  • ovulation or mid cycle pain
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14
Q

overview of menstrual cycle hormones

A
  • hypothal releases GnRH -> stim pituitary
  • pituitary releases LH and FSH -> stim ovaries
  • ovaries release estrogen -> stim endometrium to thicken and bleed unless pregnant
  • progesterone is produced by corpus luteum
  • ovaries send signal back to pituitary and hypothalamus
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15
Q

phases of the ovarian cycle

A
  • follicular phase- length can vary

- luteal phase- always 14 days

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16
Q

granulosa cells

A
  • surround oocytes
  • have FSH receptors
  • produce estrogen
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17
Q

Theca cells

A
  • surround oocytes
  • have LH receptors
  • produce androgens
18
Q

uterine/ endometrial cycle phases

A
  • proliferative phase- estrogen induces cell division -> build up of endometrial lining
  • secretory phase- cell division stops to stabilize uterine lining
  • menstruation occurs or pregnancy
19
Q

what causes LH surge and what is the purpose

A
  • elevated estradiol mid cycle

- causes egg maturation and ovulation

20
Q

amenorrhea

A
  • absence of menstruation
21
Q

primary amenorrhea

A
  • absence of menarche by age 15
22
Q

secondary amenorrhea

A
  • no period for at least 3 mo in regular cycles

- no period for at least 6 mo in irregular cycles

23
Q

causes of primary amenorrhea

A
  • gonadal dysgenesis*
  • muellerian agenesis*
  • constitutional delay of puberty
  • PCOS
  • GnRH def- rare
  • transverse vaginal septum
  • weight loss/ anorexia nervosa (if going on before menarche)
  • hypopituitarism
24
Q

causes of secondary amenorrhea

A
  • pregnancy**
  • hypothalamic*
  • pituitary
  • ovarian
  • uterine
  • other
25
Q

hypothalamic dysfunction causing amenorrhea

A
  • constitutional delay of pubert
  • GnRH def- rare
  • functional hypothalamic amenorrhea
  • infiltrative diseases and tumors of hypothalamus
  • systemic illnesses
26
Q

pituitary dysfunction causing amenorrhea

A
  • hyperprolactinemia
  • prolactin secreting pituitary adenoma
  • sellar masses
27
Q

ovarian dysfunction causing amenorrhea

A
  • turner syndrome (45X)
  • 46 XY gonadal dysgenesis- high risk ovarian cancer bc ovaries are non functioning
  • primary ovarian insufficiency
  • ovarian tumors
  • PCOS
28
Q

uterine dysfunction and outflow tract disorders causing amenorrhea

A
  • usu d/t anatomical obstruction
  • intrauterine adhesions (asherman syndrome)
  • muellerian agenesis or MRKH
  • imperforate hymen
  • transverse vaginal septum
29
Q

dx of amenorrhea

A
  • good a good history
  • PE
  • labs: hCG, FSH, TSH, prolactin, testosterone if indicated
  • focus on presence/ absence of breast dev, uterus, and FSH levels
  • US- only if you need to det if pt has uterus
30
Q

treatment for amneorrhea

A
  • treat underlying pathology
  • achieve fertility if desired
  • prevent complications
  • psych counseling
  • surgery may be required
31
Q

dysmenorrhea

A
  • recurrent crampy lower abd pain during menstruation
  • primary- no pelvic pathology
  • secondary- pelvic pathology
32
Q

what causes dysmenorrhea

A
  • excess production of endometrial prostaglandin -.> dysrhythmic uterine contractions -> ischemia -> pain
33
Q

si/sx of dysmenorrhea

A
  • crampy lower abd or pelvic pain
  • back pain
  • N/V/D
  • head ache
  • fatigue, dizziness
34
Q

treatment for dysmenorrhea

A
  • heat, exs, diet, behavioral interventions
  • 1st line= NSAIDs
  • 2nd line= OCPs, may be used 1st line if pt is sexually active
35
Q

premenstrual syndrome (PMS)

A
  • physical, emotional, behavioral, and cognitive sx that occur in second half of menstrual cycle
  • resolve after menses
  • interfere with some aspect of woman’s life
  • present for at like 3 cycles to dx
36
Q

premenstrual dysphoric disorder (PMDD)

A
  • severe form of PMS
  • sx of anger, irritability, and internal tension prominent
  • usu 5 or more sx present before menses
  • higher assoc with SI and suicide attempts
37
Q

what is the possible reason for PMS

A
  • changes in ovarian steroids and functioning of central neurotransmitters
38
Q

si/sx of PMS

A
  • mood swings, angry outbursts, irritability
  • anxiety, depression
  • increased appetite or food cravings
  • sleep disturbances/ insomnia
  • poor concentration
  • breast tenderness/ pain
  • bloating, constipation
  • HA, fatigue, dizziness
  • hot flashes
39
Q

dx of PMS

A
  • sx begin anytime after menarche, usu in 20s and continue through reproductive life
  • assess impact of QOL and suicide risk
  • ask pt to keep sx diary X 2 mo
  • r/o other behavioral and physical causes
40
Q

treatment for PMS

A
  • mild sx- exercise, stress reduction technique
  • first line= SSRIs
  • 2nd line= OCPs
  • 3rd line= GnRH agonists with low dose estrogen-progestin replacement (rare)
  • last line= surgically remove ovaries, almost never done
41
Q

dysfunctional uterine bleeding

A
  • abnormal bleeding
  • not assoc with lesions, pelvic pathology, pregnancy, or other systemic diseases
  • usu d/t problem with HPO axis
  • need to det of ovulation is occuriong
  • common after menarche and perimenopause

Clin Med III (26 decks)

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