menstrual cycle Flashcards
1
Q
menarche
A
- first menstruation
- avg age 12-13
- abnormal if < 8 or > 15
2
Q
when do pubertal changes occur in relation to menarche
A
- 2-3 years before menarche
3
Q
thelarche
A
- breast development
4
Q
pubarche
A
- pubic hair development
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
6
Q
menorrhagia
A
- abnormal heavy bleeding at regular intervals
7
Q
metorrhagia
A
- bleeding at irregular intervals
8
Q
menometorrhagia
A
- abnormal heavy bleeding at irregular intervals
9
Q
intermenstrual bleeding
A
- occurs between normal menstrual cycles
10
Q
polymenorrhea
A
- < 21 day cycle
11
Q
oligomenorrhea
A
- > 35 day cycle
12
Q
hypomenorrhea
A
- extremely light menstrual flow
13
Q
mittelschmerz
A
- ovulation or mid cycle pain
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
15
Q
phases of the ovarian cycle
A
- follicular phase- length can vary
- luteal phase- always 14 days
16
Q
granulosa cells
A
- surround oocytes
- have FSH receptors
- produce estrogen
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
hypothalamic dysfunction causing amenorrhea
- constitutional delay of pubert
- GnRH def- rare
- functional hypothalamic amenorrhea
- infiltrative diseases and tumors of hypothalamus
- systemic illnesses
26
pituitary dysfunction causing amenorrhea
- hyperprolactinemia
- prolactin secreting pituitary adenoma
- sellar masses
27
ovarian dysfunction causing amenorrhea
- turner syndrome (45X)
- 46 XY gonadal dysgenesis- high risk ovarian cancer bc ovaries are non functioning
- primary ovarian insufficiency
- ovarian tumors
- PCOS
28
uterine dysfunction and outflow tract disorders causing amenorrhea
- usu d/t anatomical obstruction
- intrauterine adhesions (asherman syndrome)
- muellerian agenesis or MRKH
- imperforate hymen
- transverse vaginal septum
29
dx of amenorrhea
- 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
treatment for amneorrhea
- treat underlying pathology
- achieve fertility if desired
- prevent complications
- psych counseling
- surgery may be required
31
dysmenorrhea
- recurrent crampy lower abd pain during menstruation
- primary- no pelvic pathology
- secondary- pelvic pathology
32
what causes dysmenorrhea
- excess production of endometrial prostaglandin -.> dysrhythmic uterine contractions -> ischemia -> pain
33
si/sx of dysmenorrhea
- crampy lower abd or pelvic pain
- back pain
- N/V/D
- head ache
- fatigue, dizziness
34
treatment for dysmenorrhea
- heat, exs, diet, behavioral interventions
- 1st line= NSAIDs
- 2nd line= OCPs, may be used 1st line if pt is sexually active
35
premenstrual syndrome (PMS)
- 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
premenstrual dysphoric disorder (PMDD)
- 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
what is the possible reason for PMS
- changes in ovarian steroids and functioning of central neurotransmitters
38
si/sx of PMS
- 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
dx of PMS
- 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
treatment for PMS
- 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
dysfunctional uterine bleeding
- 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
