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Fall 2020 Sexual and Reproductive Health > Menstrual Cycle > Flashcards

Menstrual Cycle Flashcards

1
Q

Objectives

  1. Define features of the average menstrual cycle
  2. Verbalize the key elements of a menstrual history.
  3. Understand the anatomy and physiology of the menstrual cycle: HPO-axis, ovarian cycle, endometrium cycle
  4. Define functional, ovarian cysts
  5. Recognize common non-pharmacologic and pharmacologic interventions for dysmenorrhea and PMDD (premenstrual dysmorphic disorder)
A
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2
Q

Is Monthly Menses Necessary?

A

NO

Not necessary IF we’re disrupting the cycle with exogenous hormones (birth control pills, something else with esrogen/progesterone)

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3
Q

Average Menstrual Cycle

  1. ​Ave age of menarche =
  2. WNL cycle length =
  3. WNL days of bleeding =
  4. WNL amount of flow per day =
  5. Ave age of menopause =
A
  1. 12-13 (range: 10-15)
  2. 21-38 days (ave 25-35)
  3. 2-8 days (ave 4-6)
  4. 5-80mL (30-60mL)
  5. 51 (range 45-55)

Menopause: 12 full months of no period to be post-menopausal

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4
Q

Menstrual History

  1. Current ____
  2. Age at _____
  3. _ _ _, _ _ _
  4. Bleeding _____
    1. Cycle l_____, r_____
    2. ______ of flow
    3. _____ of flow
  5. Moliminal (_______) symptoms
  6. Associated ____
  7. Other ______ symptoms
  8. ___menstrual bleeding
A
  1. Age
  2. Menarche
  3. LMP, PMP (previous menstrual period)
  4. Pattern
    1. length, regularity
    2. Duration
    3. Amount
  5. Premenstrual
  6. Pain
  7. Associated sx
  8. Intermenstrual bleeding
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5
Q

Characteristics of Menses

(4)

A

Frequency

Regularity

Duration of Flow

Volume of Blood

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6
Q

Frequency of Menses*

  1. Frequent =
  2. Normal =
  3. Infrequent =
A
  1. <21d
  2. 21-38d
  3. >38d
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7
Q

Regularity of Menses*

  1. Absent =
  2. Regular =
  3. Irregular =
A
  1. —-
  2. + 2-20d
  3. >20d
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8
Q

Duration of Flow*

  1. Prolonged =
  2. Normal =
  3. Shortened =
A
  1. >8d
  2. 4-8d
  3. <4d
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9
Q

Volume of Blood*

  1. Heavy* =
  2. Normal =
  3. Light =
A
  1. >80mL
  2. 5-80mL
  3. <5mL
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10
Q

HEAVY FLOW*

Changing pads/tampons > ?

Use of > ___ tampons for single menses

Have to change at _____

Clots > ___ inch

A_____

______ with daily _______

A

>Q3h

20

night

Clots >1 inch

Anemia

Interferes w Activity

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11
Q

Anatomy

(3)

A

Brain - Hypothalamus/Pituitary

Ovaries - Follicles/Oocyte

Uterus - Endometrium

Target Organ: Ovaries, Brain-> Ovary -> Uterus

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12
Q

Ovarian Cycle

OVUM/OVULATION

  1. D1-14
  2. D14
  3. D14-28
A
  1. Follicular
  2. Ovulation
  3. Luteal

Ovarian cycle -> to produce the egg (high in estrogen production)

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13
Q

Uterine (Endometrial) Cycle

LINING PREP

  1. Menses =
  2. Proliferative =
  3. Secretory =
A
  1. D1-6
  2. D6-14
  3. D14-28

preparation/buildup of uterus lining (progestrone dominant)

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14
Q

Ovarian Follicles

Follicle = ____ sac containing an ____ (oocyte)

At puberty ____-_____

that will be ovulated ____ - ______

Follicles recruited q month __-__

Stages of development (4)

____ dominant follicle ovulates each month (______ follicle)

A

Fluid, egg

300-400,000

300-400

10-40

Primordial, Primary, Secondary, Tertiary/Antral

One dominant ovulates each month = Graafian follicle

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15
Q

Folliculogenesis

Stages of Follicular Development

_____ _____ (yellow body) is what produces _____ (2nd half of cycle)

A

Corpus Luteum, progesterone

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16
Q

Pics of Tertiary/Antral Follicle and Graafian Follicle

A
17
Q

Ovarian Cycle- Follicular Phase

FSH targest ______ Cells -> to make ______

LH targets _____ Cells -> to make ______

1st stage: All produces _____ in the end

A

Granulosa Cells -> Aromatase

Theca Cells -> Androstenoedione (Androgen)

Estradiol (Estrogen)

18
Q

Ovarian Cycle: Ovulation

  • __ peaks: __-___ hrs prior to ovulation ->
  • _____ in follicular fluid digest follicle ____ and release _____ ->
  • Ovulation =

2nd stage

A
  • LH, 10-12
  • Enzymes, wall, prostaglandins
  • Release of Ovum
19
Q

Ovary, Follicle, Egg Pictures

A
20
Q

Ovarian Cycle: Early Luteal Phase

(3)

Increased ___ ->

Inhibits what?

A

Ruptured Follicle, Corpus Luteum, Progesterone and Estrogen

Progesterone

Inhibits Hypothalamus and pituitary from produsing GnRH, FSH, LH

High lvl of progesterone in early Luteal Phase stimulates negative feedback loop to the hypothalamus to stop producing GnRH, FSH, and LH bc we have ovulated already

21
Q

Ovarian Cycle Late Luteal Phase

4 Steps

A

Corpus Luteum Degenerates ->

Corpus Albicans ->

RAPID decline in E and P ->

Hypothalamus and Pituitary secrete GnRH, FSH, LH

Cycle starts again so stimulates HPO axis again

22
Q

Ovarian Cysts

Functional (Simple) Ovarian Cysts

Follicular:

Luteal:

A

: Follicle fails to release Egg - Majority asymptomatic

Corpus Luteum fails to break down, reseals, fills with fluid- Majority asymptomatic

We don’t really worry about them too much - extremely common and usually resolves on its own

23
Q

Menstrual Cycle Anatomy: Uterus

Top of the uterus = _____

A

fundus

24
Q

Uterus: Endometrium

=

(2) types of cells
(2) types of glands stroma

______ changes over the course of the menstrual cycle, by how much?

A

Innermost lining of the uterus (is the FUNCTIONAL layer)

Columnar and Eptihelial Cells

Functionalis and Basalis

Thickness, 2mm-16mm

25
Q

Uterine/Endometrial Cycle: Menstrual Phase

______ in Estrogen and Progesterone ->

_____ release from lysosomes ->

D______ of functional layer

B_____ in endometrial cavity

______ release

Smooth muscle _______

A

Decline ->

Enzyme ->

Dissolution

Blood

Prostaglandin

Contraction

26
Q

Uterine/Endometrial Cycle: Proliferative Phase

  • Early: Endometrium = _____
    • ​Endometrial glands:s___, n____, sh____
  • Late: Endometrium = _____
    • ​Endometrial glands: ____plasia, *______*, l____, enmeshed
  • Ends with: ________
A
  • Thin
    • ​short, narrow, short
  • Thick
    • hyperplasia, PROLIFERATE, long, enmeshed
  • Ovulation
27
Q

Uterine/Endometrial: Secretory Phase

Corpus Luteum SECRETES ______

Endometrial glands _____, fill w _______

Th___, c____ny, nut____: favorable environment for ______ of ____ egg

A

Progesterone

dilate, secretions

Thick, cushiony, nutritive, implantation of fertilized egg

28
Q

Menstrual Cycle: Associated Changes

Focus on cervical fluid changes

  • Day 1-5 =
  • Day 6-9
  • Day 10-11 =
  • Day 12-13 =
  • Day 14-15 =
  • Day 16-27 =
  • Day 28 =
A
  • Period
  • Dry
  • Sticky
  • Cloudy
  • Egg White***
  • Sticky
  • Period
29
Q

Ultrasound Transvaginal

A
30
Q

Ultrasound Endometrium

Is the Endometrium Thin or Thick? What phase?

A

Thin

Early proliferative

31
Q

Endometrium Ultrasound

Is the endometrium thin or thick? What stage?

A

Thick

Proliferative stage

32
Q

Endometrium Ultrasound

What stage?

A

Secretory phase- BRIGHT

Since we don’t get a secretory phase unless ovulation has occurred, we can also tell if someone is not pregnant through this image in an US

33
Q

Primary Dysmenorrhea Treatment Options

  1. Lifestyle changes (3)
  2. Prostaglandin Inhibition
    1. ​_______ (initiate day ____ to bleeding)
    2. ______ 400-800mg q6 hrs
    3. _______ Acid 250mg q8hrs
    4. ______ 550mg q12hrs
  3. Endometrial _____; ___orrhea: through hormonal _______
  4. Complimentary Therapies (5)
A
  1. Heat, Stress reduction, Exercise
  2. Prostaglandin inhibition
    1. NSAIDs (day before)
    2. Ibuprofen
    3. Mefanic Acid
    4. Naproxen
  3. Thinning: Amenorrhea: hormonal contraception (probably the best bet)
  4. CAM
    1. Herb: Shirazi Thymus Vulgaris
    2. Vit B1
    3. Vit E
    4. Ginger
    5. Acupunture/Accupressure
34
Q

PMDD Premenstrual Dysphoric Disorder

DSM IV Criteria

  • In most menstrual cycles during the past year, _____ or more of the following symptoms were present for most of the time during the last week of the _____ phase, begin to remit within a few days after the onset of the _____ phase, and were absent in the week of post_____, with at least one of the symptoms being either 1, 2, 3, or
  • Understand that there is a connection between the ____ and ____ systems -> therefore mood changes when there’s a functuation in these hormones
A
  • 5 sx, luteal, follicular, postmenses
  • Serotonin and Gonadotropic
35
Q

PMS/PMDD Treatment Options

______ Most Effective

  1. Any Lvl of Symptoms:
  2. Mild Symptoms:
  3. Mod-Severe Symptoms:
  4. Severe and unresponsive to SSRI or COC:
A

Multimodal

  1. Self care/health promotion, social support, psychosocial strategies, complimentary therapies
  2. Exercise, Relaxation techniques, vitamins B6, E, Calcium, Magnesium, Tumeric
  3. 1) SSRI’s (Zoloft, Paxil, CelXA, Prozac) daily luteal phase only, or premenstrual to onset of menses, 2) HC/OCP: Drosperinone containing
  4. 1) GnRH Agonist, 2) Surgery (bilateral oopherectomy/hysterectomy)

Fall 2020 Sexual and Reproductive Health (10 decks)

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