Menstrual Cycle Flashcards
Objectives
- Define features of the average menstrual cycle
- Verbalize the key elements of a menstrual history.
- Understand the anatomy and physiology of the menstrual cycle: HPO-axis, ovarian cycle, endometrium cycle
- Define functional, ovarian cysts
- Recognize common non-pharmacologic and pharmacologic interventions for dysmenorrhea and PMDD (premenstrual dysmorphic disorder)
Is Monthly Menses Necessary?
NO
Not necessary IF we’re disrupting the cycle with exogenous hormones (birth control pills, something else with esrogen/progesterone)
Average Menstrual Cycle
- Ave age of menarche =
- WNL cycle length =
- WNL days of bleeding =
- WNL amount of flow per day =
- Ave age of menopause =
- 12-13 (range: 10-15)
- 21-38 days (ave 25-35)
- 2-8 days (ave 4-6)
- 5-80mL (30-60mL)
- 51 (range 45-55)
Menopause: 12 full months of no period to be post-menopausal
Menstrual History
- Current ____
- Age at _____
- _ _ _, _ _ _
- Bleeding _____
- Cycle l_____, r_____
- ______ of flow
- _____ of flow
- Moliminal (_______) symptoms
- Associated ____
- Other ______ symptoms
- ___menstrual bleeding
- Age
- Menarche
- LMP, PMP (previous menstrual period)
- Pattern
- length, regularity
- Duration
- Amount
- Premenstrual
- Pain
- Associated sx
- Intermenstrual bleeding
Characteristics of Menses
(4)
Frequency
Regularity
Duration of Flow
Volume of Blood
Frequency of Menses*
- Frequent =
- Normal =
- Infrequent =
- <21d
- 21-38d
- >38d
Regularity of Menses*
- Absent =
- Regular =
- Irregular =
- —-
- + 2-20d
- >20d
Duration of Flow*
- Prolonged =
- Normal =
- Shortened =
- >8d
- 4-8d
- <4d
Volume of Blood*
- Heavy* =
- Normal =
- Light =
- >80mL
- 5-80mL
- <5mL
HEAVY FLOW*
Changing pads/tampons > ?
Use of > ___ tampons for single menses
Have to change at _____
Clots > ___ inch
A_____
______ with daily _______
>Q3h
20
night
Clots >1 inch
Anemia
Interferes w Activity
Anatomy
(3)
Brain - Hypothalamus/Pituitary
Ovaries - Follicles/Oocyte
Uterus - Endometrium
Target Organ: Ovaries, Brain-> Ovary -> Uterus
Ovarian Cycle
OVUM/OVULATION
- D1-14
- D14
- D14-28
- Follicular
- Ovulation
- Luteal
Ovarian cycle -> to produce the egg (high in estrogen production)
Uterine (Endometrial) Cycle
LINING PREP
- Menses =
- Proliferative =
- Secretory =
- D1-6
- D6-14
- D14-28
preparation/buildup of uterus lining (progestrone dominant)
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)
Fluid, egg
300-400,000
300-400
10-40
Primordial, Primary, Secondary, Tertiary/Antral
One dominant ovulates each month = Graafian follicle
Folliculogenesis
Stages of Follicular Development
_____ _____ (yellow body) is what produces _____ (2nd half of cycle)
Corpus Luteum, progesterone
Pics of Tertiary/Antral Follicle and Graafian Follicle
Ovarian Cycle- Follicular Phase
FSH targest ______ Cells -> to make ______
LH targets _____ Cells -> to make ______
1st stage: All produces _____ in the end
Granulosa Cells -> Aromatase
Theca Cells -> Androstenoedione (Androgen)
Estradiol (Estrogen)
Ovarian Cycle: Ovulation
- __ peaks: __-___ hrs prior to ovulation ->
- _____ in follicular fluid digest follicle ____ and release _____ ->
- Ovulation =
2nd stage
- LH, 10-12
- Enzymes, wall, prostaglandins
- Release of Ovum
Ovary, Follicle, Egg Pictures
Ovarian Cycle: Early Luteal Phase
(3)
Increased ___ ->
Inhibits what?
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
Ovarian Cycle Late Luteal Phase
4 Steps
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
Ovarian Cysts
Functional (Simple) Ovarian Cysts
Follicular:
Luteal:
: 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
Menstrual Cycle Anatomy: Uterus
Top of the uterus = _____
fundus
Uterus: Endometrium
=
(2) types of cells
(2) types of glands stroma
______ changes over the course of the menstrual cycle, by how much?
Innermost lining of the uterus (is the FUNCTIONAL layer)
Columnar and Eptihelial Cells
Functionalis and Basalis
Thickness, 2mm-16mm
Uterine/Endometrial Cycle: Menstrual Phase
______ in Estrogen and Progesterone ->
_____ release from lysosomes ->
D______ of functional layer
B_____ in endometrial cavity
______ release
Smooth muscle _______
Decline ->
Enzyme ->
Dissolution
Blood
Prostaglandin
Contraction
Uterine/Endometrial Cycle: Proliferative Phase
-
Early: Endometrium = _____
- Endometrial glands:s___, n____, sh____
-
Late: Endometrium = _____
- Endometrial glands: ____plasia, *______*, l____, enmeshed
- Ends with: ________
-
Thin
- short, narrow, short
-
Thick
- hyperplasia, PROLIFERATE, long, enmeshed
- Ovulation
Uterine/Endometrial: Secretory Phase
Corpus Luteum SECRETES ______
Endometrial glands _____, fill w _______
Th___, c____ny, nut____: favorable environment for ______ of ____ egg
Progesterone
dilate, secretions
Thick, cushiony, nutritive, implantation of fertilized egg
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 =
- Period
- Dry
- Sticky
- Cloudy
- Egg White***
- Sticky
- Period
Ultrasound Transvaginal
Ultrasound Endometrium
Is the Endometrium Thin or Thick? What phase?
Thin
Early proliferative
Endometrium Ultrasound
Is the endometrium thin or thick? What stage?
Thick
Proliferative stage
Endometrium Ultrasound
What stage?
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
Primary Dysmenorrhea Treatment Options
- Lifestyle changes (3)
-
Prostaglandin Inhibition
- _______ (initiate day ____ to bleeding)
- ______ 400-800mg q6 hrs
- _______ Acid 250mg q8hrs
- ______ 550mg q12hrs
- Endometrial _____; ___orrhea: through hormonal _______
- Complimentary Therapies (5)
- Heat, Stress reduction, Exercise
- Prostaglandin inhibition
- NSAIDs (day before)
- Ibuprofen
- Mefanic Acid
- Naproxen
- Thinning: Amenorrhea: hormonal contraception (probably the best bet)
- CAM
- Herb: Shirazi Thymus Vulgaris
- Vit B1
- Vit E
- Ginger
- Acupunture/Accupressure
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
- 5 sx, luteal, follicular, postmenses
- Serotonin and Gonadotropic
PMS/PMDD Treatment Options
______ Most Effective
- Any Lvl of Symptoms:
- Mild Symptoms:
- Mod-Severe Symptoms:
- Severe and unresponsive to SSRI or COC:
Multimodal
- Self care/health promotion, social support, psychosocial strategies, complimentary therapies
- Exercise, Relaxation techniques, vitamins B6, E, Calcium, Magnesium, Tumeric
- 1) SSRI’s (Zoloft, Paxil, CelXA, Prozac) daily luteal phase only, or premenstrual to onset of menses, 2) HC/OCP: Drosperinone containing
- 1) GnRH Agonist, 2) Surgery (bilateral oopherectomy/hysterectomy)
