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CM III Exam III > Menstrual Cycle & Abnormalities > Flashcards

Menstrual Cycle & Abnormalities Flashcards

1
Q

Three layers of the uterus

A

1) Peritoneum
2) Myometrium
3) Endometrium

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2
Q

2 layers of the endometrium

A

Basal layer and functional layer

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3
Q

Function of the endometrium

A

Responds to hormones, undergoes growth and stabilization changes during the menstrual cycle. It’s the site of implantation for an embryo

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4
Q

Function of the fallopian tube

A

Passageway where oocytes travel from ovaries to the uterus. Provides nutrients for the embryo and is crucial to its survival and developent

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5
Q

How does cervical mucus change & what cool stuff can it do

A

It changes in response to hormones (remember it’s CT, not muscle!) When not ovulating, cervical mucous will prevent sperm from reaching the uterus, which prevents fertilization. Also filters out “unfit” sperm

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6
Q

Functions of the ovaries

A

Storage, maturation and release of oocytes
Formation of corpus luteum
Production and sevretion of hormones (E and P)

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7
Q

Things that absolutely do not impact the rate of declining eggs in a woman over time

A

Definitely NOT

Age of menarche, # of pregnancies, use of contraceptives, or # of IVF cycles. We have so many eggs that we’re never going to use.

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8
Q

Most basic stage of oocyte/follicle, found in fetus

A

Primordial follicle w/ primary oocyte

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9
Q

Final follicle form (one that’s actually going to make a proper egg)

A

Graafian follicle

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10
Q

Function of hypothalamus in cycles (most basic form)

A

Pituitary serves as the communication system between the nervous/endocrine system

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11
Q

How can the thyroid gland affect a fetus

A

Impacts the HPO axis. Elevated thyrotropin stimulates the pit to secrete prolactin. Excess prolactin inhibits GnRH, which can cause pregnancy loss and complications in fetal development.

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12
Q

What does it mean if you’re in the secondary phase/secretory phase?

A

It means you’ve ovulated, marked by elevated progesterone

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13
Q

Menarche

A

First menstruation. Usually at 12-13. Abnormal if <8 or >15. % of body fat plays a big part in this. Can make it happen abnormally early/late

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14
Q

Thelarche

A

Breast development

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15
Q

Pubarche

A

Pubic hair development

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16
Q

Menorrhagia

A

Abnormally heavy bleeding at regular intervals.

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17
Q

What to keep in mind when working up menstruation pathologies

A

Find out if the woman has ovulated or not, this changes the WU

All irregular bleeding must be worked up because it can be a sign of cancer

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18
Q

Metrorrhagia

A

Bleeding at irregular intervals (the metro always runs at weird times)

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19
Q

Menometrorrhaggia

A

Abnormally heavy bleeding at irregular intervals.

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20
Q

Intermenstrual bleeding

A

Bleeding in between normal menstrual cycles

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21
Q

Polymenorrhea

A

<21 day cycle intervals. Happens too much

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22
Q

Oligomenorrhea

A

> 35 day cycles. Happens toolittle

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23
Q

Hypomenorrhea

A

Extremely light menstrual flow

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24
Q

Mittelschmerz

A

Pain mid cycle from ovulating

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25
Q

Overview of menstrual cycle (read only)

A

1) Begins at hypoT, which sends GnRH to the pit
2) Pit sends LH/FSH to the ovaries
3) Ovaries send signal to uterine endometrium & negative feedback to the hypoT and pit
4) Uterine endometrium thickens and then bleeds (if not pregnant)

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26
Q

What two phases make up the ovarian cycle

A

1) Follicular phase. Can vary in length

2) Luteal phase. Post ovulation, will always be 14 days.

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27
Q

What three phases make up the uterine cycle?

A

1) Proliferative
2) Secretory phase
3) Menstruation (or pregnancy)

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28
Q

Ovarian follicular phase corresponds to the _____

A

Proliferative phase of the uterine cycle

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29
Q

Ovarian luteal phase corresponds to the ________

A

Secretory phase of the uterine cycle

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30
Q

Uterine Proliferative phase corresponds to the _______

A

Follicular phase of the ovarian cycle

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31
Q

Uterine Secretory phase corresponds to the ________

A

Luteal phase of the ovarian cycle

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32
Q

How long is the luteal phase of the ovarian cycle?

A

14 days

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33
Q

If you don’t ovulate, you don’t have ____ phase of the ovarian cycle

A

Luteal

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34
Q

What happens to the corpus luteum if unfertilized?

A

Undergoes apoptosis/macrocytosis and forms the corpus albicans

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35
Q

What day of the cycle does ovulation happen at?

A

14 days

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36
Q

When does the secretory phase of the uterine cycle begin?

A

Begins after ovulation! Secretes loads of progesterone to stabilize the endometrium so it can sustain a fetus

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37
Q

What two cells are oocytes surrounded by? What are their function?

A

Surrounded by granulosa cells and theca cells.

Granulosa- Contain FSH receptors and produce estrogen! Also helps out by converting androgens to estrogen.
Theca- Contains LH receptors and makes estrogen.

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38
Q

What kind of receptors do granulosa cells contain

A

FSH

39
Q

What kind of receptors do theca cells contain

A

LH

40
Q

What hormone bursts “finish off” maturing the egg and getting it ready for fertilization?

A

Big burst of LH

41
Q

What kicks off the HPO (hypothal-pit-ovarian) axis?

A

Hypo releases GnRH

42
Q

What does GnRH trigger?

A

Triggers the ant pit to make LH and FSH

43
Q

What does FSH and LH do?

A

Stimulates the ovarian follicle to make estrogen. LH specifically targets the theca cells to make them produce more androgens as well

44
Q

What suppresses FSH (neg feedback!)

A

Estrogen produced from the ovary!

45
Q

What suppresses GnRH (neg feedback!)

A

Estrogen, progesterone, testosterone. The androgens produced by the theca cells

46
Q

What do elevated estrogen levels cause?

A

Triggers the ant pit to release a bunch of LH, which finishes off the egg.

47
Q

Which hormone gets only positive feedback in the HPO?

A

LH! Never gets neg feedback

48
Q

Are the hormones in the HPO axis released constantly or nah

A

Nah. Pulsatile, be wary of taking levels, you could get a low reading and it’s just a trough

49
Q

Patient comes in with primary amenorrhea, short, webbed neck and widely spaced nipples. Whatdya thinking

A

Turner’s syndrome!

50
Q

Amenorrhea

A

Absence of menstruation. Can be primary or secondary. Can be transient, intermittent or permanent

51
Q

> 50% of cases of primary amenorrhea is ____

A

Gonadal dysfunction

52
Q

Primary Amenorrhea

A

Never had menarche

53
Q

Secondary Amenorrhea

A

Started menses and then stopped.

54
Q

Most common cause of secondary amenorrhea

A

PREGNANCY

55
Q

Second most common cause of secondary amenorrhea

A

Hypothalamus dysfunction

56
Q

Three types of hypothalamic dysfunction

A

1) Constitutional delay of puberty
2) Isolated GnRH deficiency
3) Functional hypothalamic amenorrhea

57
Q

Constitutional delay of puberty

A

Everything is normal! They’re just starting a little late. Absolutely primary amenorrhea, wait and watch. However, this is a diagnosis of exclusion, you’ve got to rule out everything else first.

58
Q

Causes of functional hypothalamic amenorrhea

A

1) Stress
2) Overexercise
3) Eating disorder

High levels of cortisol shut down GnRH in hypoT. Correct the cortisol and you’ll correct the amenorrhea. Called functional because it is NOT pathologic.

59
Q

Why would we consider OCP’s for patients with amenorrhea?

A

Amenorrhea women are not producing enough estrogen so we’d be concerned about bone health

60
Q

Three main causes of pituitary dysfunction

A

1) Hyperprolactinemia
2) Prolactinomas (adenomas that secrete prolactin)
3) Other masses/diseases of the pituitary

61
Q

Causes of hyperprolactinemia

A

Tumor, anti psych Rx, trauma, stress, alterations in sleep.

62
Q

Does hyperprolactinemia usually cause primary or secondary amenorrhea

A

Secondary! Very rarely causes primary

63
Q

Causes of ovarian dysfunction

A 
Turner Syndrome (X0)
Swyer Syndrome-gonadal dysgenesis (XY)
Primary Ovarian insufficiency
Ovarian tumors (rare)
PCOS
64
Q

What is primary ovarian insufficiency?

A

Normal karyotype, but undergoes menopausal @ <40yo. Think fragile X, family history is a big part of this

65
Q

What is Swyer Syndrome (XY gonadal dysgenesis)

A

Genotypically male but phenotypically female. These patients will have non functional gonads, they’re premalignant and fibrotic, and should be removed.

66
Q

What is PCOS?

A

Polycystic ovarian syndrome. Pretty common in reproductive women. Usually oligomenorrhea rather than amenorrhea. Increased androgen decreases ovary function.

67
Q

Must have 2 out of these three things to be diagnosed with PCOS

A

1) Hyperandrogenism
2) Polycystic ovaries on US
3) Amenorrhea/oligomenorrhea

68
Q

Uterine dysfunction & outflow tract disorders that can cause amenorrhea

A

1) Intrauterine adhesions (Asherman syndrome)
2) MRKH syndrome
3) Imperforate hymen
4) Transverse vaginal septum

69
Q

What is Asherman syndrome? What type of amenorrhea does it cause?

A

Ashermans syndrome is adhesions/scarring of endometriurm/uterus. NOT CONGENITAL. Caused by PPH or infection via instrumentation. Causes secondary amenorrhea

70
Q

What is MRKH?

A

Defect in development. Absence or defect in vagina/uterus. Pts are born w/o a vagina, may or may not have a uterus or a portion of the uterus. Neovaginal out of bowel. So cool. It’s congenital, so primary amenorrhea.

71
Q

Hx questions specific to primary amenorrhea (really just read this, not a biggie)

A

1) Completed other stages of puberty?
2) Family history of delayed/absent puberty?
3) Height in relation to family members?
4) Normal neonatal and childhood health?

72
Q

Hx questions specific to secondary amenorrhea (really just read this, not a biggie)

A

1) Are there any symptoms of estrogen deficiency, including hot flashes/vaginal dryness/poor sleep/decreased libido
2) Hx of obstetrical catastrophe, severe bleeding, D&C, endometritis or anything else that may have caused scarring in the endometrial lining (Asherman)?

73
Q

PE Workup for amenorrhea

A

Growth
Skin
Breast exam/development
Pelvic exam (check for signs of E deficiency)
Parotid gland swelling or erosion of dental enamel (bullemia)

74
Q

Lab WU for amenorrhea

A 
HCG
FSH
TSH
PRL (prolactin)
T- if indicated

***do an US to make sure there’s a uterus

75
Q

Dysmenorrhea

A

Recurrent crampy lower abd pain during menstruation, no other pelvic pathology.

76
Q

What’s pathognomonic for dysmenorrhea

A

Crampy pain stops upon menses

77
Q

Sx of dysmenorrhea

A 
Crampy lower abd/pelvic pain
Back pain
N/V
Diarrhea
HA
Fatigue
Dizziness
78
Q

First line tx for dysmenorrhea

A

NSAIDS. Effective for 90% of cases.

Ibuprofen or naproxen. However if these aren’t effective, try mefenamic acid. It’s more specific to the uterus

79
Q

Second line tx for dysmenorrhea

A

Hormonal! OCPs prevent dysmenorrhea by suppressing ovulation, so they won’t have those ovulating symptoms

80
Q

When is hormonal tx first line for dysmenorrhea?

A

When the patient is sexually active

81
Q

Premenstrual syndrome (PMS)

A

Physical and emotional sx that happen recurrently in the 2nd half of menstrual cycle, resolve with menses and interfere with the woman’s life

82
Q

Premenstrual Dysphoric Disorder (PMDD)

A

Severe form of PMS marked by anger, irritability and internal tension

83
Q

Emotional symptoms of PMS/PMDD

A 
Mood swings
Angry outbursts
Irritability
Anxiety
Depression
Inc appetite or food cravings
Sleep disturbances/insomnia
Poor concentration
84
Q

Physical symptoms of PMS/PMDD

A 
Breast tenderness/pain
Bloating
Constipation
HA
Fatigue
Dizziness
Hot flashes
85
Q

When do the sx of PMS/PMDD occur

A

Must begin during the luteal phase & end with the onset of menses. ~ 6 days per month

86
Q

Why are antidepressants first line for severe PMS/PMDD

A

Because PMDD is associated with an increased risk of suicide ideation/suicide attempts. It’s a hormonal problem, we’re fixing the hormones.

87
Q

Tx for mild PMS

A

Exercise and stress reduction

88
Q

1st line for mod/severe PMDD

A

SSRI

89
Q

2nd line for mod/severe PMDD

A

OCP- maybe augment w/ a benzo

90
Q

3rd line for mod/severe PMDD

A

GnRH agonist therapy w/ low dose Estrogen/Progesterone replacement therapy. This will basically induce menopause, this is why it’s second to last line

91
Q

Last line therapy for PMDD

A

Surgery

92
Q

Dysfunctional Uterine Bleeding

A

Abnormal uterine bleeding unrelated to any kind of lesions/pregnancy/disease/pathology. Usually due to a HPO axis issue

93
Q

What is key to diagnosing dysfunctional uterine bleeding

A

Determining whether or not ovulation is occurring

94
Q

When does dysfunctional uterine bleeding normally occur and why?

A

Occurs right after menarche and during perimenopause, because these are time periods where we see a lot of menses w/o ovulation.

CM III Exam III (8 decks)

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