Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrine & Diabetes > Menstrual Cycle and Disorders > Flashcards

Menstrual Cycle and Disorders Flashcards

1
Q

At what size do follicles become dependent on endocrine hormones?

A
  • 4-5mm, after 110 days of primordial follicle growth
  • Lasts for 14 days
  • Around 20 a day get to this stage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What causes the endometrium to grow?

A

-Oestrogen causes endometrium to grow and develop/ thicken up, made in ovary/ follicles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is oestradiol made in the follicle?

A

-Granulosa cells make oestradiol under the influence of FSH
=bind to receptor cells
=made from cholesterol to androgens to oestrogens (aromatase)
=Granulosa cells CANNOT make androgens, get from theca cells
-Theca cells make androgens under the influence of LH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What tests can be done when someone presents with irregular periods?

A

-Measure oestrogen, LH, FSH, prolactin, androgens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the problem in low LH, FSH, E2 and normal prolactin?

A

-Low oestrogen as no LH or FSH so hypothalamus problem (normal prolactin= not pituitary)
=GnRH low
=Child-like hormones
=Body not fit for reproduction, as body fat low (low adipokines)
HYPOGONADOTROPHIC HYPOGANADISM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe hypogonadotropic hypogonadism

A
  • Weight loss, over exercise, stress, illness
  • BMI low
  • Management= lifestyle, pulsatile GnRH, FSH/LH injections, HRT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the problem with high LH and FSH and low oestrogen (prolactin normal)?

A

-Ovaries, not making any oestrogen (no oestrogen feedback= high LH and FSH)
=running out of eggs
=menopause hormones
=Premature Ovarian Insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe Premature Ovarian Insufficiency

A
  • Treatment (chemotherapy/radiotherapy), family history (autoimmune?), menopausal symptoms
  • Atrophic vaginitis (thinning)
  • Management= egg donation, HRT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the problem with low LH, FSH and oestrogen with high prolactin?

A

-Pituitary produces lots of prolactin, switches of gonadotropin- microadenoma (hyperprolactinaemia)
=breast-feeding
=switches of LH and FSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe Hyperprolacticaemia

A
  • Galactorrhoea
  • Bitemporal hemianopia/ tunnel vision (MRI)- optic chiasma compressed
  • Management= dopamine agonist (Bromocriptine) (prolactin regulated by hypothalamus and dopamine by switching off)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the problem with just high LH?

A

-the environment of the ovary (not naturally)
=hormone imbalance
=Androgens increase (pause follicle growth= polycystic ovary)- 1 in 5 women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe Polycystic Ovary Syndrome

A

-Hirsutism, acne, weight
-BMI high, skin, USS- scan ovaries
-Management= anti-oestrogen (clomifene citrate- lower LH and increase FSH), contraceptive pill
=oestrogen thickens endometrium, stimulates LH surge so only 5 days at beginning of cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which hormone is required to maintain progesterone production during the menstrual cycle?

A

-LH

=HCG is like long-acting LH and it does drive progesterone synthesis from the corpus luteum in early pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What problem limited the development of IVF as we know it?

A

-Premature LH surge
=when increased FSH is given Estrogen rises and there is an LH surge before the follicle and thus egg is mature
=Meiosis is completed at fertilisation but initiated by the LH surge
=Inhibin feedback is overcome by giving more FSH. Androgens are not stimulated as FSH will aid their conversion into Estrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What do prostaglandins do in menstruation?

A
  • Increase bleeding by affecting vasculature

- Increase pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When is the best tine to do a blood test for ovulation?

A

-Day 21

=Confirmation of ovulation is progesterone (if progesterone there is corpus luteum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is anovulatory bleeding?

A

-Heavy menstrual bleeding and prolonged
=periods can happen without ovulation
=can lose up to 500ml bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the oestrogen agonists?

A
  • HRT (oestradiol)

- Combined Oral Contraceptive Pill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe HRT

A
  • Physiological concentrations of natural oestrogen to prevent menopausal symptoms (plus progesterone to avoid endometrial hyperplasia)
  • Oral, transdermal (avoids first pass metabolism), nasal, vaginal (for post-menopausal atrophic vaginitis), implant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the types of HRT?

A

-Continuous combined
=taken continually, 2 years after menopause, no vaginal bleeding
-Sequential
=oestrogen given followed by 2 weeks progesterone, regular periods (after progesterone withdrawal)
=younger women with hypogonadotropic hypogonadism or in climacteric
=not contraceptive, less side effects the oral contraceptive
=Venous thromboembolism and breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the side effects of oestrogen?

A
  • Nausea
  • Headaches
  • Breast tenderness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When can oestrogen be used alone?

A
  • HRT after hysterectomy

- Induction of puberty in girls who have delayed puberty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe the combined oral contraceptive pill

A
  • Supraphysiological concentrations of synthetic Estrogen act as a contraceptive
  • oral, transdermal or vaginal but oral preparations are widely used
  • 21/28 days
  • inhibits LH and FSH release, thereby preventing follicular development and ovulation
  • High doses used if break-through bleeding
24
Q

What are the beneficial effects of the COCP?

A
  • regular and lighter periods
  • less pre-menstrual symptoms
  • better skin (as it will inhibit the natural LH-dependent secretion of androgen from the ovary)
  • less ovarian and endometrial cancer
25
Q

What are the adverse effects of the COCP?

A

-adversely affect the endometrium and cervical mucous
-It is 98-99% effective if perfectly taken but in practice it is 92-95% effective.
-cause headaches, nausea and may stimulate appetite.
-It can reduce libido and prevent lactation and is associated with thromboembolism.
=This is because estrogen stimulates the production of clotting factors in the liver.

26
Q

Why is oestrogen not given alone?

A

-Cause continued proliferation of endometrium
=heavy irregular bleeding
=endometrial hyperplasia/ cancer
=adverse psychological and physiological side-effect

27
Q

What are the oestrogen antagonists?

A
  • Clomifene= ovulation induction

- Breast cancer= Tamoxifen and Letrozole

28
Q

How does clomifene stimulate ovulation induction?

A

-Blocking oestrogen with raise gonadotrophins (FSH)
=stimulates follicular development
-Mainly used in PCOS
-As Estrogen has beneficial effects during the menstrual cycle, such as endometrial proliferation and generation of the LH surge these drugs cannot be given throughout the cycle and are given from day 2 or 3 of the cycle for 5 days only
=can cause menopausal symptoms, associated with increased rates of multiple pregnancy

29
Q

What are the progesterone agonists?

A
  • Menstrual induction (Provera)
  • Heavy menstrual bleeding (Norethisterone)
  • Pro-gestation only contraception (mini-pill)
  • Depo contraception (depo provera)
  • Implant contraception (Implanon)
  • Intrauterine system (Merina coil)
  • Post-coital contraception (Levonorgestrel)
  • Replacing progesterone in IVF cycles (Cyclogest)
30
Q

How is progesterone used in menstrual induction?

A

-Provera
-Progesterone withdrawal bleed (only occurs in presence of oestrogen)
=used in PCOS to cause a period to allow clomifene treatment from day 2 and 3 of the cycle
=anovulatory so oestrogen but no progesterone= endometrial hyperplasia
=3/4 periods required per year

31
Q

How is progesterone used as a treatment for heavy menstrual bleeding?

A

-Norethisterone (gestogen)
-Used between day 5 and 25 of menstrual cycle
=endometrium not as thick so menstrual blood loss reduced

32
Q

What is the action of progesterone in the mini-pill?

A

-Some affect follicular growth by inhibiting ovulation
-Thicker cervical mucus more hostile to sperm transport and make endometrium less receptive
-Inhibitory effect on tubal function
=variation in effect on menstruation
=can be used in breast-feeding as some do not inhibit ovulation
=90-95% effective
=no side effects compared to combined pill

33
Q

Describe depo contraception

A

-Depo Provera
-Oil based intramuscular preparation lasts 12 weeks
=inhibit gonadotrophins and generally leads to amenorrhoea
=>98% effective
=prolonged use associated with osteoporosis as ovaries are switched off and no oestrogen, prolonged recovery to fertility so not long-term

34
Q

Describe the implant

A

-Rod length of matchstick and thinner
-Inserted sub dermally, usually in upper arm, under local anaesthetic
-Lasts for three years
=over 99% effective

35
Q

Describe the intrauterine system

A

-Mirena coil is a plastic coil that sits in the uterus and releases progesterone into uterine cavity
=endometrial atrophy and thickening of mucous
=less systemic effects than other gestogen
=blood loss reduced by 97% but spotting for several months initially
=not associated with ectopic pregnancy or infection, reduced hysterectomy and sterilisation rates

36
Q

How is progesterone used as post-coital contraception?

A

-A single large dose of progesterone functions as emergency contraception
-Taken within 72 hours but ideally 12 hours
=thicken mucous, make endometrium less receptive, inhibit ovulation and alter tubal transport
=reduced chance of pregnancy by 2/3rds, fails up to 7% of the time

37
Q

How is progesterone used in IVF?

A
  • Luteal progesterone initially suppressed when LH suppressed so not enough to support pregnancy
  • 2 weeks of progesterone taken vaginally in form of pessaries after oocyte collection
38
Q

What are the progesterone antagonsists?

A
  • Termination of pregnancy (Mifepristone)
  • Post-coital contraception (Ullipristal) (irregular bleeding)
  • Fibroid growth (Ullipristal)
39
Q

How is progesterone antagonists used to terminate a pregnancy?

A

-Used up to 9 weeks
-Mifepristone then Prostaglandin E
=bleeding and uterine cramps
=blocks cortisol so not recommended in severe asthma

40
Q

How does progesterone antagonists used to reduce fibroid growth?

A

-Fibroids= benign tumours of muscle in uterus

=hormone dependent

41
Q

What are androgen agonists?

A 
-Hormone replacement (Testogel)
=topical testosterone after menopause or hysterectomy
= increase energy and libido
=side effects
=not really used
42
Q

What are androgen antagonists?

A

-Treatment of hirsutism (Cyproterone acetate= also progesterone agonist and Finasteride= 5alpha-reducatse inhibitor)
=PCOS
=Used in conjunction with pill
=libido can be reduced

43
Q

How are FSH agonists used in IVF?

A
  • Ovulation induction in injections (PCOS, fail to ovulate)= intense monitoring to prevent multiple follicular growth
  • Superovulation= collect multiple eggs for IVF
44
Q

What are FSH antagonists?

A

-Gonadotrophin Suppression
=big constant doses of GnRH will down-regulate GnRH receptors in pituitary and desensitise them
=inhibits FSH secretion
-Not orally active so needs to be taken systemically in short-acting nasal spray/ longer-acting daily injection or depot injection
-It is used to produce an artificial menopause to treat hormone dependent conditions such as breast cancer, endometriosis and uterine fibroids.

45
Q

How are LH agonists used in ovulation?

A

-Small amounts combined with FSH for superovulation in assisted conception (helps with oestrogen synthesis)
-Recombinant LH and hCG in subcutaneous injection
ovulatory signal in ovulation induction if LH surge deficient/ surrogate LH surge

46
Q

What is OHSS?

A

-Ovarian hyperstimulation syndrome (2%, PCOS risk factor)
=too many follicles= too much VEGF secreted from luteinising follicles so leaky blood vessels systemically
=Large amounts need to turn follicle into corpus luteum (angiogenesis), vascular permeability factor
=associated with large ovaries, ascites, pleural effusions and hyper-coagulability

47
Q

How are LH antagonists used in IVF?

A
  • No LH antagonist
  • The main concern for IVF treatments is that during superovulation, using exogenous gonadotrophins, multiple follicles develop.
  • This increases estrogen and would cause a premature LH surge.
  • Prevention is done using pre-treatment with GnRH agonist (to function as an antagonist) in a long protocol cycle or more recently with GnRH antagonist that doesn’t give a flare of gonadotrophins before inhibition so can be used during the cycle to prevent the LH surge in a short protocol
48
Q

Compare LH and hCG half lives

A
  • hCG >24 hrs for one injection

- LH 20 mins

49
Q

What are the prolactin agonists?

A

-Anti-emetics (Domperidone)
=Dopamine antagonist (raises prolactin by negative feedback)
=May benefit establishment of breast-feeding

50
Q

What are the prolactin antagonists?

A

-Bromocriptine
=Dopamine agonist
=Used to treat hyperprolactinaemia whether cause is pituitary or not
=inhibit galactorrhoea and restore menstrual cycles and fertility

51
Q

What are the uses of oxytocin agonists?

A

-Augmentation of labour
=increase contractions when cervix soft, shortening and dilating (membranes ruptured)
-Post-partum haemorrhage
=Caused by uterine atony
=Prolonged tonic uterine contraction to help expel placenta

52
Q

What is the use of an oxytocin antagonist?

A

-Prevention of preterm labour

=stop uterine contractions (relax uterine muscle)

53
Q

How are prostaglandins involved in the female reproductive system?

A
  • Prostaglandin E will cause cervical ripening and cervical softening and increase uterine activity to facilitate contractions.
  • Prostaglandin F causes a more powerful tonic contraction.
  • Prostaglandins are involved in menstruation and menstrual bleeding.
54
Q

How are prostaglandin agonists used?

A

-Termination of pregnancy (misoprostol)
=soften and dilate cervix to facilitate suction curette into uterus
-Induction of labour
=Vaginal E2 gel
-Severe post-partum haemorrhage
=Systemic Prostaglandin F for uterine atony

55
Q

How do prostaglandins help induction of labour?

A

-Cervical ripening
=shortening, softening, dilation
=early contractions of myometrium
-Hyperstimulation requires beta agonist (associated with foetal distress)

56
Q

How are prostaglandin antagonists used?

A

-Treatment of heavy menstrual bleeding (Mefenamic acid)
-Premature labour (Indomethacin)
=not used in later gestation as prostaglandins required in foetal ductus arteriosus to keep open

Endocrine & Diabetes (45 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions