menstrual cycle and disorders of menstruation Flashcards
4 phases of cycle
- follicular
- ovulatory
- luteal
- menstrual
**what happens in follicular
thickening of endo due to estradiol
**what is length of follicular
variable
what is hormone feedback
rising FSH 2nd to inhibin A
- progressive increase in estradiol due to follicle
- begative feedback to FSH
- rising LH- positive feedback
what happens to egg in follicular
- egg is surrounded by granulosa cells
- creates follicle
- selection of single large follicle supresses others
- aromatized androgens
what happens in ovulation phase
- rising estradiol causes LH surge and prog. prod
- oocyte relases ~36 after surge
- surge last 48-72 hrs
clinical signs of ovulation
- associated temp fall follwed by rise
- clear eggwhite mucus due to E
- maybe twinge of pain
- progesterone porduction - PMS
what happens in luteal phase
- empty follicle collapses
- turns into corpus luteum - makes prog.
- CL dependent on LH
** length if luteal phase
14 days FIXED
what is effect of high estrdiol and prog
supresses FSH so no folliculogenesis
what happens in menstruation phase
- if no preg- CL stops producing inhibin A and prog
- FSH and inhib B rise and stim estradiol and next cycle
- lack of prog. restrict spiral arteries and get period
def. primary amen
lack of
- sec characteristics by age 14
- menses by 16
- menses by 4 years after breasts
- menses 1 year after pubes
def. secondary amen
no menses for 6 months after having had 3
6 aspects of compartemental workup
- hypothal
- pit
- thyroid
- adrenal
- ovary
- outflow tract
4 issues with hypo
- CNS lesions
- anorexia, stress, female athlete
- kallman’s syndrome
- pregancy***
3 issues with pit***
- proactinoma
- other lesion
- sheehan’s syndrome - shortly after birth went hypovolemic
what is worse in thyroid
hypo worse that hyper
3 issues with adrenal
- cushings
- adrenal
- CAH
4 probs with ovary
- dysgenesis
- PCOS
- premature ovarian failure
- neoplasm
2 outflow issues
- no uterus
2. blockage
5 things to take on Hx
- preg
- nutrition/excersice
- puberty
- hormonal sx
- family Hx
6 to look for on physical
- BMI
- tanner
- hisuitism
- thyroid signs
- sense of smell - kallman
- pelvic exam
7 labs to take
- LH/FSH/E*** must be done early in cycle
- TSH
- prolactin
- bone age
- US
- B -HCG
- bone density
SX of prolactinemia
- galactrorrea
- amennorea due to decreased GnRH pulses
- inhibited by DOPA
pharma causes of prolact.
TCAs, antiHTs, antipsychs,
treat of prolactinoma
DA agonists
- surgery
signs of PCOS
- hirsuitism
- anovulation and infert
- obesity
- pol;ycystic ovaries
risk of PCOS
endometrial hyperplasia
treat of PCOS
- lose weight and excercise
- treat SX
- OCP
- cyclic provera to prevent endo growth
def. ogiomenorrhea
reduced freq. - between 35 days and 6 months
def hypomen
less flow or less days
def. menmetrorrhagia
prolonged uterine bleeding at irregular intervals
def. menorrhagia
- > 80mls
- > 7 days
- regular
what should define menorrhagia
whether blood loss is a problem should be defined by woman, not amount of blood lost
patho pf menorrhagi
- usually secondary to distortion of uterine cavity
- unable to contract down on open venous sinuses in zona basalis
4 med cause sof DUB
- coag defects
- leukemia
- ITP
- thyroid
4 gestationsal causes of DUB
- abortions
- ectopics
- trophoblastic disease
- IUP
uterine causes of DUB
- preg
- leiomyomas
- polyps
- hyperplasia
- carcinoma
- IUD
cervical causes of DUB
- polyps
- condyloma
- cervicitis
- neoplasia
most common causes of abnormal bleeds by age
premenarche- foreign body
reproductive- gestational event
postmeno - atrophy
medical mgmt of menorrhagia
- nsaids
- danazol - androgen and prog competitor
- antifibrinolytics
- OCP
- oral prog
- levonorgestrel - mirena
- GnRH agonist
- conjugated estrogens
how much blood in average period
25-60mls
