menstrual cycle and disorders of menstruation Flashcards
when do ovulatory cycles begin?
12 months after menarche -
The follicular phase in the menstrual cycle corresponds to
proliferative phase - thickening due to estrogen
FSH goes down
LH starts to increase
Remember that the follicular phase is
Variable in length!! -
signs of increasing estrogen
egg white mucous
corpus luteum is dependent on
LH support - progesterone
Luteal phase is of
FIXED length - 14 days
Luteal phase corresponds to
the secretory phase
key features of the luteal phase
1- high inhibin A
2- E2 and Prog suppress FSH
3- no folliculogenesis
normal volume of blood loss
25 - 60 mls
Primary Amenorrhea is defined as
- absence of 2 sexual characteristics by age 14
- absence of menses by 16
- absense after 4 years after breast development
- absence after 1 year post pubic hair
Secondary amenorrhea
- 6 months amenorrhea after menarche
- or atleast 3 previous documented cycles
Approach to amenorrhea
1- hypothalamus 2- pituitary 3- thyroid - hypo can cause luteal defect 4- adrenal gland 5- ovary 6- outflow tract
what lab tests should you order to check for amenorrhea
LH/FSH/E2 - TSH - Prolactin - bone age - primary amenorrhea - US - pregnancy test -
oligomenorrhea defined as
reduction in frequency 35 days to 6 months after which it is amenorrhea
Hypomenorrhea
reduction in flow < 25mls
menometrorrhagia
prolonged uterine bleeding, irregular intervals
menorrhagia
> 80ml (uterine bleeding)
prolonged (7 days)
regular
Common causes of abnormal bleeding
pre-menarchal - foreign body
reproductive age - gestational event
post-menopaus- atrophy
Pituitary causes of amenorrhea
Prolactinomas
Sheehan’s syndrome - post partum, hypovolemia, no breast feeding, infarct in pituitary gland
Hyperthyroidism can cause a
Luteal phase defect
Medical management of menorhagia
1- OCPs
2- progestins
3- mirena 0 IUD
4- GnRH agonist - inhibit FSH and lH release
5- conjugated estrogens - estrase - stop acute bleeding
