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Obstetrics and Gynaecology > Menstrual cycle and it's disorders > Flashcards

Menstrual cycle and it's disorders Flashcards

1
Q

What is puberty?

A

The onset of sexual maturity, marked by the development of secondary sex characteristics

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2
Q

Which axis stimulates menstruation?

A

The hypothalamic-pituitary axis

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3
Q

Where does menstruation fit into puberty?

A

It is normally the last manifestation in puberty

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4
Q

What hormones stimulate first menarche?

A

GnRH pulses increase in amplitude and frequency, such that pituitary FSH and then LH release increases. These stimulate oestrogen release from the ovary

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5
Q

Which hormone is responsible for the secondary sexual characteristics?

A

Oestrogen

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6
Q

In what order does puberty take place?

A

Breast development -> pubic hair -> menarche

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7
Q

What is thelarche?

A

Beginning of breast development

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8
Q

What is adrenarche?

A

Growth of pubic hair

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9
Q

What takes place on days 1-4 of the menstruation cycle?

A

Menstruation

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10
Q

What takes place during menstruation?

A

The endometrium is shed as it’s hormonal support is withdrawn. Myometrial contraction, which can be painful, also occurs

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11
Q

What phase takes during days 5-13 of the menstrual cycle?

A

Proliferative phase

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12
Q

What hormones do the follicles produce during the follicular phase?

A

Oestradiol and inhibin

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13
Q

What do oestradiol and inhibin do to FSH?

A

It suppresses FSH secretion, via a negative feedback

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14
Q

Why is FSH secretion suppressed during the follicular phase?

A

So that only one follicle matures

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15
Q

What effect does oestrodiol have on LH?

A

It causes a positive feedback on the hypothalamus and pituitary causing LH to rise sharply, stimulating ovulation

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16
Q

What phase takes place during day 14-28 of the menstrual cycle?

A

The luteal/secretory phase

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17
Q

What is the corpus luteum?

A

The follicle from which the egg was released becomes the corpus luteum

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18
Q

Which hormones does the corpus luteum produce?

A

Oestrodiol, but relatively more progesterone

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19
Q

When does progesterone peak in the menstrual cycle?

A

Between day 21-28

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20
Q

What changes does progesterone have on the endometrium?

A

The stromal cells enlarge, the glands swell and the blood supply increases.

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21
Q

What happens to the corpus luteum if it is not fertilised?

A

It breaks down, as the hormone production stops, the endometrium breaks down

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22
Q

What age is normal menstruation?

A

Under 16 years

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23
Q

What age is normal menopause?

A

Over 45 years

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24
Q

How long is normal menstruation?

A

Less than 8 days

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25
Q

How much blood is normal to lose in menstruation?

A

Less than 80mL

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26
Q

What is a normal length of menstruation?

A

23-35 days

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27
Q

What is menorrhagia?

A

Heavy menstrual bleeding in an otherwise normal menstrual cycle

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28
Q

What is the clinical definition of menorrhagia?

A

Excessive menstrual blood loss that interferes with the woman’s physical, emotional, social and material quality of life, and which can occur alone or in combination with other symptoms

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29
Q

What is the objective definition of menorrhagia?

A

Blood loss of >80ml in an otherwise normal menstrual cycle.

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30
Q

What are the most common causes of menorrhagia?

A
  1. Uterine fibroids (30%)
  2. polyps (10%)
  3. dysfunctional uterine bleeding: menorrhagia in the absence of underlying pathology. This accounts for approximately half of patients
  4. anovulatory cycles: these are more common at the extremes of a women’s reproductive life
  5. uterine fibroids
  6. hypothyroidism
  7. intrauterine devices*
  8. pelvic inflammatory disease
  9. bleeding disorders, e.g. von Willebrand disease
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31
Q

What are the clinical features of menorrhagia?

A

‘Flooding’ and the passage of large clots indicates excessive loss. Anaemia is common.

32
Q

What are the examination findings and what do they mean?

A

Irregular enlargement of the uterus suggests fibroids. Tenderness with or without enlargement suggests adenomyosis.

33
Q

What ix are carried out in heavy menstrual bleeding?

A

Haemoglobin, if the history suggests: coagulation and thyroid tests, possibly ultrasound and hysterectomy

34
Q

What is the second line medical treatment of menorrhagia for women requiring contraception?

A

COCP

35
Q

Why would you perform an ultrasound in menorrhagia?

A

To assess endometrial thickness, exclude a uterine fibroid or ovarian mass and detect larger intrauterine polyps

36
Q

What is the first line medical treatment of menorrhagia for women not requiring contraception?

A

Antifibrinolytics (tranexamic acid) or NSAIDs (mefanamic acid)

37
Q

What is the first line medical treatment of menorrhagia for women requiring contraception?

A

IUS (Mirena)

38
Q

How do fibrinolytics (tranexamic acid) help menorrhagia?

A

Taken only during menorrhagia, they reduce fibrinolytic activity, which can reduce blood loss by about 50%.

39
Q

How do NSAIDS (mefanamic acid) help menorrhagia?

A

Inhibit prostaglandin synthesis, reducing blood loss in most women by 30%.

40
Q

What is third line treatment of menorrhagia?

A

Progestogens or Gonadotrophin-releasing hormone.

41
Q

How are progestogens taken in menorrhagia?

A

Taken in high dose orally or by IM injection.

42
Q

What age is irregular menstruation most common?

A

It is most common at the extremes of reproductive age

43
Q

What are the causes of irregular menstruation?

A

Anovulatory cycles or a pelvic pathology such as fibroids, polyps and malignancy

44
Q

What investigations should be performed to assess irregular menstruation?

A

Assessing effect of blood loss and fitness (Hb). Excluding malignancy (cervical smear or US)

45
Q

What is the treatment of irregular periods?

A

Contraception or HRT in older patients

46
Q

What is primary amenorrhoea?

A

When menstruation has not started by the age of 16 years.

47
Q

What is delayed puberty?

A

When secondary sex characteristics are not present by the age of 14 years.

48
Q

What is secondary amenorrhoea?

A

When previously normal menstruation ceases for 6 months or more.

49
Q

What is oligomenorrhoea?

A

When menstruation occurs every 35 days to 6 months

50
Q

What are the causes of primary amenorrhoea?

A

Turner’s syndrome
testicular feminisation
congenital adrenal hyperplasia
congenital malformations of the genital tract

51
Q

What organs/areas can contribute towards pathological amenorrhoea?

A

The hypothalamus, the pituitary, the thyroid, the adrenals, the ovary or the uterus.

52
Q

What drugs can cause amenorrhoea?

A

Progestogens, GnRH analogues and, sometimes, antipsychotics

53
Q

What are the main causes of secondary amenorrhoea or oligomenorrhoea?

A

hypothalamic amenorrhoea (e.g. Stress, excessive exercise)
polycystic ovarian syndrome (PCOS)
hyperprolactinaemia
premature ovarian failure
thyrotoxicosis*
Sheehan’s syndrome
Asherman’s syndrome (intrauterine adhesions)

54
Q

What causes the hypothalamus pathologies that contribute to amenorrhoea?

A

Hypothalamic hypogonadism is usually due to low weight/anorexia or excessive exercise but it can occasionally be a tumour

55
Q

What causes the pituitary pathologies that contribute to amenorrhoea?

A

Hyperprolactinaemia is usually caused by pituitary hyperplasia or benign adenomas.

56
Q

Does hyper or hypo thyroidism cause amenorrhoea?

A

Both can cause amenorrhoea but hypothyroidism would lead to raised prolactin levels and amenorrhoea.

57
Q

What is postcoital bleeding?

A

Vaginal bleeding following intercourse that is not menstrual loss. Except for first intercourse, this is always abnormal and cervical carcinoma must be excluded.

58
Q

Why does postcoital bleeding happen?

A

When the cervix is not covered in healthy squamous epithelium it is more likely to bleed after mild trauma.

59
Q

What causes postcoital bleeding?

A

Cervical ectropion, benign polyps and invasive cervical cancer account for most cases.

60
Q

What investigations take place in postcoital bleeding?

A

The cervix is inspected and a smear is taken.

61
Q

What is dysmenorrhoea?

A

Painful menstruation

62
Q

What blood levels are associated with dysmenorrhoea?

A

It is associated with high prostaglandin levels in the endometrium and is due to contraction and uterine ischaemia.

63
Q

What is primary dysmenorrhoea?

A

When no organic cause is found, it is very common, nothing to worry about.

64
Q

What is secondary dysmenorrhoea?

A

When pain is due to pelvic pathology. Pain often precedes and is relieved by the onset of menstruation.

65
Q

What are the most significant causes of dysmenorrhoea?

A

Fibroids, adenomyosis, endometriosis, PID and ovarian tumours.

66
Q

What is precocious puberty?

A

Development of secondary sexual characteristics before 8 years in females and 9 years in males

67
Q

What happens to growth during precocious puberty?

A

The growth spurt occurs early, but final height is reduced due to early fusion of the epiphyses.

68
Q

Do you need to treat precocious puberty?

A

Treatment is essential to arrest sexual development and allow normal growth.

69
Q

What is the treatment for precocious puberty?

A

GnRH agonists are used to inhibit sex hormone secretion, causing regression of secondary sex characteristics and cessation of menstruation.

70
Q

What are the central causes of precocious puberty?

A

Meningitis, encephalitis, CNS tumours, hydrocephaly and hypothyroidism may prevent normal prepubertal inhibition of GnRH release.

71
Q

How do central causes of precocious puberty work?

A

They increase GnRH secretion.

72
Q

What are the ovarian/adrenal causes of precocious puberty?

A

Hormone-producing tumours of the ovary or adrenal glands will also cause premature sexual maturation. Regression occurs after removal

73
Q

How do ovarian/adrenal causes of precocious puberty work?

A

They increase oestrogen secretion

74
Q

What causes ambiguous genitalia?

A

Congenital adrenal hyperplasia is recessively inherited. Cortisol production is defective, ACTH excess causes increased androgen production.

75
Q

What is androgen insensitivity syndrome?

A

It occurs when a male has cell receptor insensitivity to androgens, which are converted peripherally to oestrogens.

Obstetrics and Gynaecology (27 decks)

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