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GI/GU Exam > Menstrual Cycle and Ovulation > Flashcards

Menstrual Cycle and Ovulation Flashcards

1
Q

What two organs are primarily involved in the menstrual cycle?

A
  • uterus

- ovary

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2
Q

What are the stages of development of the ovarian follicle? (4)

A
  • primordial follicle
  • primary follicle
  • secondary follicle
  • graafian (mature) follicle
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3
Q

How does the primordial follicle differentiate from the primary follicle? (4)

A
  • simple squamous becomes cuboidal
  • follicle begins to produce glycoproteins (ZP1, 2, 3, 4)
  • vascular wreath forms (cuz angiogenic factors)
  • zona pellucida develops
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4
Q

What are granulosa cells analogous to? What receptors do they express?

A
  • sertoli cells

- FSH receptors AND LH receptors

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5
Q

What are thecal cells analogous to? What receptor do they express? What is their major product?

A
  • Leydig cells
  • LH receptors
  • Androstenedione
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6
Q

What happens during the antral phase of follicle development? (3)

A
  • oocyte becomes suspended in fluid
  • cumulus oophorus appears
  • granulosa cells multiply exponentially
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7
Q

What are the two populations of granulosa cells during the antral phase? What do they do?

A
  • Mural granulosa = make steroid hormones

- cumulus cells = maintain gap/adhesion junctions with oocyte

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8
Q

What is the role of the theca interna during the antral stage?

A

synthesizes androgens from acetate and cholesterol, mostly androstenedione

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9
Q

What is the role of the granulosa cells during the antral stage?

A

Convert androgens from thecal cells to estrogens

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10
Q

At what point do large antral follicles go through meiosis a second time?

A

after the LH surge

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11
Q

How is meiosis arrest achieved?

A

By maintained elevated cAMP

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12
Q

How does sensitivity to FSH aid in selection of a follicle?

A

Only the biggest follicle with the most FSH receptor will become dominant, the others atrophy

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13
Q

What happens during the preovulatory period? (3)

A
  • the corpus luteum is formed
  • more progesterone is produced
  • there are structural changes to the follicle
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14
Q

What effect does luteinization have on theca and granulosa cells?

A
  • granulosa cells become granulosa lutein cells

- theca cells become theca lutein cells

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15
Q

What structural changes does the LH surge induce in the ovary/oocyte? (4)

A
  • release of cytokines and hydrolytic enzymes break down follicle wall, tuniga albuginea and surface epithelium
  • cumulus-oocyte complex detaches (frees egg)
  • basal lamina of mural granulosa degrades
  • oocyte progresses to metaphase II
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16
Q

What happens during the luteal phase in regards to the ovary?

A
  • antral cavity fills with blood/cell debris

- granulosa lutein cells collapse into antral cavity

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17
Q

How long does the corpus luteum remain?

A
  • 14 days approximately unless rescued by hCG
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18
Q

What does the corpus luteum do?

A
  • Produces increasing progesterone, which transforms uterine lining into adhesive and supportive structure
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19
Q

What effect does estrogen and progesterone have on LH?

A

They inhibit it to basal levels

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20
Q

What do lutein cells secrete? What does it do?

A
  • inhibin A

- suppress FSH

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21
Q

What is follicular atresia?

A

When the ovarian follicle apoptoses

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22
Q

What are thecal cells also referred to as? Why?

A
  • The interstitial gland of the ovary

- because they repopulate the cellular stroma of the ovary after follicular atresia

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23
Q

What stage of the follicular phase are gonadotrophs more sensitive to GnRH during? Why?

A
  • the late follicular phase

- because high levels of estradiol in late phase enhance sensitivity of gonadotrophs to GnRH

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24
Q

What specifically stimulates granulosa cells to produce inhibins?

A

LH and FSH

25
Q

What do inhibins do? What cells are they released from?

A
  • Inhibit FSH production by gonadotrophs

- released from sertoli and granulosa cells

26
Q

What do activins do? Where are they secreted from?

A
  • Stimulate FSH release from pituitary cells

- granulosa cells

27
Q

What level of estrogens stimulate negative feedback?

A

low and high levels

28
Q

What effect do estrogens and progestins have on hypothalamus and pituitary?

A

a negative feedback effect

29
Q

What level of progestins stimulate negative feedback?

A

High levels

30
Q

When does the switch to positive feedback occur? What does it cause?

A
  • Near the end of the follicular phase

- the LH surge

31
Q

What two hormones promote the LH surge?

A

Estrodiol, progesterone

32
Q

What is unique about the stimulatory effect of activins on FSH?

A

it is INDEPENDENT of GnRH action

33
Q

What peaks during the follicular phase? (3)

A
  • estradiol
  • LH
  • FSH
34
Q

What peaks during the luteal phase? (3)

A
  • progesterone
  • estradiol
  • inhibin
35
Q

What leads to decrease in hormonal levels during late luteal phase?

A

degradation of the corpus luteum

36
Q

What is the major product of the follicle during the follicular phase?

A

estradiol

37
Q

What synthesizes estrogen during the luteal phase?

A

corpus luteum

38
Q

What causes lowered BBT during follicular phase?

A

higher levels of estrogen

39
Q

What causes higher BBT during luteal phase?

A

higher levels of progesterone

40
Q

What causes drop of BBT during onset of menstruation?

A

degradation of the corpus luteum

41
Q

What happens to the endometrium when the corpus luteum degrades?

A

The tissue breaks down, leading to bleeding (was maintained by corpus luteum)

42
Q

What happens to the endometrium during the proliferative phase? (2)

A
  • proliferation of the basal stromal cells in zona basalis

- proliferation of epithelial cells from other parts of uterus

43
Q

What hormone is proliferation and differentiation of endometrium stimulated by?

A

estrogen from developing follicles

44
Q

What does estrogen induce synthesis of in endometrial tissue?

A

progestin receptors

45
Q

What happens to the endometrium during the secretory phase? (4)

A
  • vascularization of endometrium increases
  • glycogen content increases
  • endometrial glands become engorged with secretions
  • stromal cells differentiate into predecidual cells
46
Q

What hormone promotes the differentiation of stromal cells into predecidual cells?

A

PROGESTERONE

47
Q

What physiological symptoms does PCOS cause? (4)

A
  • hyperandrogenism
  • anovulation
  • polycystic ovaries
  • infertility
48
Q

What hormonal changes do individuals with PCOS experience? (3)

A
  • elevated LH
  • lowered FSH
  • elevated testosterone
49
Q

What is the classic presentation of a patient with PCOS?

A

Young, obese, hirsute females of reproductive age with oligomenorrhea or secondary amenorrhea, possibly infertility

50
Q

What is Turner syndrome the most common cause of?

A

congenital hypogonadism

51
Q

What is Turner syndrome often caused by?

A

complete absence of second X chromosome

52
Q

How do individuals with Turner syndrome typically appear, genitalia-wise?

A
  • external and internal genitalia are female
53
Q

What is the common presentation of a patient with Turner syndrome? (7)

A
  • short
  • delayed puberty
  • webbed neck
  • nonfunctional ovaries
  • skeletal abnormalities
  • learning disabilities
  • lymphedema of hands/feet
54
Q

What is menopause defined as?

A

Occurs 12 months after last menstrual period

55
Q

What is menopause caused by?

A
  • reduced estrogen

- low levels of inhibin

56
Q

What are the levels of LH and FSH? Why?

A

Elevated LH and FSH caused by lack of negative feedback from inhibin, estrogen

57
Q

What are the signs and symptoms of menopause? (9)

A
  • irregular periods
  • vaginal dryness
  • hot flashes
  • night sweats
  • sleep problems
  • mood changes
  • weight gain, slowed metabolism
  • thinning hair/ dry skin
  • loss of breast fullness
58
Q

What are some treatments to manage the symptoms of menopause? (4)

A
  • estrogen therapy
  • vaginal estrogen
  • low-dose antidepressants
  • gabapentin

GI/GU Exam (21 decks)

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