Brainscape's Knowledge GenomeTM

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


See full index

Obstetrics & Gynaecology > Menstrual cycle & disorders > Flashcards

Menstrual cycle & disorders Flashcards

1
Q

When is the first day of the menstrual cycle

A

First day of menstruation

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

Explain the hypothalamic-pituitary-ovarian axis

A
  1. Hypothalamus secretes gonadotrophin releasing hormone (GnRH) to pituitary gland
  2. Pituitary Gland secretes luteinizing hormone and follicle stimulating hormone
  3. FSH binds to ovaries:
    a. development of follicles
    b. secretion of oestrogen
    c. secretion of inhibin
  4. LH binds to ovaries:
    a. Production of oestrogen-ovulation and endometrial thickening
    b. Graafian follicle into progesterone producing corpus luteum
    c. Progesterone-endometrium receptive to implantation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Follicular phase

A
  1. FSH rises causing stimulation of few ovarian follicles
  2. Follicles compete for dominance
    3a. 1st molecule to mature (Graafian molecule) produce large amount of oestrogen
    3b. Inhibits growth of other competing follicles
  3. Oestrogen causes endometrial thickening and thins cervical mucous
  4. Oestrogen initially inhibits LH production
  5. When ovum is mature oestrogen causes a spike of LH (day 12)
  6. LH makes graafian follicle thinner
  7. Within 24-48 hrs follicle releases secondary oocyte
  8. Secondary oocyte matures into ootid and then mature ovum
  9. Ovum released and taken up by fallopian tube via fimbriae
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Luteal Phase

A
  1. After ovulation LH and FSH cause graafian follicle to form corpus luteum
  2. Corpus Luteum produces progesterone
  3. Progesterone cause:
    a. endometrium receptive to implantation of blastocyst
    b. production of oestrogen by adrenal glands
    c. negative feedback causes decreased LH and FSH
    d. increase in woman’s basal body temperature
  4. As levels of FSH and LH corpus luteum degenerates
  5. No more progesterone
  6. If ovum fertilises it produces hCG (similar to LH)
  7. Prevents degeneration of corpus luteum
  8. Placenta takes over role of corpus luteum (week 8)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define menarche

A

Date of first period

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

Define menopause

A

Healthy women over 45 years who have not had a period for at least 12 months and are not using hormonal contraception, or who do not have a uterus and have menopausal symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Symptoms of menopause

A

Vasomotor symptoms: hot flushes, night sweats
Vulvovaginal atrophy
Dyspareunia
Sleep distrurbances

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

Diagnosing menopause

A

Primarily based on symptoms
Pregnancy test to exclude pregnancy
FSH test in women with menopause under 40-45
Do not use on those in perimenopause or on COC or high progestrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Managing menopause with mild vasomotor symptoms

A

Lifestyle changes:

Lose weight, good diet, avoid spicy food, no smoking. reduce alcohol and caffeine intake.

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

Managing menopause with uterus and severe vasomotor symptoms

A

Continuous combined regimen-if amenorrhea>12 months
If perimenopause:
1.Sequential regimen
2.oestrogens, conjugated/bazedoxifene: 0.45/20mg PO OD
3.SSRI/SNRI: Paroxetine 7.5mg PO OD or Escitalopram 10-20mg PO OD
4. Gabapentin 300mg PO OD, increase gradually by 300 max 2400
5. Clonidine transdermal (patch)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Managine menopause without uterus or hormonal IUD inserted and sever vasomotor symptoms

A
  1. Oestrogen. Commonly patch
  2. SSRI/SNRI
  3. Gabapentin
  4. Clonidine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Atrophic vaginitis risk factors

A

Post menopausal women
Women on anti-oestrogenic treatment (Tamofixen)
Women who have had chemo or radiotherapy
Women who are post partum/breastfeeding

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

Symptoms of atrophic vaginitis

A 
Dysuria
Haematuria
Stress incontinence
Urinary frequency
Recurrent UTI
Genital
Dryness
Burning
Itching
Dyspareunia
Post-coital bleeding
Vaginal discharge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Treatment

A

Hormone Replacement Therapy

Non hormonal vaginal moisturiser and lubricant

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

Osteoporosis

A

Rapid loss of bone density

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

Who should have BMD test

A

Post menopausal women who:
suffer fracture suspicious of osteoporosis
are under 65 with one or more additional risk factors
age 65 and over

17
Q

Hormones in HRT

A

oestrogen – types used include estradiol, estrone and estriol
progestogen – a synthetic version of the hormone progesterone, such as dydrogesterone, medroxyprogesterone, norethisterone and levonorgestrel

18
Q

Two types of HRT

A

Combined HRT

Oestrogen only HRT

19
Q

Benefit of combined HRT over oestrogen only

A

Reduced risk of endometrial cancer

20
Q

Forms of HRT

A 
Patches 
Tablets (most common)
Creams
IUD
Vaginal ring (pessary)
Gels (only oestrogen so have to take porgestrogen some other way)
Vaginal oestrogen (helps with dryness not hot flushes)
Injection
21
Q

Cyclical HRT (recommended for women taking combined HRT who have menopausal symptoms but still have their periods)

A

Cyclical can be:
monthly HRT – you take oestrogen every day, and take progestogen alongside it for the last 14 days of your menstrual cycle. Recommended for regular periods

three-monthly HRT – you take oestrogen every day, and take progestogen alongside it for around 14 days every three months. Recommended for irregular periods

22
Q

Continuous combined HRT (recommended for women who are post-menopausal)

A

continuous HRT involves taking oestrogen and progestogen every day without a break.

Oestrogen-only HRT is also usually taken continuously.

23
Q

Adverse effects of HRT

A 
Headaches
Upset stomach/bloating
Diarrhoea
Weight/appetite changes
Change in libido
Acne
Peripheral swelling
Breast tenderness/enlargement
24
Q

Define dysfunctional uterine bleeding

A

diagnosis of exclusion and is defined as any abnormal uterine bleeding in the absence of pregnancy, genital tract pathology, or systemic disease.

25
Q

Dysfunctional uterine bleeding signs and symptoms

A

Heavy/irregular/prolonged bleeding
May have dysmenorrhoea
Anemia

26
Q

Ix for dysfunctional uterine bleeding

A

Pregnancy test (excl. pregnancy)
FBC (Hb + MCV) diagnose anaemia
STI screen
If >45 with risk factors for endometrial disease consider:
TVS USS-fibroids and polyps. Can measure endometrial thickness
Biopsy to exclude malignancy
Hysteroscopy and biopsy if no response to initial Tx

27
Q

Tx for dysfunctional uterine bleeding (medical)

A

Mirena IUS
Tranexamic acid 1g TDS-antifibrinolytic day 1-4 period
Mefenamic acid 500mg TDS- NSAID day 1-5 period
COCP-regulates cycle
Oral progestagens

If irregular also consider:
Norethisterone 5mg TDS or medroxyprogesterone acetate 5-10mg TDS-regulates cycle day 5-26 of cycle

If none work in severe cases:
GnRH analogues-Induce amenorrhoea
Medroxyprogesterone acetate 10g TDS continuous- iduce amenorrhoea

28
Q

Tx for dysfunctional uterine bleeding (surgical)

A

Endometrial ablation or hysterectomy

Complications include:
Haemorrhage, infection, bladder, uteric or bowel injury

29
Q

Types of Uterovaginal prolapse

A

Cystocele: Prolapse of anterior vaginal wall involves bladder, often has prolapse of urethra (cysto-urethrocele)

Uterine (apical) prolapse- Prolapse of uterus, cervix and upper vagina. If uterus removed the vault or top of vagina can prolapse

Enterocele: Prolapse of upper posterior wall of vagina. Pouch usually contains small bowel loops

Rectocele:Prolapse of lower posterior wall of the vagina involving anterior wall of rectum.

30
Q

Prolapse symptoms general

A 
Often asymptomatic but can include:
Dragging sensation/uncomfortable
Feeling of lump coming down
Dyspareunia or difficulty inserting tampon
Backache
31
Q

Prolapse symptoms cysto-urethrocele

A

Urinary urgecy + frequency
Incomplete bladder emptying
If urethra kinked: urine retention

32
Q

Prolapse symptom rectocele

A

Constipation

Difficulty with defecation.

33
Q

Prolapse Ix

A

USS: Exclude pelvic or abdominal mass

Urodynamics if there is incontinence ECG, CXR, FBC, U&E to asses fitness for surgey

34
Q

Prolapse conservative management

A

Pelvic floor muscle exercises

Pessary

35
Q

Prolapse surgical management

A

Anterior: colporrhapy or trasvaginal mesh repair
Apical: Vaginal hysterectomy, sacrospinous fixation
Posterior: P repair, Transvaginal mesh repair, perineal body repair

Obstetrics & Gynaecology (14 decks)

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