Menstrual Cycle, Vulva, Vagina and Uterus

Question 1

How does oestrogen and progesterone influence pulsatile GnRH release?

Answer 1

Oestrogen increases frequency
Progesterone decreases frequency

Question 2

During which days of the cycle does oestrogen produce positive feedback to hypothalamus?

Answer 2

For most of the cycle, oestrogen and progesterone cause neg. feedback to hypothalamus.

During days 12-14, higher oestrogen levels produce positive feedback, causing rise in production of oestrogen and subsequent ovulation

Question 3

What charcteristic is required of the final surviving follice?

Answer 3

Must have the most FSH and LH receptors - most sensitive to triggers to make the most oestrgoen.

Question 4

Describe the process of ovulation

Answer 4

Rapid surge in oestrogen during day 12-14 causes hypothalamus to release LH, triggering ovulation and changes the winnig follicle into CORPUS LUTEUM - now makes progesterone

Question 5

What lesions can occur on the vulva?

Answer 5

Inflammatory:

• Psoriasis
• Eczema

Cysts

• Bartholin’s duct cyst

Leukoplakia

• Vulval intraepithelial neoplasia (VIN)
• Lichen sclerosus

Question 6

Two pathways leading to vulval intraepithelial neoplasia (VIN)?

Answer 6

HPV related VIN

Differentiated VIN (Lichen sclerosus associated)

Question 7

Two main types of malignant neoplasms of vagina:

Answer 7

• Vaginal intraepithelial neoplasia (VAIN) HPV driven
• SCC

Question 8

What is dysfunctional uterine bleeding?

Answer 8

Term for bleeding that lacks an organic cause:

• Disturbance in menstrual cycel
• Polycystic ovarian syndrome
• Functiona ovarian tumours

Question 9

What is an anovulatory cycle?

Consequences?

Answer 9

Failure to ovulate

PRolonged oestrogen with no progesterone production stimulates endometrial growth

Consequences:

• Follicle disintegrates, rapid drop in oestrgen causes bleeding
• Follicle unable to meet increasing oestrogen demands and causes bleeding

Question 10

What is adenomyosis?

Answer 10

Cells that line the uterus grow into the muscle of the uterus

Question 11

What is endometriosis?

Answer 11

Ectopic endometrial tissue outside the uterus

Can result in infertility, pelvic pain, heavy and painful periods.

Question 12

What carcinomas are endometriosis associatd with?

Answer 12

Endometrioid adenocarcinoma

Clear cell carcinoma

Question 13

Cause of endometrial hyperplasia?

Answer 13

Prolonged oestrogen stimulation

Question 14

Treatment of endometrial hyperplasia

Answer 14

Hysterectomy

Progesterone therapy - Minera

Question 15

How is endometrial hyperplasia categorised?

Answer 15

NOn-atypical - 2% will go onto adencarcinoma

Atypical - 30% will have carcinoma at hysterectomy

Question 16

Two classifications of endometrial cancer and examples:

Which classification has a better prognosis?

Answer 16

Type 1

• Endometrioid adenocarcinoma

Type 2:

• Serous carcinoma
• Clear cell carcinoma
• Mixed mullerian tumour

Type 1 is much more indolent with better prognosis.

Question 17

Two types of myometrial lesions?

Answer 17

Benign leiomyoma fibroid:

• Common
• Round, well circumscribed, firm

Malignant leiomyosarcoma

• Infiltrative
• Softening
• Haemorrhage, necrosis