Menstrual Cycle Worksheet Flashcards
What are the 4 phases of endometrial cycle?
Proliferation
Secretory
Ischemic
Menstrual
What is the endometrial cycle influenced by?
Hypothalamic-pituitary-ovarian axis feedback mechanism
Explain the hypothalamic-pituitary-ovarian axis feedback mechanism.
When the hypothalamic-pit-ovarian axis feedback mechanism functions properly, other tissues undergo predictable responses.
EX: Before ovulation, BBT is less than 37C; after ovulation (with increasing progesterone levels) BBT rises
EX2: Changes in cervix and cervical mucos follow a predictable pattern..Preovu and postov mucus is viscous so that sperm penetration is discouraged–at time of ovulation, the mucus is clear and thin [it looks, feels, and stretches like egg white–the stretchable quality is called spinnbarkeit]
EX3: Some women have localized lower abdominal pain called mittelschmerz that coincides with ovulation
What are main hormones associated with endometrial cycle?
Estrogen and progesterone
Endometrial Cycle: Proliferation phase
What happens here?
A significant rich layer of myometrium and blood vessels develops to cover the endometrial cavity
Endometrial Cycle: Proliferation phase
What does this phase correlate with? What does it depend on? Can this phase support an implanted ovum?
Correlates with: Follicular phase of OVARIAN cycle
Depends on the dominance of ESTROGEN stimulation from the ovarian follicles
This phase DOES NOT adequately support and implanted ovum
Endometrial Cycle: Secretory phase
What is this phase characterized by?
Deepening and maturing of the succulent layer of endometrium implantation
Endometrial Cycle: Secretory phase
This phase is characterized by deepening and maturing of the succulent layer of endometrium implantation.
- What does this layer do?
- What is going on with progesterone at this point?
- What if pregnancy does not occur?
- This layer WILL SUPPORT the developing zygote
- Progesterone continues to be produced by the corpus lute
- If pregnancy does not occur, the corpus luteum REGRESSES, ischemia of endometrium develops, and cyclic menstrual bleeding begins
First day of the menstrual cycle is ___. What phase is this in?
Day 1; ischemic phase
What happens in the ischemic phase of the endometrial cycle?
Shedding of functional 2/3 of endometrium
What are the 3 phases of the ovarian cycle?
Follicular phase (pre-ovulatory)
Ovulation
Luteal (post-ov)
T/F: Blood levels of the ovarian hormones (estrogen and progesterone) increase toward the end of the normal menstrual cycle.
FALSE–They decline!!!
The low blood levels of hormones at the end of a normal menstrual cycles triggers the _____ to begin a new ovarian cycle by secreting _____
Hypothalamus to begin a new ovarian cycle by secreting gonadotropin-releasing hormone (GnRH)
GnRH stimulates the _______ to secrete _______ and _____. What is the target organ of these hormones?
GnRH stimulates the ANTERIOR PITUITARY to secrete follicle stimulating hormone (FSH) and luteinizing hormone (LH)
The target organ of these hormones is the OVARY
What is dominant in the follicular phase: FSH or LH? Why?
FSH…it stimulates the development of ovarian griffin follicles
One of these follicles will develop into a mature ova and a surge of LH causes the mature ova to be released from the ovary
What does a surge of LH cause?
The mature ova to be released from the ovary
The developing follicles produce ____ and ____ in large amounts. What do these hormones prepare?
Estrogen and progesterone
These hormones prepare the endometrial lining of the uterus for implantation of a zygote!
When does ovulation occur? What happens when these hormones peak?
After a marked surge of LH and a smaller peak of estrogen 14 days (+/- 2 days) before the next menstrual flow
When the hormones LH and estrogen peak, ovulation occurs within 24-36 hours
Clinical signs of ovulation: What happens in the body basal temp (BBT)?
Sharp increase in body temp
Clinical signs of ovulation: What happens to the vaginal mucus?
It becomes thin and stretchable (spinnbarkeit)
Clinical signs of ovulation: Why is spinnbarkeit important?
This characteristic of the mucus is hospitable to sperm, allowing sperm to survive and propel though the reproductive tract
Clinical signs of ovulation: How does cervical mucus pH change and why?
Changes from acidic to more alkaline. Semen is alkaline. When the mucus is more alkaline, it allows survival of the sperm.
Clinical signs of ovulation: A subjective feeling of slight abdominal discomfort
Mittelschmerz
Clinical signs of ovulation: How does progesterone plasma level changes?
Increase to about 3 mg/mL (about 3 days post-ov)
Luteal phase of the ovarian cycle: What is the follicle crater on the surface of the ovary called?
Corpus luteum
What does the corpus luteum do?
Secretes copious amounts of estrogen and progesterone (with progesterone dominant)
Luteal phase of the ovarian cycle: The hormones estrogen and progesterone peak at approx. ____ after ovulation, about the time a fertilized ovum would be implanted in the endometrium if pregnancy occurred. If no implantation occurs, what happens?
8-10 days
If no implantation occurs, corpus luteum regresses, blood levels of hormones decline and menstruation occurs
Average menstrual cycle is _____
28 days
How long is flow of menstrual cycle?
4-7 days
“Cramps” and tenderness of breasts; fatigue may occur
Dysmenorrhea
What is dysmenorrhea?
Abdominal and lower back pain during menstruation
What are examples of therapeutic management to help with dysmenorrhea?
- Heating pad, hot bath
- Massaging lower back
- Soft, rhymthic rubbing of the abdomen
- TENS
- Hatha yoga, accupuncture, and meditation
- 8 weeks of yoga
- Exercise (one specific exercise nurses can suggest= Pelvic Rocking)
What are some foods to help with therapeutic management of dysmenorrhea?
- Decreased salt and sugar 7-10 days before menses
- Asparagus, cran juice, peaches, parsley, or watermelon (natural diuretics to help reduce edema)
- Low fat vegetarian diet
NSAIDS can be given for dysmenorrhea. If one NSAID is ineffective, a different one may often be effective. If the second one is unsuccessful after a 6 month trial, combine ______ may be used.
Combined oral contraceptive pills (OCPs)
____ are effective in reliving symptoms of primary dysmenorrhea in approx. 90% of women
OCPs
Variations in menstrual cycle flow due to oral contraceptives: flow may ___
Decrease
Variations in menstrual cycle flow due to IUD: flow may ____
Increase
A collection of symptoms preceding menstruation
PMS
PMS is a collection of symptoms preceding menstruation characterized by what 6 things?
- HA
- Bloating (heaviness in lower abdomen and legs)
- Tenderness and swelling of breasts
- Food cravings
- Depression
- Irritability
Cessation of menstruation; early sign of pregnancy; symptoms of menopause, or pathology
Primary amenorrhea
Cessation of ovarian and menstrual cycles. How is it diagnosed?
Menopause; diagnosed one year after last menstrual period
Transition period during which ovarian function and hormone production decline
Climacteric
Hypogonadotropic amenorrhea: Generally reflects a problem in the __________ so that hormone production is inadequate. May also be related to ____ or ___________
Generally reflects a problem in the CENTRAL HYPOTHALAMIC PITUITARY AXIS so that hormone production is inadequate. May also be related to STRESS or INAPPROPRIATE BODY FATE to LEAN ration
Any form of uterine bleeding that is irregular in amount, duration, or timing
Dysfunctional uterine bleeding
What is another way dysfunctional uterine bleeding is referred?
Abnormal uterine bleeding
First line treatment for heavy menstrual bleeding (HMB) is nonsurgical. The most effective nonsurgical treatments, in order of efficacy, are: (4)
- LNR-IUS (an IUD)
- Danazol
- Antifibrinolytic
- Non-steroid anti-inflammatories
What are some possible causes of abnormal uterine bleeding (AUB)? (8)
- Preg related condition
- Lower reproductive tract infections
- Benign anatomic abnormalities
- Neoplasms
- Malignant lesions
- Trauma
- Systemic conditions
- Iatrogenic conditions
What is Danazol?
Synthetic testosterone–an “anti estrogen”
What does Danazol do?
Suppresses FSH and LH secretion, thus producing involution and hypogonadotropism—this results in decreased secretion of estrogen and progesterone and regression of endometrial tissue
Characterized by the presence and growth of endometrial glands and stroma outside of the uterus
Endometriosis
That was book definition
Tissue resembling endometrial tissues, but located outside the endometrium in the pelvis
Endometriosis (worksheet definition)
