menstrual disorders Flashcards
what part of the brain controls menarche
hypothalamus control due to GNRH pulsatility
what is the mean age of menopause
51 years
what causes thickening of the endometrium
oestrogen
what are the features of the menstrual phase
3-5 days
period
part of follicular phase
what are the features of the proliferative phase
period stops oestrogen causes endometrium to thicken myometrium grows synthesis of progesterone receptors 10 days part of follicular phase dominant hormone is estradiol 17b
what is the histology of the proliferative phase
repair of epithelia
proliferation of stroma
test tube shaped glands
synthesis of intracellular receptors for progesterone
contractility of the myometrium increases
what are the features of the secretory phase
begins after ovulation
endometrium increases secretory activity under influence of progesterone
endometrial glands become coiled and filled with glycogen, sugars and amino acids, angiogenesis- spiral arteries, enzymes accumulate
in order to accept an embryo
part of luteal phase
enlargement of myometrial cells but depressed excitability
12 days
what are the features of the ischaemic phase
constriction of spiral arteries ischaemia of endometrium separation of layers functional layer is shed increase in neutrophils
how many menstrual cycles will the average woman have in a lifetime
450 if well nourished
what causes bleeding without clotting
endogenous fibronolytic activity
what is the average volume of menstrual blood lost
30- 80mls
why are oestrogen and progesterone low in the menstrual phase
corpus luteum is regressing
what hormones are high during the menstrual phase
FSH and LH- causes follicles to mature
when does a single follicle become dominant
day 7
what structure secretes oestrogen in order to stimulate proliferation of the endometrium
dominant follicle
why does LH and FSH decrease during the proliferative phase
oestrogen and inhibin negative feedback
this causes degeneration of non dominant follicles
what happens during day 12-13
LH surge induced by oestrogen
oocyte completes meiosis 1
what happens in day 14
ovulation mediated by follicular digestive enzymes and prostaglandins
what does the corpus luteum do
secretes oestrogen and progesterone
this develops the secretory endometrium
secreation of FSH and LH is inhibited so no new follicles develop
what causes sloughing of the endometrium
degeneration of the corpus luteum which causes drop in oestrogen adn progesterone
how does the cervical mucus change during the proliferative phase
becomes penetrable by sperm
what is oligomenorrhoea
infrequent light periods
what is metrorrhagia
irregular bleeding
what is dysmenorrhoea
painful periods
what is polymenorrhoea
frequent periods
what is amenorrhoea
no periods
what causes heavy periods
imbalance of prostaglandin and thromboxane
treated with antifibrinolytic
what causes dysmenorrhoea
too much prostaglandins produced by endometrium in response to decreased steroid hormones
excessive uterine contractions
this can also account for nausea, vomiting and headache
what is PMS
cyclical symptoms which affect QOL
what is PMDD
premenstrual dysphoric disorder
may be very disabling
what does anxiolytic mean
reduces anxiety
what might cause pms
falling levels of progesterone which is an anxiolytic
what are the symptoms of PMS
- anxiety
- mood swings
- :redness
- irritability
- depression
- a loss in confidence
- clumsiness
- headaches
- feeling bloated
- a change in appe:te
- joint pain
- tender enlarged breasts
- abdominal pain
what are the primary causes of amenorrhoea
anatomical/ congenital
eg absence of uterus/vagina
or genetic e.g. turners, AIS, other intersex conditions
what are secondary causes of amenorrhoea
pregnancy lactation exercise and nutrition menopause PCOS iatrogenic hormonal contraceptives
what are the symptoms of eostrogen deficiency
hot flushes, vaginal dryness
loss of bone mineralisation
reduction in bone mass
why does lactation cause amenorhoea
to stop the mother getting pregnant temporarily to increase survival chance of the infant -metabolic cost
what are the possible symptoms of PCOS
• hyperandrogenemia • oligomenorrhea • obesity – depends on the ethnicity of women • hirsutism • infertility • enlarged cystic ovaries acne amenorrhoea
what are the features of PCOS
elevated oestrogen and testosterone and anti mullerian hormone
insulin resistance
on ultrasound- black cysts can be seen
how is PCOS treated
weight control oral contraceptive to regulate cycle anti androgens hair removal ovulation induction
where is prolactin released
anterior pituritary gland
what controls prolacitn
hypothalamic prolactin inhibitory factor (PIF)- dopamine
how does stress affect dopamine
inhibits dopamine which allows prolactin levels to rise
where is dopamine released
arcuate nucleus
what is a pituritary tumour called
macroadenoma
what are the effects of a pituritary tumour
prevents PIF reaching the anterior pituritary
this causes prolactin levels to rise
inhibits FSH and LH causing amenorrhoea
inapropriate lactation and loss of libido
what are the features of menopause
lack of follicular development leading to low oestrogen and elevated FSH
what can cause premature ovarian failure
idopathic, autoimmune, genetic e.g. fragile X, chemo, radiation
