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ESA 4 - Reproductive System > Menstruation > Flashcards

Menstruation Flashcards

1
Q

What does the menstrual cycle involve?

A

The interaction of many endocrine glands, as well as a responsive uterus

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2
Q

What interacts in the menstrual cycle?

A
  • The central nervous system; the hypothalamus and pituitary
  • The ovaries
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3
Q

What does the interaction between the CNS and the ovaries result in?

A

Cyclic and ordered sloughing of the uterine endometrial lining

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4
Q

What are the key hormones in the control of the menstrual cycle?

A
  • Gonadotrophin releasing hormone (GnRH)
  • Follicle stimulating hormone (FSH)
  • Luteinising hormone (LH)
  • Estradiol
  • Progesterone
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5
Q

What are the stages of the menstrual cycle?

A
  • Proliferative stage
  • Ovulation
  • Secretory phase
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6
Q

When does the proliferative stage of the menstrual cycle begin?

A

At the onset of menses

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7
Q

When does the proliferative phase end?

A

When ovulation takes place

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8
Q

What takes place during the proliferative phase of the menstrual cycle?

A

Folliculogenesis

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9
Q

What happens in folliculogenesis?

A

A dominant follicle is selected from a pool of growing follicles that will be destined to ovulate

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10
Q

What does the growth of follicules during the proliferative stage depend on?

A

Pituitary hormones

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11
Q

What does the growth of a follicle during the follicular phase lead to?

A

Production of estradiol from the layers of the granulosa cells surrounding it

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12
Q

What is estradiol responsible for in the proliferative phase?

A

The proliferation of the endometrial lining of the uterus

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13
Q

When does ovulation occur?

A

At the peak of follicular growth

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14
Q

What does ovulation occur in response to?

A

LH surge

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15
Q

What size to follicles grow to prior to ovulation?

A

Sizes greater than 20mm in average diameter

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16
Q

By what mechanism is LH released following follicular growth?

A

In a positive feedback mechanism from the anterior pituitary, due to prolonged exposure to estradiol

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17
Q

What levels of estradiol are required for positive feedback to take place?

A

Above 200pg/mL for approximately 50 hours

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18
Q

What is required for the oocyte to be released from the follicle in ovulation?

A

Several proteolytic enzymes and prostaglandins are activated, leading to digestion of the follicle wall collagen

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19
Q

What happens once an oocyte has been released in ovulation?

A

The fallopian tube is responsible for picking it up to await fertilisation

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20
Q

What happens during the secretory phase?

A

The remaining granulosa cells that are not released within the oocyte during the ovulation process enlarge and acquire lutein

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21
Q

What colour is lutein?

A

Yellow

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22
Q

What are the granulosa cells that have acquired lutein called?

A

Corpus luteum

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23
Q

What does the corpus luteum do?

A

Predominantly secretes progesterone

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24
Q

When is peak progesterone production noted?

A

1 week after ovulation takes place

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25
Q

What does the life span of the corpus luteum, and hence progesterone production, depend on?

A

Continued LH support from the anterior pituitary

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26
Q

What happen to the corpus luteum if pregnancy takes place?

A

hCG (human chorionic gonadotrophin) will maintain the corpus luteum

27
Q

What happens to the corpus luteum if pregnancy fails to happen?

A

Luteolysis takes place, and the corpus luteum is converted to a white scar, the corpus albicans

28
Q

Draw a diagram illustrating the blood supply of the endometrium

A
29
Q

What happens to the radial arteries as menses occur?

A

They shrink and compress, so blood supply to the innermost layer of the womb is affected

30
Q

What happens to the innermost layer of the womb after the radial arteries have been compressed?

A

It dies and gets sloughed off

31
Q

How long does mensturation last?

A

24-32 days, but variable

32
Q

When is regularity of menstruation best?

A

Between 20 and 40 years

33
Q

How does the length of the menstrual cycle change depending on age?

A
  • Longer in menarche
  • Shorter in pre-menopause
34
Q

What is the median blood loss per menstrual cycle?

A

37-43ml

35
Q

When does most of the blood loss during menses occur?

A

In the first 48 hours

36
Q

What % of women loose >80ml per cycle?

A

9-14%

37
Q

What % of those who loose >80ml/cycle are anaemic due to significant blood loss?

A

60-70%

38
Q

What is menorrhagia?

A

Heavy periods

39
Q

What are the causes of menorrhagia?

A
  • Abnormal clotting
  • Fibroids
  • IUCD
  • Cancer
40
Q

What are fibroids?

A

Benign growths found in the uterine cavity

41
Q

What are fibroids often present with?

A

Heavy periods

42
Q

What can very large fibroids present as?

A

Pregnancy/tumour

43
Q

In what locations are fibroids found?

A
  • Intracavity
  • Subserosal
  • Submucosal
  • Intramural
  • Pedunculated (on a stalk)
44
Q

What kind of cancer can cause heavy periods?

A

Endometrial cancer

45
Q

What is the problem with endometrial cancer?

A

Low detection rate

46
Q

Why does endometrial cancer have a low detection rate?

A
  • A lot of male doctors are reluctant to ask questions, or to follow up
  • Political correctness
  • Problems obtaining chaperones
47
Q

How can endometrial cancer be detected?

A
  • Ultrasound scan
  • Hysteroscopy
  • Pelvic MRI
48
Q

What % of cases of heavy periods are caused by dysfunctional uterine bleeding?

A

60%

49
Q

What is dysfunctional uterine bleeding?

A

No recognisable pelvic pathology, pregnancy, or general bleeding disorders. No cause has been found to account for heavy periods

50
Q

What may a person opt for in the case of dysfunctional uterine bleeding?

A

Hysterectomy

51
Q

What can cause irregular bleeding?

A

Hormone contraceptives

52
Q

When is bleeding between periods common with hormone contraceptives?

A

During the first three months

53
Q

What hormonal contraceptives can lead to irregular bleeding?

A
  • Combined oral contraceptive pill
  • Progesterone only pill
    Contraceptive patch (transdermal patch)
  • Contraceptive implant or injection
  • Intrauterine system (IUS)
54
Q

When are menstrual problems with hormone contraceptives possible?

A
  • Missed combined pills/progesterone only pills
  • If certain prescription medicines or St John’s Wort are taken when using the pill, patch, ring, or implant
  • When have vomiting/diarrhoea whilst on COCP
55
Q

Why does missed combined pills/progesterone-only pills cause menstrual problems?

A

Disrupts control of periods

56
Q

Why can vomiting/diarrhoea cause menstrual problems when taking the pill?

A

Causes a dip in hormone levels in the blood

57
Q

How can heavy periods be treated?

A

Endometrial ablation of the endometrium

58
Q

What happens in endometrial ablation of the endometrium?

A

Use a Nd-YAG laser to burn the lining of the endometrium to reduce the thickness of the layer

59
Q

How effective is endometrial ablation of the endometrium?

A

Relatively good success rate. Sometimes works, sometimes needs repeating

60
Q

What is amenorrhea?

A

No period

61
Q

What are the causes of amenorrhea?

A
  • Pre-pubertal
  • Pregnancy
  • Menopause
  • Uterine/endometrial
  • Ovarian
  • Pituitary
  • Hypothalamic
62
Q

What are the physical impacts of menstrual disorders?

A
  • Tiredness
  • Anaemia
63
Q

What is the psyschological impact of menstrual disorders?

A
  • Depression
  • Irritability
  • Mood swings
  • Anxiety
64
Q

What is the social impact of menstrual disorders?

A

Impact on ability to socialise/swim/perform sports

ESA 4 - Reproductive System (31 decks)

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