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Women's Health Rotation > Menstruation > Flashcards

Menstruation Flashcards

1
Q

Gonadotropin-Releasing Hormone (GnRH)

A

Stimulates release of FSH and LH initiating puberty and sustaining menstrual cycle
Secreted by hypothalamus

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2
Q

Follicle-stimulating hormone (FSH)

A

Secreted by anterior pituitary gland during 1st half of menstrual cycle
Stimulates growth and maturation of Graafian follicle before ovulation
Thins the endometrium

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3
Q

Luteinizing Hormone (LH)

A

Secreted by the anterior pituitary gland
Stimulates final maturation of Graafian follicle
Surge of LH about 14 days before next menstrual period causes ovulation
Stimulates transformation of Graafian follicle into corpus luteum
Thickens the endometrium

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4
Q

Estrogen

A

Secreted primarily by the ovaries, corpus luteum, adrenal cortex, and placenta in pregnancy
Stimulates thickening of the endometrium; causes suppression of FSH secretion
Responsible for the development of secondary sex characteristics
Stimulates uterine contractions
High estrogen concentration inhibits secretion of FSH and prolactin but stimulates secretion of LH
Low estrogen concentration after pregnancy stimulates secretion of prolactin

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5
Q

Progesterone

A 
Secreted by the ovary, corpus luteum and placenta during pregnancy
Inhibits secretion of LH
Has thermogenic effect
Relaxes smooth muscles thereby decreases contractions of uterus
Causes cervical secretion of thick mucus
Maintain thickness of endometrium
Allows pregnancy to be maintained
Prepares breasts for lactation
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6
Q

Prolactin

A

Secreted by anterior pituitary gland

Stimulates secretion of milk

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7
Q

Oxytocin

A

Secreted by posterior pituitary gland
Stimulates uterine contractions during birth and compress uterine blood vessels and control bleeding
Stimulates let-down or milk-ejection reflex during breastfeeding

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8
Q

Prostaglandins

A

Fatty acids categorized as hormones
Produced by many organs of the body, including endometrium
Affects menstrual cycle
Influences the onset and maintenance of labor

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9
Q

Follicular phase of menstruation

A

Varies in length more than other phases

In the first half, the primary event is growth of recruited follicles

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10
Q

Levels of estrogen, progesterone, FSH, and LH in first half of follicular phase

A

Estrogen and progesterone production is low. As a result, overall FSH increases slightly
Circulating LH levels increase slowly

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11
Q

What happens with estradiol with recruited ovarian follicles?

A

It increases

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12
Q

What occurs during the second half of the follicular phase?

A

The follicle selected for ovulation matures
FSH levels decrease; LH levels are affected less
Levels of estrogen increase exponentially

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13
Q

Ovulatory phase- estradiol and progesterone

A

Ovulation occurs. Estradiol levels usually peak as the phase begins
Progesterone levels also begin to increase

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14
Q

LH levels during ovulatory phase

A

Stored LH is released in massive amounts, usually over 36-48 hrs

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15
Q

How are estradiol and progesterone levels affected during the LH surge in the ovulatory phase?

A

Estradiol levels decrease, but progesterone levels continue to increase

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16
Q

How LH works during the ovulatory phase

A

Surge stimulates enzymes that initiate breakdown of the follicle wall and release of the now mature ovum within about 16-32 hrs. It also triggers completion of the first meiotic division of the oocyte within about 36 hrs

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17
Q

What occurs during the luteal phase?

A

The follicle is transformed into a corpus luteum
The corpus luteum secretes primarily progesterone in increasing quantities, peaking 6-8 days after ovulation, which stimulates development of the secretory endometrium

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18
Q

What occurs with LH and FSH during the luteal phase?

Estradiol and progesterone?

A

LH and FSH levels decrease

Estradiol and progesterone levels decrease late in this phase

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19
Q

What happens if implantation occurs?

A

The corpus luteum does not degenerate but remains, supported by hCG that is produced by the developing embryo

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20
Q

Amenorrhea

A

Absence of menses

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21
Q

Dysmenorrhea

A

Painful menstruation

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22
Q

Oligomenorrhea

A

Scanty menstruation

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23
Q

Polymenorrhea

A

Too frequent menstruation

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24
Q

Menorrhagia

A

Excessive menstrual bleeding

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25
Q

Metorrhagia

A

Bleeding between periods of less than 2 wks (can be spotting or heavy)

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26
Q

Hypomenorrhea

A

Abnormally short menses

27
Q

Hypermenorrhea

A

Abnormally long menses

28
Q

What ties all the s/sx of PMS together?

A

They affect your pt only in the 14 days just before her monthly period
During luteal phase

29
Q

Emotional and behavioral sx of PMS

A 
Tension or anxiety
Depressed mood
Crying spells
Mood swings and irritability or anger
Appetite changes and food cravings
Trouble falling asleep
Social withdrawal
Poor concentration
30
Q

Physical signs and sx of PMS

A 
Joint or muscle pain
HA
Fatigue
Wt gain from fluid retention
Abdominal bloating
Breast tenderness
Acne flare-ups
Constipation or diarrhea
31
Q

Tx options for PMS

A 
Antidepressants
NSAIDs
Diuretics
Oral contraceptives
Depo Provera
32
Q

Alternative med ideas for PMS

A 
Calcium
Magnesium
Vitamin B6
Vitamin E
Herbal remedies
Natural progesterone creams
33
Q

What is the difference between PMS and PMDD?

A

Sx of PMDD are similar to those of PMS, but they are generally more severe and debilitating

34
Q

Timeline of PMDD

A

Sx occur during the 7-10 days just before menstrual bleeding and usually improve within a few days after the period starts

35
Q

Diagnostic criteria for PMDD

A

Five or more of the following sx must be present:

  • Disinterest in daily activities and relationships
  • Fatigue or low energy
  • Feeling of sadness or hopelessness, possible suicidal thoughts
  • Feelings of tension or anxiety
  • Feeling out of control
  • Food cravings or binge eating
  • Mood swings marked by periods of teariness
  • Panic attack
  • Persistent irritability or anger that affects other ppl
  • Trouble concentrating
  • Physical sx, such as bloating, breast tenderness, HAs, and joint or muscle pain
  • Sleep disturbances
36
Q

Tx for PMDD

A

Balanced diet (with increased whole grains, vegetables, fruit, and decreased or no salt, sugar, alcohol and caffeine)
Adequate rest
Regular exercise 3-5 times per week
Diary or calendar to record the type, severity, and duration of sx
SSRIs, nutritional supplements, and OTC meds for symptomatic relief

37
Q

Primary amenorrhea

A

The absence of menstrual bleeding and secondary sexual characteristics in a girl by age 14 yrs
OR
The absence of menstrual bleeding with normal development of secondary sexual characteristics in a girl by age 16 yrs

38
Q

Secondary amenorrhea

A

The absence of menstrual bleeding in a woman who had been menstruating but later stops menstruating for 6 or more mos

39
Q

Reasons for amenorrhea

A

An abnormality in the hypothalamic-pituitary-ovarian axis
Anatomical abnormalities of the genital tract
Functional causes

40
Q

Hypothalamic causes of amenorrhea

A 
Craniopharyngioma
Teratoma
Sarcoidosis
Kallman syndrome
Nutritional deficiency/eating disorders
Low body weight
Constitutional delay
41
Q

Pituitary causes of amenorrhea

A 
Prolactinemia
Other pituitary tumors
Postpartum pituitary necrosis
Autoimmune hypophysitis
Pituitary radiation
Sarcoidosis
42
Q

Ovarian causes of amenorrhea

A 
Anovulation
Hyperandrogenemia
PCOS
Premature ovarian failure
Turner syndrome-primary
Pure gonadal dysgenesis
Autoimmune oophoritis
Fragile X premutation
Radiation or chemo
43
Q

Other causes of amenorrhea

A

Galactosemia
Anatomical abnormalities of the genital tract
-Intrauterine adhesions
-Mullerian defects
–Imperforate hymen
–Transverse vaginal septum
–Aplasia of the vagina, the cervix, or the uterus

44
Q

Functional causes of amenorrhea

A 
Anorexia/bulemia
Chronic diseases
Excessive wt gain or wt loss
Malnutrition
Depression or other psychiatric disorders and/or their therapeutic tx
Recreational drug abuse
Excessive stress or excessive exercise
Cycle suppression with systemic birth control methods
45
Q

Work up secondary amenorrhea

A

If 3 consecutive menses have been missed, work up is indicated
Pregnancy test
Hormone levels (FSH, LH, estradiol, free and total testosterone, androstenedione), thyroid funciton, serium prolactin
CT or MRI of head
Pelvic exam to r/o physical cause
U/s or other evaluation of the uterus
Tx is dependent on cause

46
Q

Causes of oligomenorrhea

A 
Prolactinomas
Systemic contraceptives
PCOS
Thyrotoxicosis
Hormonal changes in perimenopause
Graves disease
47
Q

Workup for oligomenorrhea

A 
PCOS labs
Thyroid panel
FSH
LH
Estradiol levels
48
Q

Reasons for abnormal uterine bleeding

A 
Polyps
Adenomyosis
Leiomyomata
Malignancy or hyperplasia
Coagulopathy
Ovarian dysfunction
Endometrial
Iatrogenic
Not yet classified
49
Q

When are irregular menses common in premenopausal pts?

A

For up to 2 yrs after menarche

50
Q

What is the most likely dx of AUB in premenopausal women with nl findings on PE?

A

AUB secondary to anovulation

Check for PCOS or thyroid dz

51
Q

Other differentials of AUB in premenopausal women

A

Pregnancy
Infection
Coagulopathy

52
Q

DDx of perimenopausal AUB

A 
Fibroids
Polyps
Anovulatory bleed d/t declining ovarian function
Adenomyosis
Endometrial hyperplasia or neoplasm
53
Q

What must be considered early in the investigation of AUB in perimenopausal women?

A

Endometrial bx and other methods of detecting endometrial hyperplasia or carcinoma

54
Q

What is commonly seen with AUB in postmenopausal women?

A

Uterine pathology, particularly endometrial carcinoma

55
Q

What is included in the intial investigation of AUB in postmenopausal women?

A

Endometrial bx and/or transvaginal u/s

56
Q

What is considered CA until it is ruled out?

A

Postmenopausal bleeding

57
Q

Tx of premenopausal AUB

A

May respond to oral contraceptives, cyclic medroxyprogesterone therapy or cyclic clomiphene

58
Q

Tx of perimenopausal AUB

A

Low-dose oral contraceptives if they don’t smoke or medroxyprogesterone or a progesterone IUD

59
Q

Primary dysmenorrhea

A

Dysmenorrhea that has no cause

60
Q

Tx of primary dysmenorrhea

A 
Primary cause is believed to be related to prostaglandin secretion
Based on symptomatic relief:
-NSAIDs at a therpeutic dose (ALWAYS first line)
-OCPs
-Progestin only pills
-Progesterone IUDs
-Heating pads/hot showers
-Exercise
61
Q

When does primary dysmenorrhea start?

A

Once ovulatory cycles begin

62
Q

Causes of secondary dysmenorrhea

A 
Endometriosis
PID
Myomata
Uterine adenomyosis
Endometrial polyps
Ovarian cysts
Retroverted uterus
Cervical stenosis
Pelvic adhesions
Congenital uterine anomalies
IUD
63
Q

Hx questions to ask in regards to secondary dysmenorrhea

A 
How painful?
What changed?
Is it getting worse?
What other sx are you having?
Any FHx?
What meds (including BC) are you on?
STD exposure
64
Q

Tx of secondary dysmenorrhea

A

Based upon cause
Any existing pathology must be addressed
Pain control
Cycle control if indicated

Women's Health Rotation (15 decks)

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