Menstruation Flashcards
What two hormones are responsible for puberty in females and what stimulated these to be produced? What age does this typically start?
Two hormones - FSH + LH
Stimulated by - pulses of GnRH
Starts at - 8yrs
What do the two hormones stimulate?
Stimulate oestrogen production from ovaries
What is thelarche?
Development of breast (9-11yrs)
What is adrenarche?
Growth of pubic hair (11-12yrs)
What is menarche?
First period (13yrs). Initially irregular but with increasing oestrogen they become regular
What other hormone is usually associated with puberty?
Increased growth hormone (GH)
What are the stages of the menstrual cycle?
- Follicular phase (days 1-13)
- Menstrual (1-4)
- Proliferative (5-13)
- Secretory/luteal phase (15-28)
On what day in a menstrual cycle does ovulation occur?
Day 14
What happens in the menstrual phase?
Corpus luteum fails and stop producing progesterone and oestrogen = endometrium unsupported = bleed
What occurs in the proliferative stage and what is the main hormone at work?
Oestrogen (E).
- produced by granulosa cells of the follicle. This then suppresses FSH to prevent more than one follicle developing
- Primes endometrium for progesterone (P) + thickens
- Suppresses FSH from hypothalamus but peak in (E) causes ^LH = ovulation
What occurs during the luteal/secretory phase and which is the main hormone?
Progesterone.
Follicular cells -> corpus luteum.
Corpus luteum supported by LH for 2 weeks. CL produces (P) mainly.
(P) causes secretory changes in endometrium:
- stromal cells swell
-Glands become swollen
- Vascularisation of endometrium
-Accumulation of enzymes and glycoproteins
If there is no corpus luteum what happens to the levels of (E) and (P)? Why does the corpus luteum fail?
Production of both is decreased.
CL fails due to lack of hCG present.
What changes occur within the endometrium and myometrium during menstruation?
- constriction of uterine blood vessels = reduced blood supply and nutrients
- disintegration of endometrial lining
- Endometrial capillaries filate and bleed through weakened capillaries
- Myometrium undergoes rhythmic contractions
What age does the menopause typically occur?
> 45yrs
What is the average blood loss during in menstruation?
<80mls
What is the range of menstrual cycle length?
24-38 days
What is AUB? Define it:
Abnormal Uterine Bleeding. Variation from the normal menstrual cycle including changes in regularity, frequency, duration and amount of blood loss.
Give the two categories of causes for AUB and examples of each:
Structural - - P - polyps - A - Adenomyosis - L - Leiomyomas (fibroids - M - Malignancy and hyperplasia Non-structural - - C - coagulopathy - O - ovulatory dysfunction - E - endometrial haemostasis dysfunction - I - iaratogenic - N - not yet specified
Give 6 investigations you may do in someone with AUB:
- FBC
- TFT
- Coagulation test
- Urine pregnancy test
- Cervical smear
- USS
If a patient has one of the following in AUB what would you perform? (USS abnormal, age >40yrs, significant IMB, failed medical Rx, risk factors for endometrial cancer [Obesity, DM, nulliparity, PCOS Hx, FH of HNPCC)
Endometrial biopsy
What characterised heavy menstrual bleeding (HMB)?
> 80mls, interfers with QoL, ^^pads
What defines irregular and frequent bleeding?
Irregular >38 day intervals
Frequent <24day intervals
What would prolonged and shortened bleeding be?
Prolonged - >8days
Shortened - <3days
List 3 types of non-menstrual bleeding:
IMB
PCB
Pre/post- menstrual spotting
List 3 types of non-menstrual bleeding:
IMB
PCB
Pre/post- menstrual spotting
What investigation would be performed on women >40yrs or those <40yrs with significant IMB/endometrial canecer risk factors, with AUB?
Pelvic USS + endometrial biopsy or hysteroscopy
List relevant treatment of those with AUB and are >40yrs or those <40yrs with significant IMB/endometrial canecer risk factors:
If contraception wanted - IUS/COC (to reduce volume)
If regular menses but ^ volume - Tranexamic acid/NSAIDs
Irregular menses - cyclical progestogens
If menopausal - HRT
What investigations would you perform in those with postmenopausal bleeding only?
- Urgent USS
- Pipelle biopsy +/- hysteroscopy if endometrium >4mm or recurrent bleeding
Ix in those with post coital bleeding alone. Give one cause too
Cervical smear/colposcopy - if -ve consider cryotherapy
- Polyp/invasive cancer
What treatment would you give to a female <40years presenting with AUB?
If want contraception - IUS/COC
If wanting to conceive - Tranexamic acid or NSAIDs (mefanamic acid)
If the above two fail -> Endometrial biopsy
What is the treatment for fibroids?
Removal -
- Trans-cervical-resection of fibroid (TCRF)
- Myomectomy (fibroid removal)
List 2 causes of precocious puberty (early):
Central - ^GnRH: meningitis, hydrocephalus, hypothyroidism, tumours)
Adrenal - hormone producing tumours of ovaries/adrenal glands
What is Rokitansky syndrome?
Absent vagina with/without missing uterus
What is Ashermans syndrome?
Cervical stenosis due to excess curettage at evacuation of retained product of contraception (ERPC)
What effect does prolactin have upon menses?
It suppresses the pulsatile GnRH production by the hypothalamus -> no LH-surge inducing ovulation.
What inhibits prolactin? And how does this relate to iaratogenic AUB?
Dopamine. Drugs which suppress dopamine (antipsychotics) can cause hyperprolactinaemia and thus amenorrhea.
Where is prolactin produced?
ANTERIOR pitutary
Where is GnRH produced?
Hypothalamus
Where are FSH and LH produced?
ANTERIOR pituitary
