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Reproduction & Sexual Health > Menstruation & Uterine Pathology > Flashcards

Menstruation & Uterine Pathology Flashcards

1
Q

Name four hormones involved in the menstrual system

A
  • oestrogen
  • progesterone
  • LH
  • FSH
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2
Q

When is the primary follicle formed?

A

Day 5

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3
Q

What is produced by the primary follicle at day 5?

A

Inhibin - causes FSH to fall and oestrogen to rise

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4
Q

What does the oestrogen rise at day 5 stimulate?

A

Proliferative phase in the uterus

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5
Q

Describe the events leading up to ovulation

A

Oestrogen reaches threshold and changes to positive feedback leading to an LH surge and rise in FSH

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6
Q

What does the LH surge cause?

A

Ovulation, oocyte released into the uterine tubes and secretory phase in the uterus

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7
Q

What is left of the follicle after the oocyte has been released?

A

Corpus luteum - produces progesterone causing a progesterone and oestrogen to rise

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8
Q

What happens if implantation occurs?

A

Placenta produces HCG - this maintains the corpus luteum

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9
Q

What happens if no implantation occurs?

A

Corpus luteum will breakdown causing a fall in oestrogen and progesterone

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10
Q

What is the result of the oestrogen and progesterone fall?

A

Menstruation in the uterus

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11
Q

Describe the proliferative phase

A

Stratum basalis proliferates and increases the thickness of the endometrium - pseudostratified columnar epithelium is relatively straight

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12
Q

Describe the secretory phase

A

Glands become coiled with corkscrew appearance and secrete glycogen

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13
Q

Describe the menstrual phase

A

Arterioles in SF constrict causing ischaemia, tissue breakdown and bleeding

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14
Q

What are the two methods of uterine sampling?

A

Pipette

Dilatation and curettage

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15
Q

How thick should the endometrium be?

A

Premenopausal <16mm

Postmenopausal <4mm

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16
Q

What are the indications for uterine sampling?

A 
Abnormal uterine bleeding
Infertility investigation
Pregnancy loss 
Endometrial ablation 
Prior to hysterectomy 
Incidental finding of thickening 
Cancer screening in high risk cases
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17
Q

Define menorrhagia

A

Prolonged and increased menstrual flow

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18
Q

State the local causes of menorrhagia

A 
Fibroids 
Adenomyosis 
Polyps 
Cervical eversion 
Endometrial hyperplasia 
IUCD 
Pelvic Inflammatory Disease (Chlamydia)
Endometriosis 
Malignancy 
Hormone producing tumours 
Endometrial carcinoma
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19
Q

State the systemic causes of menorrhagia

A

Endocrine - thyroid, diabetes mellitus, adrenal disease
Disorders of homeostasis
Liver/renal disorders
Drugs - anticoagulants

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20
Q

What are the symptoms of PCOS?

A

Oligomenorrhoea/amenorrhoea
Weight gain
Facial hirsutism/acne
Hair loss/thinning

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21
Q

What diseases are associated with PCOS?

A

T2DM (insulin resistance), hypercholesterolaemia, hypertension, sleep apnoea (obesity), higher risk of endometrial carcinoma due to high oestrogen

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22
Q

Describe the diagnostic criteria for PCOS?

A
  1. Oligo/amenorrhoea
  2. Polycystic ovaries (scan appearance)
  3. Clinical and/or biochemical signs of hyperandrogenism
23
Q

Describe the management of PCOS

A

Lifestyle, statin, COCP, mirena coil, ovarian drilling, metformin

24
Q

Define disordered uterine bleeding

A

Irregular uterine bleeding that reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining

25
Q

What are the two types of DUB?

A

Anovulatory

Luteal Phase

26
Q

Describe anovulatory cycle

A

Corpus luteum does not form as secondary oocyte is not released - lack of control of proliferation leads to irregular breakdown

27
Q

Describe luteal phase deficiencies

A

Insufficient progesterone or poor response by endometrium. Abnormal follicular development leads to poor corpus luteum

28
Q

What investigations are done in DUB?

A

FBC, cervical smear, TSH, coagulation, LFT/renal function, transvaginal ultrasound, endometrial sampling

29
Q

What are the treatment options for DUB?

A

Medical
Mirena Coil
Endometrial resection/ablation
Hysterectomy (total or subtotal)

30
Q

What is the medical management of DUB?

A 
Progestogens 
COCP 
Synthetic testosterone 
GnRH analogues 
NSAIDs 
Anti-fibrinolytics
Transexamic acid (taken while bleeding)
31
Q

What medication is required after endometrial resection and hysterectomy?

A

Endometrial resection - combined HRT

Hysterectomy - oestrogen only HRT

32
Q

What is endometritis?

A

Abnormal pattern of inflammatory cells (plasma cells in the stroma)

33
Q

What makes the endometrium resistant to infection?

A

Cervical mucous plug protects the endometrium from ascending infection in addition to cyclical shedding

34
Q

State the infectious causes of endometritis

A 
Neisseria 
Chlamydia 
TB/CMV
HSV 
Actinomyces
35
Q

State the inflammatory causes of endometritis

A 
IUD 
Postpartum/post arbortal
Post curettage 
Chronic endometritis NOS 
Granulomatous 
Associated leiomyomata or polyps
36
Q

When do endometrial polps most commonly occur?

A

Around/after menopause

37
Q

What are the products of conception after miscarriage?

A

Chorionic villi
Trophoblast
Foetal RBCs
Black nucleus - <12 weeks

38
Q

Define molar pregnancy

A

Abnormal pregnancy where a non-viable fertilised egg implants in the uterus

39
Q

What disease is a molar part of?

A

Gestational Trophoblastic Disease

40
Q

Describe gestational trophoblastic disease

A

A mass grows with characteristic swollen chorionic villi and proliferating trophoblasts

41
Q

Describe a complete mole

A

One or two sperm combine with an egg that has lost DNA to form a egg with 46 chromosomes all of paternal DNA as sperm replicates

42
Q

Describe a partial mole

A

Egg fertilised by two sperm or one perm with reduplicates to yield 69 chromosomes

43
Q

What is the risk of molar pregnancy?

A

They can invade the myometrium and risk of transformation into choriocarcinoma

44
Q

What is an adenomyosis?

A

Presence of endometrial glands and stroma in the myometrium leading to menorrhagia/dysmenorrhoea

45
Q

What is leiomyoma?

A

Benign tumour of smooth muscle - Fibroid

46
Q

How may fibroids present?

A

Menorrhagia, infertility, mass effect, pain

47
Q

What hormone stimulates fibroid growth?

A

Oestrogen

48
Q

Name the malignant subtype of leiomyoma

A

Leiomyosarcoma - pleomorphism, necrosis, proliferation

49
Q

Define metrorrhagia

A

Regular intermenstrual bleeding

50
Q

Define polymenorrhoea

A

Menses occurring at <21 day interval

51
Q

Define polymenorrhagia

A

Increased bleeding and frequent cycle

52
Q

Define menometrorrhagia

A

Prolonged menses and intermenstrual bleeding

53
Q

Define amenorrhoea

A

Absence of menstruation >6 months

54
Q

Define Oligomenorrhoea

A

Menses at intervals >35 days

Reproduction & Sexual Health (36 decks)

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