mestruation Flashcards
what are the 2 phases of the menstrual cycle?
follicular phase
luteal phase
what is the follicular phase?
during the first 14 days the endometrium thickens under the influence of estrogen–> in the ovaries, the dominant follicle matures leading to ovulation
what is the luteal phase?
after ovulation, the ruptured follicle becomes the corpus luteum that secrets progesterone (and some estrogen)
what does progesterone do?
enhances the lining of the uterus to prepare it for implantation
what happens if there is no implantation?
the corpus luteum degenerates leading to a steep decrease in both estrogen and progesterone
what does the steep drop in estrogen and progesterone cause?
menstruation
what is the follicular phase aka?
proliferative
what hormone dominates during days 1-2?
estrogen; and there is a pulsatile gnrh release from the hypothalamus, that leads to an increase in the release of FSH and LH from the pit gland that then stimulates the ovarie
what do the ovaries do during the follicular phase?
FSH: causes follicle and egg maturation in the ovary
LH: stimulates the maturing follicle to produce estrogen
what does the uterus endometrium do during the follicular phase?
estrogen causes the endometrium to build up (proliferation)
what sort of estrogen feedback occurs during the follicular phase?
*negative feedback in the HPO system
increased estrogen inhibits hypothalamuse gnrh release thus decreasing LH and FSH, so new follicles can start maturing
what happens between days 12-14?
ovulation! this happens bc the increased estrogen being released from the mature follicle switches from neg to post feedback on gnrh, causing increases in both estrogen, FSH and LH
what does the sudden surge of LH cause after the follicular phase?
causes ovulation, egg release!
describe the luteal phase?
secretory
what hormone predominates during the luteal phase?
progesterone
what does the LH surge cause the ruptured follicle to do?
become the corpus luteum
what does the corpus luteum secrete?
progesterone and estrogen to maintain the endometrial lining
what happens during luteal phase if prego occures?
the blastocyte (maturing zygote) keeps the corpus lutum functional, so estrogen and progesterone continue to be secreted, and keeps the endometrium from sloughing off
what is menstruation?
first day of follicular
what happens if the egg is not fertilized?
the corpus luteum soon deteriorates, causing a fall of progesterone and estrogen levels which has 2 effects
what are the 2 effects when estrogen and progesterone levels fall?
1) the endometrium is no longer maintained and sloughs off leading to mensturation
2) the neg feedback on GnRH subsides, causing increased pulsatile gnrh secretion, which leads to incrase in FSH and LH which startes the follicle matruation process all over again
what is premenstural syndrome?
cluster of physical, behavioral, and mood changes with cyclical occurrence during the luteal phase of the menstrual cycle
-sx seen in about 75-85% of pts, significant disruption in only 5-10%
what is premenstrual dysphoric disorder?
severe PMS w/ functional impairment
s/sx of pms?
physical: bloating, breast swelling/pain, bowel habit changes, fatigue, muscle/joint paiun
emotional: depression, hostility, irritabiliity, libido changes, aggressiveness
behavioral: food creavings, poor concentration, noise sensitivity, loss of motor senses
dx of PMs
sx initiate during the luteal phase (1-2 weeks before menses and relieved wi/in 2-3 days of the onset of menses plus at least 7 sx free days during follicular phase
tx of pms? (non-pharmaceutical)
life stylle h changes: stress reduction, exercise, caffeine and salt restriction, nsaids, vitamines B6 and E
tx for emotional sx ofpms?
ssri, ssnri: fluoxetine, sertraline, paroxetine, citalopram
hormonal tx for pms?
drospirenone-containing: leads to amenorrhea
if that doesnt work: GnRH with estrogen back up tx
tx for bloating?
sprionolactone; calcium carbonate, low salt diet
how does spironolactone work?
androgen inhibitor taken during the luteal phase to relieve sx of breast tenderness and bloating,
tx for refractory breast pain?
danazole or bromocriptine