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mestruation Flashcards

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1
Q

what are the 2 phases of the menstrual cycle?

A

follicular phase

luteal phase

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2
Q

what is the follicular phase?

A

during the first 14 days the endometrium thickens under the influence of estrogen–> in the ovaries, the dominant follicle matures leading to ovulation

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3
Q

what is the luteal phase?

A

after ovulation, the ruptured follicle becomes the corpus luteum that secrets progesterone (and some estrogen)

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4
Q

what does progesterone do?

A

enhances the lining of the uterus to prepare it for implantation

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5
Q

what happens if there is no implantation?

A

the corpus luteum degenerates leading to a steep decrease in both estrogen and progesterone

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6
Q

what does the steep drop in estrogen and progesterone cause?

A

menstruation

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7
Q

what is the follicular phase aka?

A

proliferative

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8
Q

what hormone dominates during days 1-2?

A

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

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9
Q

what do the ovaries do during the follicular phase?

A

FSH: causes follicle and egg maturation in the ovary
LH: stimulates the maturing follicle to produce estrogen

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10
Q

what does the uterus endometrium do during the follicular phase?

A

estrogen causes the endometrium to build up (proliferation)

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11
Q

what sort of estrogen feedback occurs during the follicular phase?

A

*negative feedback in the HPO system

increased estrogen inhibits hypothalamuse gnrh release thus decreasing LH and FSH, so new follicles can start maturing

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12
Q

what happens between days 12-14?

A

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

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13
Q

what does the sudden surge of LH cause after the follicular phase?

A

causes ovulation, egg release!

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14
Q

describe the luteal phase?

A

secretory

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15
Q

what hormone predominates during the luteal phase?

A

progesterone

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16
Q

what does the LH surge cause the ruptured follicle to do?

A

become the corpus luteum

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17
Q

what does the corpus luteum secrete?

A

progesterone and estrogen to maintain the endometrial lining

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18
Q

what happens during luteal phase if prego occures?

A

the blastocyte (maturing zygote) keeps the corpus lutum functional, so estrogen and progesterone continue to be secreted, and keeps the endometrium from sloughing off

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19
Q

what is menstruation?

A

first day of follicular

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20
Q

what happens if the egg is not fertilized?

A

the corpus luteum soon deteriorates, causing a fall of progesterone and estrogen levels which has 2 effects

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21
Q

what are the 2 effects when estrogen and progesterone levels fall?

A

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

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22
Q

what is premenstural syndrome?

A

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%

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23
Q

what is premenstrual dysphoric disorder?

A

severe PMS w/ functional impairment

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24
Q

s/sx of pms?

A

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

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25
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
26
tx of pms? (non-pharmaceutical)
life stylle h changes: stress reduction, exercise, caffeine and salt restriction, nsaids, vitamines B6 and E
27
tx for emotional sx ofpms?
ssri, ssnri: fluoxetine, sertraline, paroxetine, citalopram
28
hormonal tx for pms?
drospirenone-containing: leads to amenorrhea if that doesnt work: GnRH with estrogen back up tx
29
tx for bloating?
sprionolactone; calcium carbonate, low salt diet
30
how does spironolactone work?
androgen inhibitor taken during the luteal phase to relieve sx of breast tenderness and bloating,
31
tx for refractory breast pain?
danazole or bromocriptine
32
dysmenorrhea
painful menstruation that affects normal activities
33
what is primary dysmenorrhea?
NOT due to pelvic pathology b/c increased prostaglandins that causes uterine muscle wall activity-->usually starts 1-2 yrs after onset of menarche in teens
34
what is secondary dysmenorrhea?
due to pelvic pathology ex. endometriosis, adenomysosi, leiomyomas, adhesions, PID * increased incidence as wemon age, especialy > 25 yrs
35
s/sx of dysmenorrhea
-diffuse pelive pain right before or with the onset of menses +/- lower abdomen, suprapubic or pelvic pain that may radiate to the lower back legs - may be associated with HA, N, V - cramps last 1-3 days
36
PE of dysmenorrhea?
normal, may have uterine tenderness
37
first line tx for dysmenorreha?
NSAIDS
38
how do NSAIDs help with dysmenorrhea?
inhibit prostaglanding-mediated uterine activity: best to starr before onset of sx/menstruation and given for 2-3 days
39
what are some supportive tx for dysmenorrhea?
local heat, vit E started 2 days prior and for 3 days into menses
40
what else can be done for dysmenorrhea?
ovulations suppression, laparoscopy to r/o secondayr causes of medications fail
41
dysfunctional uterine bleeding?
abnormal frequency/intensity of menses due to NON-ORGANIC cause (dx of exclusion)
42
types of DUB?
amenorrhea (absence) cryptomenorrhea (light spotting) menorrhagia (heavy or prolonged bleeding w/ nrmal intervals) metrorrhagia (irregular bleeding btw expected cycles) menometrorrhagia (irregular, excessive bleeding btw expected cycles) oligomenorrhea (infrequent menstruation) polymenorrhagia (frequenct interval cycles)
43
what can cause DUB?
1) chronic anovulation (90%): disruption of Hypothalamus-pit axis 2) ovulatory
44
describe chronic anovulation DUB
seen with extremes of ages unopposed estrogen: w/o ovulation there is no progesterone--> unopposed estrogen--> increased endometrial overgrowth w/ irregular, unpredictable shedding/bleeding as the endometrium outgrows its own blood supply
45
describe ovulatory DUB
-regular cyclical shedding + ovulation w/ prolonged progesterone secretion (due to decreased estrogen levels --> increased blood loss from endometrial vessel dilation and prostaglandins --> menorrhageia
46
dx of DUB
exculsion: r/i reproductive , systemic, iatrogenic causes
47
what does the workup of DUB include?
hormone levels, transvag US, endometrial bx if endometrial stripe > 4mm on TVUS or in women > 35 to r/o ca/hyperplasia **if work up shows no evidence of organic cause, and neg pelvic exam, DUB!
48
tx of DUB
goal: control acute bldding, prevent future bleed, and minimize endometrial CA rks
49
tx for acute severe bleeding:
high does IV estrogens or OCP: reduce dose as bleeding improves -D&C if meds fail
50
tx for anovulatory
OCP Progesterone if estrogen is contraindicated (medroxyprogesterone acetate) can also use GnRH like leuprolide
51
tx of ovluatory
same as anovulatory
52
what is last line tx for DUB
surgery 1) hysterectomy 2) endometrial ablation for pts that dont want hysterectomy
53
what is amenorrhea?
the absence of menses
54
how do you work up amenorrhea?
prego test, serum prolactin, FSH, LH, TSH
55
what is primary amenorrhea?
failure of menarche onset by age 15 yo in the presence of secondary sex characteristics or 13 yrs in the absence of secondary sex characteristics
56
what do you think if there are breasts present, a uterus present, and amenorrhea?
outflow obstruction --> transverse vaginal septum, imperforate hymen
57
what do you think if there are breasts present, a uterus absent, and amenorrhea?
- mullerian agenesis (46XX) | - androgen insensitivity
58
what do you think if there are breasts absent, a uterus present, and amenorrhea?
- elevated FSH and LH: ovarian causes such as premature ovarian failure or gonadal dysgenesis (Turners) - normal or low FSH or LH: hypothalamus-pit failure or puberty delay (athletes, illness, anorexia)
59
what do you think if there are breasts absent, a uterus absent, and amenorrhea?
rare: usually caused by defect in testosterone synthesis - presents like a phenotypic immature girl with primary amenorrhea, will often have intra-abdominal testes -
60
what is the MC cause of secondary amenorrhea?
PREGO
61
WHAT IS THe def of secondary amenorrhea
absence of menses for > 3 mnths in a pt with previously normal menstruation (or > 6 mnths in a pt who was previously oligomenorrheic)
62
what can cause secondary amnorreha?
- hypothalamus dysfxn - pituitary dsyfnxn - ovarian disorders - uterine dz
63
how does hypothalamus dysfunction cause secondary amenorrhea?
disruption of normal pulsatile hypothalamic secretion of gnrh that directly leads to subsequent decrease in FSH and LH secretion by the pit gland
64
how is hypothalmuse in 2 amen. dx?
normal to low FSH and LH, low estradiol, normal prolactin
65
how does pit dysfunction cause secondary amenorrhea?
ex. prolactin-secreting pit adenoma
66
how does ovarian dysfunction cause secondary amenorrhea?
PCOS, prematuer ovarian failure
67
what is premature ovarian failure
follicular failure or follicular resistance to LH or FSH, Turners syndrome
68
how does uterine dysfunction cause secondary amenorrhea?
it is scarred! caused by Asherman's syndrome
69
what is ashermann's syndrome
acquried endometrial scarring secondary to PP hemorrhage, s/p D&C or endometrial infection
70
amenorrhea, neg prego, low FSH and LH, increased prolactin (galactorrhea) and a + MRI
pit adenoma
71
what labs results would indicated a primary ovarian disorder
increased FSH, and LH, decrease estradiol
72
what are s/sx of ovarian disorder caused 2cd amenorrhea
sxs of estrogen deficiency: similar to menopause, hot flashes, sleep and modd distrubances, dysparenunia, dry/thin skin, vag dryness/atrophy
73
what lab restuls would indicate a secondary or tertiary secondary amenorreha?
normal or decreased FSH/LH
74
how is a hypothalamus dsyfxn secondary amenorrhea tx?
stimulate gonadotropin secretion: Clomiphene or menotropin (pergonal)
75
how is a pit adenoma tx
transsphenoidal surgery
76
what specific test can be used to dx ovarian caused 2cd amneorreha?
progesterone challenge test
77
describe the progesterone challenge test
10 mg medroxyprogesterone for 10 days: + w/drawal bleeding: pt is anovulatory or oligoovulatory (there is enough estrogent present) No w/drawal bleeding: hypoestrogenic (hypoth.-pit failure) OR uterin
78
how is a uterine disoder cuased secondary amenorrhea dx?
Pelvic US : absence of normal uterine strip | hysteroscopy: dx and tx
79
how is a uterine disorder caused secondary amenorrhea tx?
estrogen tx to stimulate endometrial regeneration of the denuded area

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