Normal Menstrual cycle

Question 1

WHat is the average length of menstrual cycle?

Answer 1

28 days

Question 2

What are the phases of the normal menses?

Answer 2

Follicular

Ovulation, luteal

Question 3

When do the different phases of menses fall in relation to the LH surge?

Answer 3

Follicular: onset and ends on day of LH surge
Ovulation: within 30-36 hours of LH surge
Luteal: Begins on the day of LH surge and ends with onset of menses

Question 4

How long are each of the phases in menstruation?

Answer 4

Luteal phase usually 14 days long

Follicular phase can vary

Question 5

What hormones do the Granulosa and theca cells produce?

Answer 5

Gran: produce estrogen, have FSH receptors
Theca: Produce androgens which are converted to estrogen in the Granulosa cells

Question 6

What is needed before a follicle will progress?

Answer 6

FSH is elevated and LH is low

Follicle needs to be able to convert an androgen envt to an estrogen envt.

Question 7

What are the phases of the Follicular Phase?

Answer 7

Primordial
Preantral
Antral

Question 8

What happens when the lesser follacles become atretic?

Answer 8

Theca cels produce androgens
Enhances process of atresia
Stimulates Libido

Question 9

What hormonal and cellular changes happen at ovulation?

Answer 9

Estradiol Plunges
Gran cells enclose the follacle and become luteal cells
Fall in LH
Mittelschmerz-twinge of pain at ovulation

Question 10

WHat happens in the lutela phase?

Answer 10

Progesterone levels rise sharply

Corpus luteum declines 9-11 days after ovulation

Question 11

What can prevent decline of Corpus luteum?

Answer 11

Rapidly rising HCG

HCG maintains steroidogenesis of the corpus luteum until 9-10th week of ovulation

Question 12

WHat causes cramping during menstruation?

Answer 12

Prostaglandins in the secretory endometrium and mens. blood causes contractions of BVs and Muscles which causes ischemia

Question 13

What are the 3 endometrial events caused by loss of estrogen and progesterone?

Answer 13

Vasomotor reactions, tissue loss, menstruation

Question 14

What are the other changes that happen during menstrual cycle?

Answer 14

Endocervix: Inc cervical mucus
Breasts: more tenderness and fullness
Vagina: estrogen increases lubrication
Hypothalmic Thermoreg: inc temp by .5-1 degree

Question 15

What are the causes of Amenorrhea?

Answer 15

Pregnancy
Hypothalamic - pit dysfunction
Ovarian dysunction
Alteration of genital otflow tract

Question 16

What are the causes of Hypothalmic - Pituitary Amenorrhea?

Answer 16

Functional: wt loss, excessive exercise, obesity
Drug induced: antidepressants, marajuana
Neoplastic: pit adenoma
-Craniopharyngiaoma
-Hypothalamic hamartoma
Psychogenic 
Other

Question 17

How is Amenorrhea Dx and Tx?

Answer 17

Progesterone Challenge test
Will induce withdrawl bleed within one week
Bleeding? Anovulatory
No Bleed? Hypoestrogenic or anatomic

Question 18

How can an amenorrheic women be treated if she desires pregnancy?

Answer 18

Induce ovulation with clomiphene citrate, hyman menopausal gonadotropins, pulsatile GnRH or aromatase inhibitors

Question 19

What is a luteal phase defect?

Answer 19

Ovulation occurs but corpus luteum doesn’t secrete adequate progesterone to support the endometrium, and can’t support a preganancy
Menses shortened

Question 20

What causes AUB?

Answer 20

Chonic Unnoposed estrogen stimulation of the endometrium => inc proliferation followed by hyperplasia and endomet cancer

Question 21

What is the Tx of Abnormal Uterine Bleeding?

Answer 21

Progestin for 10-14 days (mimics physiologic withdrawl of progesterone)
Combo of contraception (supresses the endometrium and establishes a regular withdrawl cycle)
Acute heavy bleeding: high dose estrogen/progest

Question 22

What is the Surgical Tx of AUB?

Answer 22

D & C