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Reproduction and Sexual Health > normal menstruation and menstrual cycle > Flashcards

normal menstruation and menstrual cycle Flashcards

1
Q

how long is luteal phase of the menstrual cycle?

A
  • constant duration of 14 days
  • follicular phase varies from 10-16
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2
Q

what does inhibin do?

A

selectively inhibits FSH at anterior pituitary

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3
Q

what are the 3 events that occur during menstrual cycle?

A
  • follicular phase, ovulation and luteal phase
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4
Q

what hormone levels rise in the first days of the follicular phase (first few days of menstrual cycle)

A
  • FSH
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5
Q

within the follicle, there are 2 types of cells involved in oestrogen and progesterone synthesis, what are these cells?

A
  • theca and granulosa cells
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6
Q

theca cells respond to what hormone?

A
  • LH
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7
Q

granulosa cells respond to what hormone

A
  • FSH
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8
Q

LH stimulates production of what from theca cells?

A

androgens from cholesterol - which are converted to oestrogen by aromatisation in granulosa cells under influence of FSH

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9
Q

as follicles grow, there is negative feedback by what 2 hormones on pituitary to decrease FSH secretion?

A
  • oestrogen and inhibin
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10
Q

the decrease in FSH secretion allows for the selection of one follicle to continue its development towards ovulation. what is this follicle called?

A
  • dominant follicle
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11
Q

the dominant follicle continues to secrete what 2 hormones?

A
  • oestrogen and inhibin which enhances androgen synthesis under LH control
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12
Q

inhibin and activin has opposite actions true or false?

A
  • true activin (also produced by granulosa cells) and pituitary works to increase FSH binding in follicles
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13
Q

other regulators produced by the theca cells include?

A
  • IGF-1
  • IGF-2
    -> produced under action of LH and receptors are present on both theca and granulosa cells
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14
Q

what marks end of follicular phase and start of ovulation?

A
  • dominant follicle has grown and matured
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15
Q

production of oestrogen increases until it reaches threshold to exert a [ ] feedback effort on hypothalamus and pituitary to cause the LH surge

A
  • positive
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16
Q

granulosa cells surround the [ ], forming structures called [ ]

A
  • oocytes
  • follicles
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17
Q

follicles go through 4 key stages of development in the ovaries what are these?

A
  • primordial follicles
  • primary follicles
  • secondary follicles
  • antral follicles aka graafian follicles
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18
Q

once follicles reach the secondary follicle phase they develop receptors for [ ]

A
  • FSH
    -> further development after secondary follicle stage requires stimulation from FSH
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19
Q

as follicles grow, the granulosa cells that surround secondary follicles secrete increasing amounts of [ ]

A
  • oestradiol (oestrogen)
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20
Q

oestrogen has a [ ] feedback effect on pituitary gland

A
  • negative
    -> reducing the quantity of LH and FSH produced
    -> rising oestrogen, causes cervical mucus to become more permeable -> so sperm can penetrate cervix around time of ovulation
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21
Q

one of the follicles will develop further and become the [ ]

A

dominant follicle

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22
Q

what hormone spikes just before ovulation

A
  • LH
    -> causing dominant follicle to release the ovum (unfertilised egg) from the ovary
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23
Q

ovulation occurs when?

A
  • 14 days before end of menstrual cycle
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24
Q

after ovulation, follicle that released ovum collapses and becomes what?

A
  • corpus luteum
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25
Q

corpus luteum secretes progesterone which maintains what?

A
  • endometrial lining
26
Q

progesterone also causes cervical mucus to do what?

A
  • become thick and no longer penetrable
  • also secretes small amount of oestrogen
27
Q

when fertilisation occurs, what structure of the embryo secretes HCG?

A
  • syncytiotrophoblast
28
Q

HCG maintains what?

A
  • corpus luteum
  • without HCG corpus luteum degenerates
  • this is what pregnancy tests check for to confirm pregnancy
29
Q

if no fertilisation, what happens to corpus luteum?

A
  • degenerates and stops producing oestrogen and progesterone (corpus luteum is remaining granulosa and theca cells)
  • causing endometrium to break down and menstruation to occur
30
Q

stromal cells of endometrium does what in response to menstruation?

A
  • release prostaglandins
  • prostaglandins encourage the endometrium to break down and uterus to contract
31
Q

when does menstruation begin?

A
  • starts on day 1 of menstrual cycle
  • negative feedback from oestrogen and progesterone on hypothalamus and pituitary gland ceases, allowing LH and FSH to rise again, and cycle to restart
32
Q

menstruation involves what layers of endometrium to break down?

A
  • superficial and middle layer separating from basal layer
33
Q

study this diagram

A
34
Q

theca granulosa cells around follicles secrete what?

A
  • oestrogen
35
Q

oestrogen has a negative feedback effect on hypothalamus and ant pituitary suppressing release of { }, { }, and { }

A
  • GnRH, LH and FSH
36
Q

oestrogen is what?

A
  • steroid sex hormone
  • produced by ovaries in response to LH and FSH
37
Q

the most prevalent and active version of oestrogen is what?

A
  • 17-beta oestradiol
  • acts on tissues with oestrogen receptors to promote female secondary sexual characteristics
38
Q

what does oestradiol stimulate?

A
  • breast tissue development
  • growth and development of female sex organs - vulva, vagina and uterus at puberty
  • blood vessel development in uterus
  • development of endometrium
39
Q

progesterone is what?

A
  • steroid sex hormone produced by corpus luteum after ovulation
  • when pregnancy occurs, progesterone is produced mainly by placenta from 10 weeks gestation onwards
40
Q

progesterone acts on tissue previously stimulated by oestrogen. what does it act to do?

A
  • thicken and maintain the endometrium
  • thicken cervical mucus
  • increase body temperature
41
Q

LH surge is best predictor of WHAT?

A
  • imminent ovulation and is used in ovulation predictor tests
  • ovulation occurs around 12 hrs after LH surge - when dom follicle ruptures and releases oocyte
42
Q

the high levels of progesterone during luteal phase (by LH) suppress FSH and LH secretion to a level that will not produce what?

A
  • further follicular growth in the ovary during that cycle
43
Q

during proliferative phase, during follicular phase what happens to endometrium?

A
  • endometrium changes from single layer columnar cells to a pseudostratified epithelium w frequent mitoses
44
Q

if fertilisation occurs, progesterone induces formation of a temporary layer called the?

A

decidua

45
Q

what is amenorrhea?

A
  • absence of menstruation > 6 months
46
Q

what is oligomenorrhea?

A
  • periods at intervals of > 35 days or 5 or fewer menstrual cycles over a year
47
Q

what is menorrhagia?

A
  • prolonged and increased > 80ml per period menstrual flow
  • heavy menstrual bleeding
48
Q

causes of menorrhagia?

A
  • fibroids
  • adenomyosis
  • endocerivcal/endometrial polyp
  • endometrial hyperplasia
  • IUCD
  • PID
  • PID
  • endometriosis
  • malignancy of uterine or cervix
  • hormone producing ovarian tumours
  • AV malformation
  • drugs - anticoags - warfarin, clopidogrel, rivaroxaban
49
Q

what is climateric?

A
  • perioid around beginning of menopause also called perimenopause
  • marks transition from reproductive state to non-reproductive state
50
Q

premature menopause is menopause occurs before age of?

A
  • age of 45
  • 2 measurements are done to confirm this
51
Q

due to cessation of follicular development and ripening, levels of various hormones decrease. which ones are these?

A
  • oestradiol, progesterone, inhibin, androgens
52
Q

physical effects of menopause?

A
  • vasomotor symptoms - hot flushes and night sweats
  • joint aches and pains
  • dry and itchy skin
  • hair changes
  • vaginal dryness and soreness causing dyspareunia
  • recurrent UTI, urinary urgency
  • urogenital prolapse
  • osteoporosis increasing risk of fractures
  • CV disease
  • dementia
53
Q

psychological effects of menopause?

A
  • labile mood, anxiety, tearfulness
  • loss of concentration, poor memory
  • loss of libido
54
Q

medical mx for menopause?

A
  • HRT - main hormone is oestrogen
  • progesterone
  • testosterone
55
Q

cyclical combined HRT is often recommended for who?

A
  • perimenopausal women who still get periods and involves taking oestradiol tablet each day of month and progestogen tablet on last 14 days
  • important to note women on continous combined systemic HRT can often have erratic bleeding first 3-6 months after therapy
56
Q

tx for reduced libido is?

A

testosterone

57
Q

what SSRIs are being used as non-hormonal tx of menopausal symptoms often in women w history of breast cancer but HRT still remains far more effective

A
  • fluoxetine
58
Q

contraception should continue for how many years are last period in women under 50 and over 50?

A
  • 2 years in women <50
  • 1 year in women >50
59
Q

side effects of HRT

A
  • oestrogen related - breast enlargement, leg cramps, dyspepsia, fluid retention, nausea, headaches
  • wear off w time
60
Q

side effects of progestogen?

A
  • similar to premenstrual symptoms
  • fluid retention, breast tenderness, headaches, acne, mood swings, depression, irritability, constipation, increased appetitie
61
Q

is HRT CI in breast cancer?

A
  • yes
  • also endometrial cancer
  • known VTE
  • suspected pregnancy
  • acute liver disease
  • thrombophilia etc
62
Q

what are some relative CI to HRT?

A
  • uninvestigated abnormal bleeding
  • large uterine fibroids
  • past hx of benign breast disease
  • unconfirmed personal hx or strong FH of VTE
  • chronic stable liver disease
  • migraine w aura

Reproduction and Sexual Health (29 decks)

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