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JUST4MED clinical cases > O+G- Menstrucal Cycle + Menstrual Disorders > Flashcards

O+G- Menstrucal Cycle + Menstrual Disorders Flashcards

1
Q
A
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1
Q

The luteal phase of the ovarian cycle corresponds to which phase of the uterine cycle?

a) Secretory phase
b) Menstrual phase
c) Proliferative phase

A

a) Secretory phase

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2
Q

What is the main hormone produced by the corpus luteum?

a) LH
b) FSH
c) Progesterone
d) Oestrogen

A

c) Progesterone

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3
Q

Which cells produce FSH?

a) Granulosa cells
b) Gonadotropic cells
c) Theca cells

A

b) Gonadotropic cells

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4
Q

What is the menstrual cycle?

A

•The menstrual cycle is a series of natural changes that occur in a woman’s reproductive system

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5
Q
  • The average cycle lasts __ days, with ovulation occurring at around day __
  • The average age for a woman’s first menstrual bleeding (_______) is between _____ years old
  • The menstrual cycle is controlled by the endocrine system via the __________, anterior pituitary, and the ______
  • The menstrual cycle can be looked at as the ________ _____ (cycle of the ovum), and the ________ _____ (changes of the lining of the uterus)
  • A woman is most fertile __ days before ovulation and ____ days after
A
  • The average cycle lasts 28 days, with ovulation occurring at around day 14
  • The average age for a woman’s first menstrual bleeding (menarche) is between 12-13 years old
  • The menstrual cycle is controlled by the endocrine system via the hypothalamus, anterior pituitary, and the gonads
  • The menstrual cycle can be looked at as the ovarian cycle (cycle of the ovum), and the uterine cycle (changes of the lining of the uterus)
  • A woman is most fertile 5 days before ovulation and 1-2 days after
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6
Q

What is Premenstrual syndrome?

A

refers to the physical and emotional symptoms a woman experiences in the 5-10 days before her period

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7
Q

Signs and symptoms of Premenstrual syndrome

A
  • Acne
  • Breast swelling and tenderness
  • Fatigue and disturbed sleeping patterns
  • Abdominal cramps – usually 1-2 days before, and during menstrual bleeding
  • Changes in appetite, bloating, constipation or diarrhea
  • Headaches
  • Mood swings, irritability, feeling anxious or upset
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8
Q

______ cells form part of the ovarian follicle, and ________ cells closely surround it

A

Theca cells form part of the ovarian follicle, and granulosa cells closely surround it

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9
Q

What does theca cells produce?

What does granulosa cells produce?

A
  • Theca cells produce androgens and granulosa cells use these androgens to produce oestradiol
  • After ovulation, granulosa cells produce progesterone
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10
Q

Where are GnRH released?

A

• Released by neurons in the hypothalamus

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11
Q

What inhibits GnRH?

A

• High oestrogen levels inhibit GnRH, low levels stimulate it

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12
Q

Where does the GnRH act on?

A

• Acts on the anterior pituitary

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13
Q

Where is FSH produced?

A

Produced and secreted by gonadotropic cells in anterior pituitary

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14
Q

Function of FSH?

A
  • Stimulates growth of immature follicles in the ovaries, acts on granulosa cells that surround the egg to produce oestrogen
  • Stimulated by GnRH, inhibited by oestrogen
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15
Q

Where is LH produced and secreted?

A

• Produced and secreted by gonadotrophin cells of the anterior pituitary

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16
Q

LH is inhibited by ______

LH is stimulated by _______

A

Inhibited by low levels of oestrogen,

stimulated by high levels of oestrogen

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17
Q

Surge in ____ triggers ovulation, supports increase in oestrogen by binding to ______cells

A

Surge in LH triggers ovulation, supports increase in oestrogen by binding to theca cells

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18
Q

TRUE OR FALSE

oestrogen is a steriod hormone?

A

TRUE

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19
Q

Where is oestrogen produced?

A

Produced primarily by granulosa cells of the ovarian follicles, which are stimulated by FSH

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20
Q

Function of oestrogen?

A

Promotes female secondary sexual characteristics, and endometrial growth

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21
Q

Where is progesterone produced?

A

Steroid hormone that is produced mainly by the corpus luteum in th

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22
Q

Progesterone has a _____ effect with oestrogen

A

synergistic

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23
Q

Funciton of progesterone?

A

“The hormone of pregnancy” – promotes endometrial development and thickens vaginal epithelium and cervical mucus so sperm can not enter the uterus, inhibits lactation until birth

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24
Q

The ovarian cycle can be split into……

A

the follicular phase, ovulation, and the luteal phase

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25
Q

Explain the follicular phase:

A
  • FSH levels begin to rise causing stimulation ovarian follicles, once a follicle has matured, it produces large amounts of oestrogen to inhibit the other follicles, the mature follicle is known as the tertiary / Graafian follicle
  • The oestrogen causes endometrial thickening and inhibits LH at low levels. Once oestrogen reaches a higher level, it causes a surge of LH at around day 12, which means ovulation can occur at around day 14
  • The LH causes the tertiary follicle to become thinner so that it can rupture and release a secondary oocyte – this is ovulation
  • This then matures into an ovum, which is released into the fallopian tube
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26
Q

Explain the Luteal phase:

A
  • The pituitary hormones LH and FSH cause the remaining part of the tertiary follicle to develop into the corpus luteum
  • The corpus luteum produces progesterone which maintains the endometrium, induces the production of oestrogen, and inhibits production of LH and FSH

• Inhibition of LH and FSH means that the corpus luteum atrophies, and progesterone is no longer produced, this fall in progesterone causes the endometrium to shed and therefore menstrual bleeding occurs

  • The corpus luteum is broken down and forms the corpus albicans
  • If an ovum is fertilised, the outer layer (syntiotrophoblasts) becomes part of the placenta, these cells produce hCG which is similar to LH and can preserve the corpus luteum, this means that progesterone levels do not drop, and menstrual bleeding does not occur
27
Q

The uterine cycle has 3 phases which are?

A

the proliferative, secretory & menstrual phases

28
Q

Which phase does this describe?

  • Corresponds to the second half of the follicular phase of the ovarian cycle
  • Endometrium is repaired and grows due to rising levels of oestrogen
A

• The proliferative phase:

29
Q

Which phase does this describe?

  • This phase begins once ovulation has occurred (luteal phase in ovarian cycle)
  • Progesterone produced by the corpus luteum maintains the endometrium and causes secretions from endometrial glands to prepare the uterus for embryo implantation
A

The secretory phase:

30
Q

Which phase does this describe?

  • Corresponds to the first half of the follicular phase
  • Occurs if no implantation occurs, loss of corpus luteum causes decrease in progesterone so the functional endometrium sheds
A

Menstrual phase:

31
Q

Which is an example of a menstrual disorder?

a) Polycystic Ovarian Syndrome
b) Premature Ovarian Failure
c) Menorrhagia
d) Endometriosis

A

c) Menorrhagia

The others are examples of menstrual disorder causes

32
Q

What is Menorrhea?

A

refers to the flow of blood at menstruation

33
Q

What is amenorrhea?

a) Painful periods
b) Lack of periods
c) Infrequent periods
d) Heavy periods

A

b) Lack of periods

34
Q

What is an example of Premenstrual Syndrome symptom?

a) Abdominal pain
b) Vaginal discharge
c) Bloating
d) Emotional lability

A

d) Emotional Lability

This is very common and experienced by the majority of women before onset of the menses

35
Q

Menstrual Disorders

What is it?

A

Menstrual disorder is an umbrella term used to describe abnormal conditions that occur within a woman’s menstrual cycle.

36
Q

Examples of Menstrual disorders?

A
  • Amenorrhea
  • Dysmenorrhea
  • Oligomenorrhoea
  • Menorrhagia
  • Premenstrual syndrome
37
Q

What is Primary Amenorrhea?

A

Primary amenorrhea is a failure of menses to occur by either:

  • Age 16 or 2 years after the onset of puberty
  • Age 14 in girls who have not gone through puberty

If by age 13 menses has not occurred and there is no onset of puberty a workup for primary amenorrhea should begin

38
Q

Causes of primary amenorrhea (ovulatory) include:

A

• Chromosomal or genetic abnormalities: Turner syndrome, Kallmann syndrome, Obstructive abnormalities i.e. Vaginal/Uterine Aplasia

• Problems with the hypothalamus or pituitary gland: Eating disorders, Excessive exercise, Extreme stress

39
Q

What is Secondary Amenorrhea?

A

Secondary amenorrhea is the cessation of the menses after they have begun:

• If they have been absent for ≥ 3 months or ≥ 3 typical cycles

There is disruption in the gonadotrophin stimulated oestrogen production which results in changes in the endometrial cycle causing anovulatory amenorrhea.

40
Q

Common causes of secondary amenorrhea include

A

• Natural causes: Pregnancy

• Medications and therapies: Contraception, Antidepressants, Chemotherapy

• Gynecological causes: Polycystic Ovarian Syndrome, Premature Ovarian Failure

• Thyroid Problem

• Pituitary tumors

41
Q

How do you diagnose amenorrhea?

A
  • History including whether the menses have ever occurred, how old the patient was at menarche, if the periods were regular, LMP, how long and heavy menses is, any accompanying symptoms with menses, cyclic breast changes and mood changes and were certain growth and development milestones reaches
  • Review of Systems
  • Physical examination including pelvic examination to detect anatomic genetic abnormalities, evidence of virilization i.e. hirsutism, temporal balding, acne, voice deepening, increased muscle mass and feminization
  • Measure FSH, LH, Testosterone/DHEAS, prolactin and Karyotype the patient
42
Q

Treatment for amenorrhea?

A
  • Treat the underlying disorder
  • Treat the symptoms and long term effects of oestrogen deficiency/excess
  • Minimize hirsutism and long term effects of androgen excess
43
Q

What is Dysmenorrhea

A

Dysmenorrhea is uterine pain around the time of the menses:

  • Pain may occur with menses
  • Or precede menses by 1 to 3 days

Pain tends to peak 24 hours after onset of menses and subside after 2 -3 days.

44
Q

Other symptoms of Dysmenorrhea?

A

Other common symptoms include: Headache, nausea, constipation or diarrhea, lower back pain, urinary frequency.

45
Q

What is the difference between primary and secondary dysmenorrhea?

A
  • Primary symptoms cannot be explained by structural gynecologic disorders
  • Secondary symptoms are due to pelvic abnormalities i.e. endometriosis, uterine adenomyosis and fibroids
46
Q

Treatment for dysmenorrhea

A

Treat underlying disorders

47
Q

WHat is Oligomenorrhea?

A

Condition with infrequent menstrual periods, who regularly go more 35 days without menstruating

• Oligomenorrhoea occurs after more than 90 days without a period

48
Q

Causes of Oligomenorrhea?

A
  • Side effect of hormonal birth control
  • Participate in sports or engage in heavy exercise
  • Eating disorders
  • Diabetes or thyroid problems
  • High blood levels of prolactin
49
Q

How do you diagnose Oligomenorrhea

A

Usually diagnosed as a review of your menstrual history

50
Q

Treatment for Oligomenorrhea?

A
  • It is not a serious condition on its own
  • Menstrual periods can be adjusted with a change in hormonal control or progestin
51
Q

What is Menorrhagia?

A

Menorrhagia is excessive menstrual blood loss that occurs regularly and interferes with a women’s physical, emotional, social and material quality of life.

  • Quantified as loss of 80ml or more with a duration of more than 7 days
  • It can also be defined as the need the change menstrual products every one to two hours, passage of clos greater than 2.54cm or “very heavy” periods as reported by woman

Can occur alone or in combination with other symptoms

52
Q

Causes of Menorrhagia

A
  • 50% of women with menorrhagia have no known cause
  • Uterine and Ovarian pathologies
  • Systemic disorders
  • Iatrogenic
53
Q

Complications of Menorrhagia

A

Affects quality of life, iron deficiency anaemia, endometrial hyperplasia

54
Q

Diagnosis of Menorrhagia

A
  • History and examination (Abdominal and Bimanual examination as well as speculum)
  • Blood tests (iron deficiency anaemia and underlying systemic disorders i.e. TFTs)
  • Referral to gynecology
55
Q

Treatment for Menorrhagia

A
  • Levonorgestrel intrauterine system
  • NSAIDs or Combined Oral Contraceptives
56
Q

What is Premenstrual Syndrome

A

PMS is characterised by irritability, anxiety, emotional lability, depression, oedema, breast pain and headaches, occurring during the week before onset of the menses

57
Q

Premenstrual Syndrome

common symptoms?

A

Common symptoms include: irritability, anxiety, anger and agitation, insomnia, difficulty concentrating and fatigue.

58
Q

PMS is diagnosed……

A
  • based on physical symptoms.
  • by symptoms, women must have 5 or more symptoms for most of the week before the menses that subside following the onset of the menses.
59
Q

PMS treatment?

A
  • General: Symptomatic treatment, adequate sleep, regular exercise and relaxing activities.
  • NSAIDs: Relieve aches, pains and dysmenorrhea
  • SSRI:s Provide relief for the anxiety, irritability and other emotional symptoms
60
Q

OSCE tips

gynae history?

A
  • Onset, duration, severity, course, intermittent/continuous, precipitating factors, relieving factors, associated features and previous episodes
  • Use SOCRATES to explore the pain (particulary in dysmenorrhea)
  • Menstrual history (Duration, frequency, menstrual blood flow, date of LMP, age of menarche)
  • Contraception (If currently used or any reproductive plans)
  • Any abnormal bleeding (post – coital, intermenstrual)
  • Vaginal discharge (Volume, colour, consistency, smell)
  • Dyspareunia
  • Any other relevant symptoms
  • Any other gynecological past history and cervical screening, Family History - Obstetric history
61
Q

When should amenorrhea be investigated?

a) Failure of the menses before the age of 13 with no puberty onset
b) Failure of the menses before the age of 14 with puberty onset
c) Failure of the menses for two consecutive cycles
d) Failure of the menses after 16 years of ag

A

a) Failure of the menses before the age of 13 with no puberty onset

62
Q

What is secondary dysmenorrhea?

: Dysmenorrhea is pain around the time of the menses

a) Dysmenorrhea caused by structural gynecological abnormalities
b) Dysmenorrhea with no known cause
c) Dysmenorrhea that is constant throughout the cycle
d) Dysmenorrhea not caused by structural gynecological abnormalities

A

d) Dysmenorrhea caused by structural gynecological abnormalities

Primary dysmenorrhea has no known structural gynecological cause and so is treated symptomatically

63
Q

What is the first line treatment for Menorrhagia?

a) Combined Oral Contraceptives
b) Nonsteroidal Anti – Inflammatory Drugs
c) Levonorgestrel Intrauterine System
d) Tranexamic Acid

A

c) Levonorgestrel Intrauterine System

ALL of these treatments can be explored before referring to the Gynaecologist

64
Q
A

JUST4MED clinical cases (15 decks)

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