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Reproduction > Physiology and pathology > Flashcards

Physiology and pathology Flashcards

1
Q

Gonadotrophin releasing hormone (GnRH) is secreted from where and stimulates the release of what?

A
  • secreted from the hypothalamus

- stimulates the release of follicle stimulating hormone (FSH) and luteinising hormone (LH) from the anterior pitutiary

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2
Q

What is the role of FSH?

A

Initiates follicular growth

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3
Q

What is the role of LH?

A

Stimulates the further development of follicles

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4
Q

What stimulates the ovarian follicles to secrete oestrogen?

A
  • FSH

- LH

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5
Q

What secretes progesterone?

A

The corpus luteum

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6
Q

When does the menstrual phase occur?

A

Usually the first five days of the cycle

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7
Q

What occurs in the ovaries during the menstrual phase?

A
  • under the influence of FSH primary follicles develop into secondary follicles
  • this may take several cycles
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8
Q

What occurs in the uterus during the menstrual phase?

A
  • a fall in oestrogen and progesterone stimulates release of prostaglandins causing uterine spiral arterioles to constrict
  • the cells supplied by these arterioles die and the entire stratum functionalis of the endometrium sloughs off leaving the thin stratum basalis
  • 50-150ml of blood tissue, mucus and epithelial cells shed from the endometrium passing through the cervix and vagina
  • normal blood loss is 5-80ml
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9
Q

How long does the preovulatory phase last?

A

The time between menstruation and ovulation varies in length and has the main impact on cycle length

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10
Q

What occurs in the ovaries in the preovulatory phase?

A
  • secondary follicles secrete oestrogen

- one secondary follicle outgrows the rest to become dominant and develops into the graafian follicle

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11
Q

What occurs in the uterus in the preovulatory phase?

A
  • oestrogens released into the circulation by the growing secondary follicles and graafian follicle stimulate growth of the endometrium
  • cells of the stratum basalis undergo mitosis and produce a new stratum functionalis
  • endometrial thickness double to 4-10mm
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12
Q

When does ovulation occur?

A

Ovulation occurs on day 14 in a 28 day cycle (14 days before menstruation)

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13
Q

What occurs in the ovaries during the ovulatory phase?

A
  • oestrogen stimulates more GnRH release
  • this leads to an increase in LH and FSH release
  • LH causes the rupture of graafian follicle and expulsion of a secondary occyte (approximately 9 hours after the LH surge)
  • the occyte is taken into the fallopian tube
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14
Q

What occurs in the uterus during the ovulatory phase?

A
  • progesteron and oestrogen continue to stimulate proliferation to the endometrium
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15
Q

When does the postovulatory phase occur?

A

This is the most constant phase and routinely last for 1 days with little variation

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16
Q

What occurs in the ovary in the postovulatory phase?

A
  • the collapsed follicle becomes the corpus luteum under the influence of LH
  • the corpus luteum secretes progesterone, oestrogen, relaxin and inhibin
  • if fertilisation does not occur this secretory activity declines after 2 weeks and a new cycle begins
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17
Q

What occurs in the uterus during the postovulatory phase?

A
  • progesterone and oestrogen promote growth and coiling of the endometrial glands, vascularisation and further thickening of the endometrium (12-18mm)
  • endometrial glands begin to secrete glycogen
18
Q

Name symptoms of PMD

A 
Physical;
- breast tenderness 
- bloating 
- headache 
- skin disorder 
- weight gain 
- swelling 
- joint pain 
- fatigue 
Psychological; 
- mood swings 
- anger 
- depression 
 - tension 
- not in control 
- lack in interest 
- loneliness 
- hopelessness 
- suicidal ideation 
Behavioural; 
- sleep disturbance 
- change in appetite 
- restlessness 
- poor concentration 
- confusion 
- social withdrawal
19
Q

Name drugs that can be used for ovulation suppression in PMD

A
  • yasmin and eloine (1st line)
  • GnRH agonists
  • danazol
  • oestrogen
  • bilateral oophrectomy and hysterectomy with add back oestrogen only
20
Q

Describe the management of heavy menstrual bleeding

A
  • minera coil (1st line)
  • tranexamic or COC (2nd line)
  • norethisterone or DMPA (3rd line)
  • 4th line is surgical management
21
Q

Name causes of heavy menstrual bleeding

A
  • fibroids
  • polyps
  • adenomyosis
  • coagulopathy
22
Q

What are fibroids?

A

Benign smooth muscles tumours of the uterus

23
Q

Describe adenomyosis

A
  • defined as the presence of non-neoplastic endometrial glands and stroma in the myometrium
  • associated with hyperplasia and hypertrophy of the surrounding myometrium
  • associated with a history of c section, uterine curettage, surgical termination of pregnancy, increasing age, oestrogen exposure and tamoxifen use
24
Q

Describe surgical options for heavy menstrual bleeding

A
  • polypectomy
  • endometrial ablation
  • uterine artery embolisation
  • myomectomy
  • hysterectomy
25
Q

Name indications for endometrial sampling

A
  • abnormal uterine bleeding
  • investigation for infertility
  • spontaneous and therapeutic abortion
  • assessment of response to hormonal therapy
  • endometrial ablation
  • work up prior to hysterectomy for benign indications
  • incidental finding of thickened endometrium on scan
  • endometrial cancer screening in high risk patients
26
Q

What is menorrhagia?

A

Prolonged and increased menstrual flow

27
Q

What is metorrrhagia?

A

Regular intermenstrual bleeding

28
Q

What is polymenorrhoea?

A

Menses occuring at <21 day interval

29
Q

What is polymenorrhagia?

A

Increased bleeding and frequent cycle

30
Q

What is menometrorrhagia?

A

Prolonged menses and intermenstrual bleeding

31
Q

What is amenorrhoea?

A

Absence of menstruation >6 months

32
Q

What is oligomenorrhoea?

A

Menses at intervals of >35 days

33
Q

Name causes of abnormal uterine bleeding in adolesence / early reproductive life

A
  • DOB usually due anovulatory cycles
  • pregnancy / miscarriage
  • endometritis
  • bleeding disorders
34
Q

Name causes of abnormal uterine bleeding in life / perimenopause

A
  • pregnancy / miscarriage
  • DUB; anovulatory cycles, luteal phase defects
  • endometritis
  • endometrial / endocervical polyp
  • leiomyoma
  • adenomyosis
  • exogenous hormone effects
  • bleeding disorders
  • hyperplasia
  • neoplasia; cervical, endometrial
35
Q

Name causes of abnormal uterine bleeding in post menopausal women

A
  • atrophy
  • endometrial polyp
  • exogenous hormones; HRT, tamoxifen
  • endometritis
  • bleeding disorders
  • hyperplasia
  • endometrial carcinoma
  • sarcoma
36
Q

Describe how to sample the endometrium

A 
Endometrial pipelle; 
- 3.1mm diameter, no dilatation needed 
- no anaesthesia 
- outpatient procedure 
- very safe 
- limited sample 
Dilatation and curretage; 
- most common operation performed on women 
- most through sampling method 
- can miss 5% hyperplasias / cancer
37
Q

Name causes of endometritis

A 
Micro-organisms; 
- nisseria 
- chlamydia 
- TB 
- CMV 
- actinomyces 
- HSV 
Inflammation without specific organisms; 
- intra-uterine contraceptive device 
- postpartum 
- postabortal 
- post curettage 
- chronic endometritis 
-  granulomatous 
- associated with leiomyomata or polyps
38
Q

What is a molar pregnancy?

A
  • an abnormal form of pregnancy in which a non-viable fertilised egg implants in the uterus (or tube)
  • a form of trophoblastic disease which grows as a mass characterised by swollen chorionic villi, categorised as partial moles or complete moles
39
Q

How does a complete mole occur?

A
  • a single or two sperm combining with an egg which has lost its DNA
  • the sperm then reduplicates forming a complete 46 chromosome set
  • only paternal DNA is present in a complete mole
40
Q

How do partial moles occur?

A
  • when egg is fertilised by two sperm or by one sperm which reduplicates itself yielding the genotype 69, XXY (triploid)
  • partial moles have both maternal and paternal DNA
41
Q

What type of mole has a higher risk of developing into choriocarcinoma?

A

A complete hydatidiform mole

42
Q

What is adenomyosis?

A
  • endometrial glands and stoma within the myometrium

- casues menorrhagia / dysmenorrhoea

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