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Y3 Reproduction > Physiology - Menstrual Cycle > Flashcards

Physiology - Menstrual Cycle Flashcards

1
Q

what does GnRH stimulate?

A

release of FSH and LH from the anterior pituitary

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2
Q

what effect do FSH and LH have on follicles?

A

FSH initiates follicular growth

LH stimulates further development

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3
Q

what effect do FSH and LH have on the ovaries?

A

stimulate the follicles to secrete oestrogen

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4
Q

what secretes progesterone?

A

the corpus luteum

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5
Q

what effect to progesterone and oestrogen have on the endometrium?

A

prepare and maintain it for implantation

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6
Q

how long is a normal menstrual cycle?

A

24-38 days

no more than 9 days variation

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7
Q

how long should bleeding last in a normal menstrual cycle?

A

no more than eight days

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8
Q

when does the menstrual phase occur?

A

roughly the first five days of the cycle

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9
Q

what happens in the ovaries during the menstrual phase?

A

primary follicles develop into secondary follicles under the influence of FSH

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10
Q

what happens in the uterus during the menstrual phase?

A

fall in oestrogen + progesterone causes release of prostaglandins, causing arteriolar construction

cells die off and stratum functionalis sheds

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11
Q

what time period has the main impact on the length of a menstrual cycle?

A

the time between menstruation and ovulation

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12
Q

what happens in the ovaries during the preovulatory phase?

A

secrete oestrogen

one follicle outgrows the rest and becomes the Graafian follicle

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13
Q

what happens in the uterus during the preovulatory phase?

A

new stratum functionalis produced

endometrial thickness doubles

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14
Q

when does ovulation occur in a 28 day cycle?

A

day 14

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15
Q

what happens in the ovaries during the ovulatory phase?

A

oestrogen stimulates GnRH, which causes an LH surge

this causes expulsion of the oocyte from the Graafian follicle

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16
Q

how long does the postovulatory phase last?

A

14 days - constant

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17
Q

what happens in the ovary during the postovulatory phase?

A

follicle becomes the corpus luteum under the influence of LH

18
Q

what hormones does the corpus luteum secrete?

A

progesterone
oestrogen
relaxin
inhibit

19
Q

what do the endometrial glands secrete during the postovulatory phase?

A

glycogen

20
Q

what are pre-menstrual disorders (PMD)?

A

when premenstrual symptoms have an impact on daily living

21
Q

for a diagnosis of PMD, when must symptoms occur?

A

must be cyclical

occur in the post-ovulatory or luteal phase

22
Q

what are some physical symptoms of PMD?

A 
breast tenderness
bloating 
headache 
skin problems 
weight gain
23
Q

what are some psychological symptoms of PMD?

A

mood swings
anger
depression
suicidal ideation

24
Q

what are some behavioural symptoms of PMD?

A 
sleep disturbance 
appetite changes 
restlessness 
poor concentration 
confusion
25
Q

how is PMD diagnosed?

A

symptom diary filled out for a minimum of two cycles

26
Q

what is the principle of management of PMD?

A

ovulation suppression

27
Q

what is the first line management for PMD?

A

COC

needs to contain drospirenone

28
Q

what is a second line option for management of PMD?

A

GnRH agonists

for a maximum of six month

29
Q

what are possible side effects of GnRH agonists?

A

vasomotor side effects such as hot flushes and osteoporosis

30
Q

what is the final option for management of PMD?

A

bilateral oophorectomy and hysterectomy

31
Q

what is heavy menstrual bleeding?

A

blood loss that impacts with life

32
Q

what needs to be excluded when someone presets with heavy menstrual bleeding?

A

pregnancy

33
Q

what investigations are done for heavy menstrual bleeding?

A 
FBC
smear 
swabs for infection 
USS 
coagulation screen if indicated
34
Q

what is the first line management of heavy menstrual bleeding?

A

mirena coil

35
Q

how does the mirena coil help heavy menstrual bleeding?

A

slowly releases localised progesterone and prevents proliferation of the endometrium

36
Q

what are the two second line options for heavy menstrual bleeding?

A

tranexamic acid

COC

37
Q

what type of drug is tranexamic acid?

A

anti fibrinolytic

38
Q

how does the COC help heavy menstrual bleeding?

A

suppresses ovulation and endometrial proliferation

also regulates cycles

39
Q

what are the third line options for heavy menstrual bleeding?

A

norethisterone

DMPA injections

40
Q

what is the last line management for heavy menstrual bleeding?

A

surgical management or referral to secondary care

41
Q

what are some possible causes of heavy menstrual bleeding?

A 
fibroids 
polyps 
adenomyosis 
coagulopathy 
malignancy
42
Q

what are fibroids?

A

benign smooth muscle tumours of the uterus

Y3 Reproduction (49 decks)

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