Physiology of the Female Pelvis Flashcards
1
Q
oral contraceptives
A
- inhibits ovulation and changes endo lining and cervical mucus
- contain estrogen and progesterone
- ovulatory phase should not occur
- nondominant follicles may be present
- endo appears as a thin echogenic line
2
Q
luteinizing hormone
A
- essential in both males and females for reproduction
- secreted by the anterior pituitary gland
- increasing estrogen levels stimulate LH production
- increase triggers ovulation and initiates the conversion of the residual follicle into a corpus luteum. corpus luteum produces progesterone to prepare the endo for possible implantation
- LH surge typically lasts only 48 hours
3
Q
LH releasing factor
A
becomes active after puberty
produced by the hypothalamus
released into the bloodstream, reaching the anterior pituitary gland
4
Q
luteinizing hormone
A
hormone that stimulates ovulation
5
Q
FSH releasing factor
A
- becomes active before puberty
- produced by the hypothalamus
- released into the bloodstream, reaching the anterior pituitary gland
- low levels of estrogen stimulates FSH production
6
Q
follicle stimulating hormone
A
- initiates follicular growth and stimulates the maturation of the graafian follicles
- secreted by anterior pituitary gland
- levels low in childhood and slightly higher after menopause
- levels decline in late follicular phase and slight increase at end of luteal phase
7
Q
corpus albcians
A
scar from previous corpus luteum
asymptomatic
hyperechoic focus within the ovary
differential: cystic teratoma
8
Q
proliferation phase of the endo
A
- overlaps the postmenstruation phase and occurs from days 6-14
- increasing estrogen levels regenerates the functional layer
- coincides with the follicular phase of the ovary
- early phase 4-6mm
- late phase 6-10mm
9
Q
luteal phase of the ovary
A
- days 15-28
- corpus luteum grows for 7-8 days, secreting some estrogen and an increasing amount of progesterone
- if ovum is fertilized, the corpus luteum will continue to secrete progesterone
- if fertilization does not occur, corpus luteum regresses after 9 days and progesterone levels decrease
10
Q
postmenopause without hormone replacement
A
- uterus generally decreases in length and width
- endo thickness should not exceed 8mm in asymptomatic patients or 5mm with vaginal bleeding
- ovaries atrophy and may be difficult to visualize
- decrease in estrogen can shorten the vagina and decreasecervical mucus
11
Q
amenorrhea
A
absence of menstruation
12
Q
endometrium
A
- thickness should not exceed 14 mm
- thickness of the postmenopausal endo without hormone replacement therapy should not exceed 8mm and is consistently benign when measuring 5mm or less
- fluid within the endo cavity is not included in the measurement of the endo thickness
13
Q
mittelschmerz
A
used to describe pelvic pain preceding ovulation
14
Q
ovulatory phase of the ovary
A
- occurs at the rupture of the graafian follicle-day 14
- pelvic pain increases over the ovulatory ovary (mittelschmerz)
- minimal amount of cul-de-sac fluid
15
Q
estrogen
A
- primary female sex hormone
- naturally occuring estrogens include estradiol, estroil, and estrone
- primarily produced by developing follicles and the placenta
- FSH and luteinizing hormone stimulate the production of estrogen in ovaries
- breast, liver, and adrenal glands produce small amounts
- promotes secondary sex characteristics, accelerates growth in height and metabolism, reduces muscle mass, stimulates endo growth and proliferation, and increases uterine growth
16
Q
secretory phase of the endo
A
- aka postovulatory or premenstrual phase
- days 15-28
- progestrone level increase stimulates changes in endo
- 7-14mm
17
Q
polymenorrhea
A
time between monthly menstrual cycles that is fewer than 21 days
18
Q
levonorgestrel implants
A
- inhibits ovulation and thickens cervical mucus
- thin capsule is placed under the skin
- lasts 5 yrs
- ovulatory phase should not occur
- endo appears as a thin echogenic line
19
Q
follicular phase of ovary
A
- begins at strat of menstruation
- ends at ovulation
- generally 14 days
- FSH stimulates the growth of primary follicles
- dominant follicle will grow 2-3 mm/day
- estrogen levels increase
- days 1-5
- days 6-13
20
Q
intrauterine device
A
- foreign body is placed in endo cavity at level of fundus and superior corpus
- paraguard- copper T shape
- mirena- hormone releasing plasctic T shape
- risks: infection, perforation, attachment to the basal layer
- ovulation and formation of a corpus luteum continue
21
Q
precocious puberty
A
- early pubic hair, breast, or genital development, early maturation or from other conditons
- menstruation in girls before 10 years
- functional ovarian cysts
- pubic hair or genital enlargement in boys before 9 years
- elevated hormone levels indicate the possible presence of a hypothalamus, gonad, or adrenal gland neoplasm
22
Q
dysmenorrhea
A
painful menses
23
Q
simple cyst
A
- premenarche: follicular in origin resulting from excessive hormones
- menarche: failure of a dominant follicle to rupture
- postmenopausal: follicular in orgin
- asymptomatic
- pelvic pain
- irregular menses
- anechoic, smooth walls, posterior enhancement, most measure < 5cm
- differential: serous cystadenoma, paraovarian cyst, hydrosalpinx, bladder diverticulum
24
Q
precocious pseudopuberty
A
- early breast development
- adrenal or ovarian mass can secrete excess estrogen
- uterine cervix is larger than the fundus
- normal ovaries without functional follicles
25
Q
corpus luteum cyst
A
- small, irregular anechoic structure
- thick, irregular wall margins
- may contain internal echoes
- anechoic mass demonstrates peripheral hypervascularity (ring of fire)
26
Q
postmenopause with hormone replacement
A
includes both estrogen and progesterone
endo varies in thickness but should measure <8mm in diameter
atrophy of the ovaries is not as prevalent
27
Q
estradiol
A
during pregnancy estradiol levels will steadily rise
small amounts are present in the adrenal cortex and arterial walls
28
Q
functional cyst
A
- benign cyst that respond to hormonal stimulation
- asymptomatic
- pelvic pain
- anechoic ovarian mass measuring < 3cm
- smooth wall margins
- differential: paraovarian cyst, hydrosalpinx, bladder diverticulum
29
Q
oligomenorrhea
A
time between monthly menstrual cycles that exceeds 30 days
30
Q
depot-medroxyprogesterone acetate
A
- inhibits ovulation and thickens cervical mucus
- intramuscular injection every 3 months
- ovulatory phase should not occur
- endo appears as a thin echogenic line
31
Q
menorrhagia
A
abnormally heavy or long menses
32
Q
physiology of ovaries
A
- 200,000 primary follicles
- secretion of FSH stimulates follicular development
- follicles will fill with fluid and secrete increasing amounts of estrogen
- 5 to 11 follicles will begin to develop, with one reaching maturity each cycle
- ovulation is regulated by the hypothalamus
- LH peak 10 to 12 hours before ovulation
- a surge in LH accomplished by a smaller FSH surge triggers ovulation
33
Q
menstrual phase of the endometrium
A
- occurs days 1-5
- functional layer undergoes necrosis from a decrease in estrogen and progesterone levels
- early phase 4-8mm
- late phase 2-3mm
34
Q
progesterone
A
- levels are low in childhood and postmenopause
- produced in the adrenal glands, corpus luteum, brain, and placenta
- increasing amounts of progesterone are produced during pregnancy
- levels low during preovulatory phase, increase after ovulation, and remain elevated during the luteal phase
- prepares endo for possible implantation or starting the nest menstrual cycle
35
Q
normally physiology of female pelvis
A
- menstruation generally occurs between 11 and 13 years of age
- cessation of menstruation usually occurs around age 50
- mentrual cycle ranges 21 and 35 days, average 28 days
- rupture of graafian follicle each cycle
- menstruation depends on functional integrity of hypothalamus, pituitary gland, and ovarian axis.
36
Q
hemorrhagic cyst
A
- rupture of a blood vessel at ovulation
- severe acute pelvic pain
- nausea/ vomting
- low-grade fever
- complex, hypoechoic, possible septations, fluid in cul-de-sac
- differential: torsion, cystadenoma, ectopic pregnancy, theca lutein cyst
