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Obs and Gynae > Physiology of the Mentrual Cycle > Flashcards

Physiology of the Mentrual Cycle Flashcards

1
Q

What are the 3 phases of the normal menstrual cycle?

A

Follicular Phase
Ovulatory Phase
Luteal Phase

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2
Q

What cells make up the ovarian follicle?

A

Theca cells (externa and interna)
Granulosa cells
Oocyte

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3
Q

Describe the endocrinology of the Follicular phase of the menstrual cycle.

A
  1. Low FSH stimulates Hypothalamus to release GnRH
  2. GnRH stimulates the anterior pituitary to release more LH and FSH
  3. LH stimulates Theca cells to produce androstendione
  4. FSH stimulates granulosa cells to make Aromatase
  5. Aromatase converts androstendione to oestrogen
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4
Q

Describe the endocrinology of the Ovulatory phase.

A
  1. Rising oestrogen reaches a critical level causing positive feedback to the hypothalamus via the kisspeptin system resulting in increased GnRH secretion and LH surge.
  2. LH surge causes follicle to rupture releasing oocyte
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5
Q

Describe endocrinology of the Luteal phase.

A

Ruptured follicle is called the Corpus Luteum

1. Corpus Luteum is stimulated by LH to secrete progesterone

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6
Q

What is the role of Oestrogen in the Luteal phase?

A

Stimulates proliferation of the lining of the uterus, cervix, and vagina
Increases breast progestogen receptors
Thickens cervical mucus

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7
Q

What is the role of Progesterone in the Luteal phase?

A

Builds up lining of the uterus causing it to enter the secretory phase
Stops pituitary from secreting more LH

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8
Q

How do you define Primary and Secondary, Amenorrhoea and Oligomenorrhoea

A

Primary: no menstruations before 16 years
Secondary: occurring after normal menses have begun.

Amenorrhoea: >6 months between periods
Oligomenorrhoea: 6 weeks-6 months between periods

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9
Q

What are the WHO classifications of Anovulation?

A

WHO I - Hypothalmic Pituitary failure
WHO II - Hypothalmic-Pituitary Ovarian failure (predominantly as a result of PCOS)
WHO III - Ovarian failure (old age)

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10
Q

What is the definition of Menorrhagia?

A

heavy menstrual loss as excessive blood loss that interferes with a woman’s physical, social, emotional and/or quality of life (NICE)

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11
Q

What is the difference between Menorrhagia and Dysfunctional Uterine Bleeding?

A

DUB is Menorrhagia without a known cause

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12
Q

What are the causes of Menorrhagia?

A

Pelvic Pathology

  • Fibroids
  • Endometrial polyps
  • Endometriosis, PID, PCOS

Systemic diseases

  • Coagulation disorders (e.g. Von Willebrands)
  • Hypothyroidism

Iatrogenic

  • Anticoagulant treatment
  • IUD
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13
Q

What are the treatments for Dysfunctional Uterine Bleeding?

A

1st - Mirena Coil - Levonorgestrel releasing IUD
2nd - Tranexamic acid - Antifibrinolytic (Risk of thrombosis), NSAID’s (antiplatelet)
3rd - Progestogens
Short acting - Northisterone tablets
Long acting - Depot-Provera

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14
Q

What are fibroids?

A

Benign smooth muscle cell tumours in the myometrium

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15
Q

What is the Rotterdam criteria for PCOS diagnosis?

A

2 out of 3 of the following:

  • Oligo-anovulation or anovulation
  • Clinical +/- biochemical signs of hyper-androgenism
  • Polycystic ovaries: the presence of 12 or more follicles in one or both ovaries +/- increased ovarian volume (>10ml)
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16
Q

What is the cause of PCOS?

A

Multi factorial
Excess androgens produced by Theca cells of the developing follicle
Insulin resistance which causes increased androgen production - which cause

17
Q

What is the criteria for Clinical Hyper-Androgenism

A

Hirsutism
Acne
Male pattern alopecia

18
Q

What tool is used to define Hirsutism?

A

Ferriman-Gallway Scale
9 body areas rated from 0-4
Total score of 6-8 defines Hirsutism

19
Q

How do you treat Hirsutism?

A
  • Spironolactone
    Aldosterone and androgen receptor antagonist
  • Cyproterone acetate
    Progestogen with anti-androgen properties, combined with an Oral contraceptive pill
  • Flutamide
    Androgen receptor antagonist
20
Q

Define infertility and subfertility

A

Infertility:
Unable to conceive at all

Subfertility:
More than 12 months without conceiving despite
unprotected intercourse. Lower chance per month of
conceiving in a given month than normal (± 20% per cycle)

21
Q

What are some the basic investigations for infertility?

A

Basic Investigations
In there an egg?: Mid-luteal phase progesterone
Is there sperm?: Semen analysis
Can they meet?: Tubal patency test, Hysterosalpingogram, Diagnostic Laparoscopy

22
Q

What fertility treatment is available for Anovulation?

A

Ovulation Indution

23
Q

What types of medication is available for Ovulation Induction?

A

Oestrogen inhibitors - Clomid - 80% ovulation, 10-15% chance of conceiving per cycle

Gonadatrophins (LH and FSH) - 90% ovulation, cumulative pregnancy chance - 50%

24
Q

What is the risk of multiple pregnancy in Gonadatrophin Ovulation Induction?

A

20%

25
Q

What fertility treatment is available for sperm defects or unexplained infertility?

A

Intra-uterine-insemination
Sperm washed and injected into uterus
Chance per cycle 8%

26
Q

When is IVF considered?

A

Tubal blockage
Unsucessful OI or IUI
Severe male factor
Long term unexplained infertility

27
Q

What is the most serious disorder that can arise following IVF/OI?

A

Ovarian Hyperstimulation Syndrome

28
Q

What is the pathologenesis of Ovarian Hyper Stimulation Syndrome?

A

Ovariese form 20+ follicles and swell up.

Vasoactive mediators are released from swollen ovaries, increasing capillary permeability

Fluid shifts into the third space compartments causing effusions, increased risk of thrombosis, and liver/kidney dysfunction.

29
Q

What are the symptoms of OHSS?

A 
Abdominal bloating
Abdo bain
Nausea vomiting
Adult respiratory distress syndrome
Thromboembolism
30
Q

What is the management of OHSS?

A

With-hold HCG
Analgesia
Antiemetics
Thromboprophylaxis

31
Q

What are the 6 types of pelvic pain?

A 
Cyclical (usually gynaecological)
Non-Cyclical (may or may not be gynaecological)
Dysmenorrhoea (painful periods)
Dyspareunia (pain during sex)
Dyschesia (pain whe passing stool)
Dysuria (pain when passing urine)
32
Q

What are the 4 gynaecological causes of cyclical pelvic pain?

A

Endometriosis
Adenomyosis
PID
Primary dysmenorrhoea

33
Q

What are the non-cyclical causes of pelvic pain?

A

Gynaecological: Adhesions, Hydrosalpinges, Tumours
IBS
Urological: Recurrent UTIs, Interstitial Cystitis
Neurological: Nerve injury/entrapment
Musculoskeletal: Myofascial pain

34
Q

What is the definition of Endometriosis?

A

The presence of endometrial-like tissue outside the uterus, which induces a chronic, inflammatory reaction

35
Q

What are the common sites of endometriosis?

A

Ovaries
Utero-sacral ligaments
Pouch of Douglas
Broad ligament

36
Q

What is the most common gynaecological pelvic pain referral?

A

Endometriosis 20% of all gynae consultations

37
Q

What is the gold standard for endometriosis diagnosis?

A

Laparoscopy and histological diagnosis

38
Q

What treatment is available for endometriosis?

A

Simple analgesia

Hormonal:

  • Progestogens
  • Combined oral contraceptive
  • Mirena
  • Gonadotrophin releasing hormone agonists +/- add back HRT
39
Q

What are the 4 stages of endometriosis?

A

Stage I: Minimal
In minimal endometriosis, there are small lesions, or wounds, and shallow endometrial implants on your ovary. There may also be inflammation in or around your pelvic cavity.

Stage 2: Mild
Mild endometriosis involves light lesions and shallow implants on an ovary and the pelvic lining.

Stage 3: Moderate
Moderate endometriosis involves deep implants on your ovary and pelvic lining. There can also be more lesions.

Stage 4: Severe
The most severe stage of endometriosis involves deep implants on your pelvic lining and ovaries. There may also be lesions on your fallopian tubes and bowels.

Obs and Gynae (4 decks)

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