repro 2 Flashcards
menstrual cycle phases?

hormones involved in mesntrual phases

which hormone triggers stroma and gland proliferation?
oestrogen
types of abnormal uterine bleeding (AUB)

causes of AUB?
cervical ectropion
pelvic inflammatory disease
endometritis
endometrial polyp
leiomyoma (fibroid)
leiomyosarcoma
adenomyosis
bleeding disorders
hyperplasia
cervical/endometrial cancer
atrophy (post-menopause)
DUB = anovulatory cycles/luteal phase defects
method of assessing endometrial hyperplasia?
indication for biopsy?
TVUS
indications for biopsy:
postmenopausal = endometrial thickness >4mm
premenopausal = >16mm
method of assessing polps or local thickening?
hysteroscopy
biopsy methods uterus
endometrial pipelle
* outpatient procedure, limited sample
dilatation and curretage
* most thorough sampling method
* can miss 5% of hyperplasias/cancers
disordered uterine bleeding (DUB)?
Ax?
abnormal uterine bleeding with no organic cause
most cases due to anovulatory cycles e.g. PCOS, hypothalamic dysfunction, thyroid disorders, hyperprolactinaemia
* commonest at either end of reproductive life
* corpus luteum does not form
rare cases due to luteal phase deficiency
* insufficient progesterone
* abnormal corpus luteum forms
anovulatory cycle pathophys
ovulation does not occur so endometrium continues to grow
glands appear cystically dilated (PCOS)
will break down irregularly i.e. oligomenorrhoea
endometritis?
Ax?
inflammatory cells in uterus
Ax
* gonorrhea + chlamydia (also TB, CMV, HSV)
* IUD
* postpartum (cause of secondary PPH)
* post-abortion
* post-curretage
* granulomatous (sarcoid, TB, foreign body)
* leiomyomata/polyps
endometritis rule?
infectious until proven otherwise (chlamdia, ghonorrhoea)
endometrial polyp s/s?
trigger?
risk?
common - usually asymptomatic but may present with bleeding
often occur during menopause
risk = almost always benign but endometrial carcinoma can present as a polyp
molar pregnancy types?
Complete mole
sperm combinies with egg which has lost its DNA
sperm then replicates forming 46 chromosome set
Only paternal DNA is present in complete mole
Partial mole
Egg fertilized by sperm which replicates itself yielding genotypes of 69, XXY (triploid)
partial moles have both paternal + maternal DNA
which mole is more dangerous?
complete mole - can develop into choriocarcinoma
myometrium Ax of AUB?
adenomyosis = endometrial glands and stroma in myometrium
* causes menorrhagia + dysmenorrhoea
leiomyoma = fibroids
leiomyoma symptoms?
growth?
risk?
menorrhagia
infetility
pain
growth is oestrogen dependent
very rarely can develop into leiomyosarcoma

what triggers ovulation?
LH surge (day 14)
when does progesterone peak?
day 21 of cycle
decidualisation?
progesterone-induced endometrial remodelling
normal menstruation
normal length of menstrual cycle?
usually lasts 4-6 days
mentrual flow peaks day 1-2
<80ml per menstruation
average 28 day cycle
between 21 to 35 days is normal
how many cases of AUB are DUB?
50%
so 50% have no organic cause
systemic disorders causing menorrhagia?
endocrine = hypothyroidism, diabetes, prolactin disorders
haemostasis = VWF, ITP, clotting dactor deficiency
liver disorders (clotting factorsO
renal disease
drugs - anticoagulants
PCOS symptoms?
complication?
oligomenorrhoea/amerneorrhoea
weight gain
facial hirsutism
facial acne
hair loss/thinning
associated with T2DM (insulin resistance), hypercholesterolaemia, hypertension, sleep apnoea
associated with increased risk of endometrial carcinoma
































