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Kofi: Pure Clinical Sem 3 > Reproduction: Menstrual Cycle and Drug > Flashcards

Reproduction: Menstrual Cycle and Drug Flashcards

1
Q

What is the purpose of the menstrual cycle?

A

Preparation of

  • Gamete via the ovarian cycle
  • Endometrium by the uterine cycle
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2
Q

What are the control mechanism of the menstrual cycle?

A

Gonadotrophins acting on the ovary

Ovarian steroids:

  • Acting on tissues of the reproductive tract
  • Acting to control the cycle
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3
Q

Outline the HPO axis control of the menstrual cycle

A
  • GnRH produced by the hypothalamus
  • Acts on the anterior pituitary to release the gonadotrophins: FSH and LH
  • Gonadotrophins act on the ovary to promote follicular development and produce ovarian hormone like steroid hormones and inhibit
  • The gonadal hormones act to control the system
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4
Q

What happens if GnRH release is continuous rather than intermittent?

A
  • Continuous exposure of the GnRH receptors to GnRH lead to them becoming desensitised
  • FSH and LH production stops
  • Gonadal steroid production stops
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5
Q

What are the feature of the start of the menstrual cycle?

A
  • No ovarian hormone
  • Early development of follicles begin
  • Low steroid and inhibin levels
  • Little inhibition at hypothalamus or anterior pituitary
  • Free from inhibition
  • FSH levels are rising
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6
Q

What is the effect of FSH in the menstrual cycle?

A
  • Bind to granulosa cells
  • Follicular development continues
  • Theca interna appears
  • Follicle now capable of oestrogen secretion
  • Inhibin secretion begins
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7
Q

What occurs in the mid-follicular phase?

A
  • Need a nominate a dominant follicle
  • Prevention of recruitment of any further follicles
  • The follicular oestrogen is now at a concentration that it can exert positive feedback at hypothalamus and anterior pituitary
  • Gonadotrophin levels rise
  • Follicular inhibit rising which seleively inhibits FSH production for m the anterior pituitary
  • Effect on LH only
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8
Q

What are the hormonal changes resulting in ovulation?

A
  • Circulating estradiol and inhibit rise rapidly
  • Oestradiol production no longer dependant on FSH
  • Surge in LH production
  • Progesterone production begins as the granulosa cells become responsive to LH
  • Modulation of GnRH pulse generator
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9
Q

What is completed and started in ovulation?

A

Meiosis 1 is completed

Meiosis 2 is started

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10
Q

How is the mature oocyte extruded?

A

It is extruded through the capsule of the ovary

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11
Q

What are the effects of LH after ovulation?

A
  • Folicle is lutenised
  • Oestrogen and progesterone are secreted in large quantities
  • Inhibin continues to be produced
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12
Q

What is the effect of progesterone on LH production?

A

-LH is suppressed by progesterone via negative feedback

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13
Q

Describe the luteal phase.

A
  • Corpus luteum formed and produced progesterone, oestrogens from androgens. It also produced inhibin
  • Production of progesterone is promoted
  • Corpus luteum regresses spontaneously however in the absence of further rise in LH
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14
Q

What is the effect of oestrogen on the endometrium?

A

-Proliferates and secretes

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15
Q

What is the effect of progesterone on the endometrium?

A

-Secretion

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16
Q

What is the endometrium?

A

Specialised epithelium

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17
Q

What is the uterus made of?

A
  • Muscular wall called the ‘Myometrium’
  • Endometrium which is the epithelial layer. Has a functional layer which is hormone responsive and sheds if no pregnancy occurs. Functional layer is developed on the basal layer
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18
Q

What occurs at the end of the menstrual cycle?

A
  • Absence of further rise in LH means the corpus luteum regreses
  • Dramatic fall in gonadal hrmone
  • Relieving of the negative feedback
  • Resets to start again
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19
Q

What are the series of changes the uterus undergoes in the menstrual cycle?

A
  • Early proliferative: Glands sparse and straight
  • Late proliferative: Functional layer has doubles and the glands are now coiled
  • Early secretory: Endometrium max thickness and very pronounced coiled glands
  • Late secretory: Glands adopt characteristic saw tooth appearance
20
Q

If the ovum is fertilised, which hormone is produced to support the corpus luteum and what by?

A

-Human chorionic gonadotrophin (HCG) by the Syncytiotrophoblast

21
Q

How does the corpus luteum support the pregnancy?

A

It produces steroid hormone which support the pregnancy

22
Q

What controls the HPO axis throughout most of pregnancy?

A
  • The placenta
  • Oestrogen and Progesterone
  • Responsible for maintaining the pregnancy state
  • Take over from corpus luteum by 11th week
23
Q

What are the actions of progesterone in the luteal phase?

A
  • Further thickening of the endometrium into secretory form
  • Thick, acid cervical mucus
  • Thickening of the myometrium but reduction of motility
  • Changes in mammary tissue
  • Increased body temperature
  • Metabolic changes
  • Electrolyte changes
24
Q

What is the normal duration of the menstrual cycle?

A

21-35 days

25
Q

What are the action of oestrogen in the follicular phase?

A
  • Fallopian tube function
  • Thickening of the endometrium
  • Growth and motility of the myometrium
  • Thcnk alkaline cervical mucus
  • Vaginal changes
  • Changes in skin, hair, metabolism
26
Q

Which phase affect variation in the cycle duration?

A

Follicular phase

27
Q

What is the luteal phase strictly controlled to?

A

14 days +/-2 days

28
Q

Which physiological states affect the menstrual cycle?

A
  • Pregnancy

- Lactation

29
Q

What are some non-physiological factors that affect the menstrual cycle?

A
  • Emotional stress

- Low body weight

30
Q

What is the effect of moderate levels of oestrogen on the HPO axis and high levels?

A

Moderate levels - Negative Feedback. Reduce GnRH

High levels - Positive feedback. Increase GnRH so increase in LH

31
Q

What is the effect of the high oestrogen and progesterone on the HPO axis?

A

Negative feedback

32
Q

What is primary amenorrhea?

A

Failure to establish menstruation by 16 years

33
Q

What is secondary amenorrhea?

A

Cessation of previously normal menstruation for greater than 6 months

34
Q

What is oligomenorhea?

A

Infrequent menstruation

35
Q

What is menorhaggia?

A

A complain of excessive menstrual blood loss over consecutive cycles

36
Q

What is dysmenorrhoea?

A

Pain during menses associated with ovulatory cycles

37
Q

What is dysfunctional uterine bleeding?

A

Heavy and irregular menstrual bleeding that occurs secondary to anovulation

38
Q

What is PMS?

A

Cyclical disorder occurring in the latter half of the menstrual cycle. Symptoms can be physical or psychological and resolve with onset of menstruation

39
Q

What is premenstrual dysphoric disorder?

A

Severe end of the PMS spectrum with extreme mood symptoms

40
Q

What are some causes of amenorrhoea?

A
  • Physiologic causes such as prepubertal, pregnancy and menopause
  • Pathology at the various levels of endocrine control such as hypothalamic, pituitary, ovarian, uterine

Gonadotrophin levels indicate the level of the pathology

41
Q

What are the structural causes of menstrual disorders??

A
  • Agenesis/hypoplasia at any level of the genital tract
  • Leiomyoma (uterine fibroids)
  • Imperforate hymen, vaginal septal
  • Asherman’s syndrome
  • Cervical stenosis
42
Q

What are the causes of menorrhagia?

A
  • Uterine fibroids
  • Uterine polyps
  • Endometrial cancer
  • Bleeding diathesis
  • Drugs like warffarin
  • Copper IUCD
43
Q

What causes irregular bleeding?

A
  • Hormonal Contraception
  • STI’s/PID
  • Cervical ectopy or pathology which normally results in postcoital bleeding
  • Endometrial pathology such as polyp or cancer
  • Ovarian cyst secreting hormones
44
Q

What causes dysmenorrhoea?

A
  • Primary dysmenorrhoea is idiopathic and due to response of the uterus to local prostaglandins hence painful contractions.
  • Secondary dysmenorrhea can be due to endometriosis or obstructed menses
45
Q

What are the features of PMS?

A
  • Subjective
  • Cyclical
  • Can be distressing and even debilitating

Kofi: Pure Clinical Sem 3 (44 decks)

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