Session 6: Group Work

Question 1

Average length of menstrual cycle.

Answer 1

21-35 days

Question 2

Describe the levels and the effects of oestrogen and progesterone in the proliferative phase.

Answer 2

Oestrogen - increasing gradually + thickens the endometrium

Progesterone - Low and no real effect

Question 3

Describe the levels and the effects of oestrogen and progesterone in the secretory phase.

Answer 3

O - High but decreasing + endometrium growth stabilising

P - High levels causing a cervical plug. Negative feedback on FSH, LH and GnRH

Question 4

List some of the other functions of oestrogen.

Answer 4

Maintain smooth muscle tone
Maintain bone structure
Closes the epiphyseal growth plates

Question 5

List some of the other functions of progesterone.

Answer 5

Natriuresis in elevated progesterone levels
Breast development
Libido

Question 6

If implantation does not occur, what is the life span of the corpus luteum?

Answer 6

14 days

Question 7

What is the most common karyotype for Turner syndrome?

Answer 7

45 XO

Question 8

Sometimes the diagnosis will only occur at puberty when patients present with primary amenorrhoea.
Define primary amenorrhoea.

Answer 8

No period at age of 16

Question 9

What other signs would be present on examination of a patient with Turner syndrome.

Answer 9

Webbed neck
Constriction of aorta
Poor breast development
Short stature
Amenorrhoea

Question 10

What are some of the significant health problems associated with Turner syndrome?

Answer 10

Heart problems
Diabetes
Hypothyroidism

Question 11

What possible explanations of primary amenorrhoea might you consider if plasma FSH levels are elevated?

Answer 11

Due to very low levels of oestrogen resulting in no inhibition.

Question 12

What possible explanations of primary amenorrhoea might you consider if plasma FSH levels and LH levels are very low?

Answer 12

No positive feedback from oestrogen
Pituitary problem?
No GnRH?
Kallman Syndrome?

Question 13

If other secondary sexual characteristics were present, what possible explanation would you consider causing the primary amenorrhoea?

Answer 13

Complete androgen insensitivity syndrome

No paramesonephric duct

Mullerian agenesis

Transverse vaginal septum

Imperforate hymen

Question 14

A 26 yr old woman presents to the GP with heavy periods.

How might you quantify that a woman is experiencing heavy periods?

Answer 14

Objective vs subjective

Question 15

Name some possible causes of menorrhagia that could be investigated.

Answer 15

Cancer
Ectopic pregnancy
Thyroid issues
Fibroids

Question 16

Sometimes if it has been a long time since a woman’s last period the next one can be heavy. Why might this happen?

Answer 16

Long proliferative phase leading to increased thickening of the functional layer of the endometrium.

Question 17

A 51 yr old woman sees her GP as she thinks she might be going through menopause.

At menopause the ovary’s supply of follicles becomes depleted. What will the effect of this have in terms of the endocrine function of the ovary?

Answer 17

Lower oestrogen and high FSH

Question 18

What will initially happen to plasma levels of:

FSH, LH and secretion of GnRH.

Answer 18

FSH - very high

LH - highish

GnRH low

Question 19

Why are the changes in LH and FSH secretion at the menopause different?

Answer 19

No negative feedback of oestrogen on LH and FSH.

However there is no inhibin secretion so FSH is even less inhibited.

Question 20

List some symptoms that the patient might expect around the time of menopause.

Answer 20

Hot flushes
Irritability
Insomnia
Bloating
Sweating
Mood swings
Pruritus
Twitching
Weight gain

Question 21

Briefly describe some management options that might help with the symptoms listed above.

Answer 21

HRT - pills with oestrogen and progesterone

Vaginal cream with oestrogen

Transdermally with oestrogen