The menstrual cycle

Question 1

Menstruation starts on the same day as which stage of the ovarian cycle?

Answer 1

Follicular phase

Question 2

What is the lower + upper range of days for a menstrual cycle to be considered normal?

Answer 2

21 - 35 days

Question 3

What are the functional units of the ovaries?

Answer 3

Ovarian follicles

Question 4

In an ovarian follicle, which cells surround the oocyte?

Answer 4

Granulosa cells

Question 5

In an ovarian follicle, which cells form a layer around the entire follicle?

Answer 5

Theca cells

Question 6

Which part of the ovarian follicle is a fluid-filled space?

What does it contain?

Answer 6

Antrum

Hormones

Question 7

What is the main hormone in the first half of the menstrual cycle?

Answer 7

Oestrogen

Question 8

What is the main hormone in the second half of the menstrual cycle?

Answer 8

Progesterone

Question 9

Which form of oestrogen is the most potent + primary form during the reproductive cycle?

Answer 9

Oestradiol

Question 10

Oestrogen + progesterone are derived from what?

Answer 10

Cholesterol

Question 11

Which cells secrete progesterone?

Answer 11

Theca cells

Question 12

What is cholesterol first converted into before becoming progesterone?

Answer 12

Pregnenolone

Question 13

Which enzyme converts cholesterol into pregnenolone?

Answer 13

Cholesterol desmolase

Question 14

Which hormone stimulates cholesterol desmolase in theca cells, thereby stimulating progesterone secretion?

Answer 14

LH

Question 15

Describe the synthesis of oestrogen from pregnenolone.

Answer 15

In theca cells -
Pregnenolone into androstenedione

In granulosa cells -
Androstenedione into testosterone

Testosterone into oestradiol via aromatase enzyme

Question 16

What does the aromatase enzyme do?

Answer 16

Converts testosterone into oestradiol

Question 17

Which hormones stimulates aromatase in granulosa cells, thereby stimulating oestrogen production?

Answer 17

FSH

Question 18

Which hypothalamic nucleus secretes GnRH?

Answer 18

Arcuate nucleus

Question 19

What effect does oestrogen have on LH + FSH in the early follicular phase?

Answer 19

Inhibits LH + FSH via negative feedback

Question 20

What is the term for the dominant follicle?

Answer 20

Graafian follicle

Question 21

The proliferative phase of the uterine cycle corresponds with what stage of the ovarian cycle?

Answer 21

Follicular phase

Question 22

What triggers the surge in LH release prior to ovulation?

Answer 22

Oestrogen - it reaches a threshold where it switches to have a positive feedback effect

Question 23

The secretory phase of the uterine cycle corresponds with what stage of the ovarian cycle?

Answer 23

Luteal phase

Question 24

What is cervical mucus like during the follicular / proliferative phase?

Answer 24

Thin / watery / elastic - allows sperm entry

Question 25

What is cervical mucus like during the luteal / secretory phase?

Answer 25

Thick, acidic, non-elastic - blocks sperm and pathogens

Question 26

Menstruation is triggered by what hormonal changes?

Answer 26

Fall in oestrogen + progesterone at the end of the luteal phase

Question 27

What is the lower + upper range of days for a period to be considered normal?

Answer 27

2 - 7 days

Question 28

What are the limits of normal blood loss on a period?

Answer 28

20 - 90 ml (1 - 5 tablespoons)

Question 29

What are the ranges of the fertile window in relation to ovulation?

Answer 29

5 days before ovulation + 1 day post-ovulation

Question 30

For how many days can sperm live in the female reproductive tract?

Answer 30

5-7 days

Question 31

When during the ovarian cycle is there a small increase in basal body temperature?

Answer 31

Post-ovulation

Question 32

Which days of the menstrual cycle is the implantation window?

Answer 32

Days 20 - 24

Question 33

How many days after fertilisation does implantation occur?

Answer 33

6 - 7 days after fertilisation

Question 34

What is the diagnostic criteria for menorrhagia?

Answer 34

Blood loss >80 mls and/or duration >7 days

Question 35

Dysmenorrhoea is thought to be due to an excess or imbalance of which 2 mediators?

Answer 35

Prostaglandins Leukotrienes

Question 36

What are the 2 diagnostic criteria options for amenorrhoea?

Answer 36

13 or 14 in the absence of secondary sexual characteristics 15 or 16 with normal secondary sexual characteristics

Question 37

What is the diagnostic criteria for secondary amenorrhoea?

Answer 37

Cessation of previously established menstruation for 3 cycles or for 6 months or more

Question 38

What are the 3 diagnostic criteria for PCOS?

Answer 38

At least 2 of the following: Polycystic ovaries on USS or elevated serum anti-mullerian hormone Oligo- and/or anovulation Clinical and/or biochemical signs of hyperandrogenism (e.g. acne, alopecia)

Question 39

What causes decreased release of sex-hormone binding globulin from the liver in PCOS?

Answer 39

Hyperinsulinaemia

Question 40

What is endometriosis?

Answer 40

Growth of endometrial-like tissue outside of the uterus

Question 41

What is the classic triad of symptoms of endometriosis?

Answer 41

Dysmenorrhoea Dyspareuria Infertility