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Clin Med 3 - Exam 3 (Women's Health) > The Menstrual Cycle & Abnormalities > Flashcards

The Menstrual Cycle & Abnormalities Flashcards

1
Q

pelvic anatomy is form from what embryologically?

A

Muellerian ducts

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2
Q

layers of the uterus?

A

peritoneum, myometrium, endometrium

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3
Q

2 sub-layers of the endometrium?

A

the basal layer and functional layer

  • basal layer closests to the myometrium
  • functional layer sheds during menses
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4
Q

what layer of the endometrium shed during menses?

A

functional layer

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5
Q

what is the site of implantation of an embryo?

A

the uterus - endometrium layer

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6
Q

what are the Fallopian tubes?

A

Passageways through which oocytes travel from ovaries to uterus

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7
Q

what do the fallopian tubal fluids provide for the embryo?

A

nutrients - crucial to the embryo’s survival and development

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8
Q

what does the cervix consist of?

A

internal os, cervical canal, and external os

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9
Q

what changes in the cervix throughout menstrual cycle d/t hormones?

A

Cervical mucus changes throughout menstrual cycle in response to hormones

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10
Q

how does the cervical mucus change throughout menstrual cycle? (HINT: in middle of cycle and after ovulation)

A

in middle of cycle, estrogen levels are high -> cervical mucous becomes permeable to sperm, thin and allows fertilization to occur

after ovulation, estrogen levels are low and cervical mucous thickens and becomes impermeable to sperm

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11
Q

how are ovaries attached to uterus?

A

via ovarian ligament (aka suspensory ligament)

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12
Q

what are the functions of ovaries? (HINT: 3)

A

Storage, maturation, and release of oocytes (eggs)

Formation of the corpus luteum

Production and secretion of hormones including estrogen and progesterone

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13
Q

what factors DON’T impact rate of decline of follicles & oocytes in a woman?

A

Age of menarche, number of pregnancies or births, use of contraceptives, or number of IVF cycles

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14
Q

what is the functional unit of an ovary? what is it exactly?

A

the follicle - sac that contains the egg

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15
Q

how long is the cycle from a primordial follicle to a dominant follicle?

A

120 days

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16
Q

what is another name for a dominant follicle?

A

Graafian follicle (egg that’s ovulated during menstrual cycle)

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17
Q

what is the corpus luteum? what does the corpus luteum secrete?

A

sac that is left over from the ovulated egg -> the follicular sac

it secretes progesterone

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18
Q

what hormone is very important for a pregnancy to develop? what does this hormone keep active and why?

A

progesterone - keeps the corpus luteum active to support the pregnancy (make it keep secreting progesterone)

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19
Q

where in the brain does the whole menstrual process start?

A

hypothalamus and pituitary

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20
Q

elevated TRH stimulates the pituitary gland to produce what?

A

prolactin

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21
Q

what does prolactin do? what’s the result?

A

prolactin inhibits GnRH -> shuts off whole HPO axis, so no menstruation

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22
Q

what is menarche?

A

first menstruation

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23
Q

mean age of menarches? abnormal ages?

A

12-13 y/o (abnormal if < 8 or > 15 y/o)

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24
Q

what pubertal changes come before menarche by 2-3 years?

A

growth/height spurt, breast development (thelarche) and pubic hair development (pubarche)

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25
Q

what is average cycle length? normal cycle length? abnormal cycle length?

A

average cycle length = 28 days

normal cycle length = 21-35 days

abnormal cycle length = <21 or >35 days

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26
Q

what is average duration of menstrual cycle? normal duration? abnormal duration?

A

average duration of cycle = 4 days

normal duration of cycle = 1-8 days

abnormal duration of cycle = >8 days

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27
Q

what is average blood loss during menstruation? normal blood loss? abnormal blood loss?

A

average blood loss = 35ml

normal blood loss = 20-80ml

abnormal blood loss = >80ml

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28
Q

what is menorrhagia?

A

Abnormally heavy bleeding at regular intervals (ex: 1-2 pads an hours)
-Regular periods, but are very heavy

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29
Q

what is metrorrhagia?

A

Bleeding at irregular intervals

-Menses not every 28 days

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30
Q

what is polymenorrhea?

A

< 21 day cycle intervals -> short cycle intervals

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31
Q

what is oligomenorrhea?

A

> 35 day cycle intervals -> long cycle intervals

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32
Q

what is hypomenorrhea?

A

Extremely light menstrual flow

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33
Q

what is Mittelschmerz?

A

Ovulation or mid-cycle pain

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34
Q

what are the 2 phases of the ovarian cycle?

A

(1) follicular phase (Correspond to the proliferative phase of the uterine cycle)
(2) luteal phase (Corresponds to the secretory phase of the ovarian cycle)

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35
Q

what are the 2 phases of the uterine (endometrial) cycle?

A

(1) proliferative phase (corresponds to follicular phase of ovarian cycle)
(2) secretory phase (corresponds to the luteal phase of the ovarian cycle)

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36
Q

what is the length of the follicular phase? what is occurring in it?

A

Follicular phase can vary in length of days í first 14 days, but can be 7 days, 21 days

Follicles and eggs are growing and developing in this phase

37
Q

what is the length of the luteal phase? does it always occur? what forms in luteal phase?

A

Luteal Phase is ALWAYS 14 days in ovulatory cycle

If no ovulation -> NO LUTEAL PHASE

Corpus luteum forms in luteal phase

38
Q

what are oocytes surrounded by?

A

granulosa and theca cells

39
Q

what do theca cells contain and what do they produce?

A

Theca cells contain LH receptors and produce androgens

-LH from pituitary binds to receptors on theca cells -> produces androgens

40
Q

what do granulosa cells contain and what do they produce?

A

Granulosa cells contain FSH receptors and produce estrogen as well as convert androgens to estrogens

-FSH is coming from the pituitary -> FSH binds to receptors on granulosa cells and prompts them to produce estrogen and convert androgens to estrogens

41
Q

what is the proliferative phase of the uterine (endometrial) cycle?

A

1st half

endometrium is growing (proliferating)

estrogen that’s produced from the ovaries causes endometrium to thicken

42
Q

what is the secretory phase of the uterine (endometrial) cycle?

A

2nd half

begins after ovulation

progesterone is produced from the corpus luteum, which halts cell division of the endometrium and causes morphologic changes in the endometrium which stabilize the lining in order to allow the embryo or pregnancy to implant

43
Q

if pregnancy doesn’t occur in the secretory phase, what occurs

A

progesterone levels drop causing the lining to shed

44
Q

what is amenorrhea? what may it result from?

A

absence of menstruation

may result from dysfunction of the hypothalamus, pituitary, ovaries, uterus, or vagina

45
Q

what is primary amenorrhea?

A

failure of menarche onset by age 15y in the presence of secondary sex characteristics

OR

13y in the absence of secondary sex characteristics

46
Q

what is secondary amenorrhea?

A

absence of menses for >3 cycles in women with previously normal menstruation

OR

> 6 months in women who have irregular menstrual cycles

47
Q

causes of primary amenorrhea?

A

gonadal dysgenesis, Mullerian genesis, constitutional delay of puberty, GnRH deficiency, transverse vaginal septum, weight loss/anorexia nervosa, hypopituitarism

48
Q

what is the MOST COMMON cause of secondary amenorrhea?

A

Pregnancy

49
Q

what is constitutional delay of puberty? common/uncommon in who? dx of what? dysfunction of what?

A

delay of normal puberty, but have completely normal development, but at a later age

uncommon in females, more common in males

DX OF EXCLUSION

HYPOTHALAMIC DYSFUNCTION

50
Q

what is isolated GnRH deficiency?

A

HYPOTHALAMIC DYSFUNCTION

congenital lack of GnRH

51
Q

what is functional hypothalamic amenorrhea?

A

HYPOTHALAMIC DYSFUNCTION

REVERSIBLE

d/t stress, over exercising, anorexia (nutritional deficiencies) -> all of these increase cortisol levels which shuts down secretion of GnRG from hypothalamus -> amenorrhea

52
Q

what causes pituitary dysfunction?

A

anything that causes an elevated prolactin level

-hyperprolactinemia, prolactinomas, drugs (antipsychotics), stress, breast stimulation, sex, etc.

53
Q

what does prolactin prevent the secretion of?

A

prolactin prevents the secretion of GnRH -> amenorrhea

54
Q

what diseases cause ovarian dysfunction, thus causing amenorrhea?

A

Turner syndrome, 46 XY gonadal dysgenesis, primary ovarian insufficiency, ovarian tumors, PCOS

55
Q

what is Turner’s syndrome?

A

45X

missing 1X chromosome
-ovaries replaced with fibrous tissue, but everything else develops normally

56
Q

what is 46XY gonadal dysgenesis? what must they be started on early in life? chance of what later in life?

A

RARE; 46 XY

Genotypically male karyotype, but the way it is expressed is female phenotype, but gonads are non-functional b/c are fibrous tissue

chance of gonads becomes cancerous later in life

MUST BE STARTED ON HORMONE THERAPY EARLY IN LIFE

57
Q

what is primary ovarian insufficiency?

A

development of menopause before the age of 50, but pts have a normal karyotype

may have other genetic abnormalities (ex: Fragile X syndrome)

can be caused from chemo, radiation, autoimmune

CAUSES SECONDARY AMENORRHEA

58
Q

what amenorrhea cause primary ovarian insufficiency cause?

A

secondary amenorrhea

59
Q

ovarian tumors and amenorrhea

A

rare cause of SECONDARY AMENORRHEA

ovarian tumors that secrete inhibit (gives the negative feedback)

60
Q

what amenorrhea does PCOS cause?

A

secondary amenorrhea, but most commonly causes oligomenorrhea (long cycles)

ovaries have increased androgen production, which arrests growth of the follicles -> follicular phase isn’t followed by a secretory phase

61
Q

sx’s of PCOS?

A

signs of androgen excess, insulin resistance, obesity, facial hair

62
Q

what are the criteria to dx PCOS?

A

2 out of 3 criteria to dx PCOS:

-hyperandrogenism, oligomenorrhea or amenorrhea, polycystic ovaries on US

63
Q

what are intrauterine adhesions? what amenorrhea do they cause? caused by what?

A

i.e. Asherman syndrome

adhesions of the uterus/scarring of lining of uterus (endometrium) - caused by postpartum hemorrhage or infection of endometrium after instrumentation

causes SECONDARY AMENORRHEA

64
Q

what is Mullerian agenesis or Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome?

A

defect in development of Mullerian

causes PRIMARY AMENORRHEA

  • absence/defect in vagina and variable uterine development
  • usually no vagina, but may/may not have uterus and if do have uterus it is small
65
Q

what is imperforate hymen?

A

hymen is still intact and needs to be surgically excised

causes PRIMARY AMENORRHEA

66
Q

what is transverse vaginal septum?

A

septum b/w hymen and cervix -> structural defect

causes PRIMARY AMENORRHEA

67
Q

labs for amenorrhea?

A

hCG, FSH (send on cycle day 3 when it’s the highest), TSH, Prolactin (PRL), testosterone if indicated

68
Q

primary amenorrhea workup evaluated most efficiently by focusing on the presence or absence of what?

A

of breast development, uterus, and FSH level

69
Q

when do you do US for primary amenorrhea?

A

if need to determine whether uterus is present

70
Q

treatment for primary/secondary amenorrhea?

A

psychological counseling (esp for Mullerian agenesis to see if ready for fake vagina surgery)

surgery may be required in some pts

constitutional delay resolves itself

GnRH deficiency -> give supplement

71
Q

what is dysmenorrhea?

A

recurrent crampy lower abdominal pain that occurs during menstruation in the absence of pelvic pathology

72
Q

what is dysmenorrhea caused by?

A

Caused by excess production of endometrial prostaglandin F2 alpha

73
Q

dysmenorrhea signs and sx’s? when can it not happen?

A

diffuse pelvic pain right before or with the onset of menses (cramps last 1-3 days)

CAN’T HAPPEN IN MIDDLE OF MENSTRUAL CYCLE B/C THEN NOT DYSMENORRHEA

74
Q

history of pt for dysmenorrhea?

A 
menstrual hx (want full hx)
-age at menarche, duration of cycle, menstrual flow assessment

sexual hx
-active? contraception? STIs? PID?

75
Q

physical exam of pt for dysmenorrhea? if have endometriosis where do you have pain?

A

normal, may have uterine tenderness midline

if endometriosis pain then have pain in other areas of abdomen

76
Q

FIRST LINE tx for dysmenorrhea?

A

NSAIDs - ibuprofen, naproxen
-inhibit the prostaglandins

Mefenamic acid if ibuprofen, naproxen don’t work

TAKE WITH FOOD

77
Q

2nd line tx for dysmenorrhea?

A

hormonal OCPs

  • can use for first line tx if pt is sexually active
  • prevent dysmenorrhea by preventing ovulation
78
Q

what is PMS?

A

physical, emotional, behavioral, and cognitive symptoms that occur repetitively in the second half of the menstrual cycle, resolve after onset of menses, and interfere with some aspects of the women’s life

MUST OCCUR IN THE 5-7 DAYS BEFORE THE ONSET OF MENSES AND BE PRESENT IN AT LEAST 3 CONSECUTIVE MENSTRUAL CYCLES

79
Q

what is PMDD?

A

severe form of PMS in which symptoms anger, irritability, and internal tension are prominent

Use DSM to help diagnose this

80
Q

pathogenesis of PMS/PMDD?

A

thought to result from the interaction b/w cyclic changes in ovarian steroids and the functioning of central neurotransmitters

Changes in gonadal steroids during the Luteal phase -> steroids are affecting the functioning of the NTs in the brain

81
Q

signs and sx’s of PMS/PMDD?

A

Must begin during the end of the Luteal phase and subside with the beginning of menses (have sx free period during follicular phase of the menstrual cycle)

affective/behavioral sx’s:
-mood swings, angry, irritability, depression, food cravings

physical:
breast tenderness/pain, bloating, constipation, HOT FLASHES

82
Q

what sx is highly suggestive of PMS/PMDD?

A

HOT FLASHES

83
Q

what is important to assess for PMS/PMDD?

A

their impact on quality of pts life and suicide risk

PMDD associated with increased risk of suicidal ideation and attempts

84
Q

have PMS/PMDD pts keep what?

A

a symptom diary for 2 months

85
Q

FIRST LINE tx for PMS/PMDD?

A

SSRIs

-can take all the time or only in Luteal phase

86
Q

other meds for PMS/PMDD that aren’t first line?

A

OCPs (2nd line), Benzo’s, GnRH agonist with low-dose estrogen-progestin replacement (3rd line), surgery (4th line)

87
Q

what is dysfunctional uterine bleeding?

A

Abnormal uterine bleeding unrelated to anatomical lesions of the uterus, pelvic pathology, pregnancy, or systemic disease -> usually caused by a problem with the HPO axis

88
Q

key component to evaluation of dysfunctional uterine bleeding?

A

to determine whether ovulation is occurring

89
Q

when does dysfunctional uterine bleeding occur? dx of what?

A

Commonly occurs after menarche and during perimenopause b/c have more anovulatory cycles on those time

Dx of exclusion

Clin Med 3 - Exam 3 (Women's Health) (9 decks)

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