The Ovarian and Menstrual Phases Flashcards
Definitions
–______ is the bleeding/shedding of the endometrial lining, occurring approx monthly from –
Menarche - Menopause
–Menstrual cycles vary from b/t ___ -___ days, monthly
Menstruation “Status” is described as:
____ Menarche
–pre puberty (before onset of menses)
______:
–the onset of menses usually occurring between 11-14 years, late pubertal age.
–Premature ______:
termination of regular menses prior to 40 years.
–______:
termination of regular menses usually occurring at 45-55 years.
menstruation 15 31 pre menarche menopause menopause
Menstrual and Ovarian Hormonal
Regulation & Interactions
–The _____ and ______ responds to estrogen and progesterone levels in blood These levels are determined by a feedback mechanism b/t the ovaries and hypothalamus/pituitary complex
–When serum estradiol levels fall below a given concentration, the ______ (1) produces –
Gonadotropic Releasing Hormone (GnRH), which signals the pituitary gland (2) to secrete pituitary gonadotrophins: Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH)
–A “trophic” hormone signals another organ to function or secrete.
**********
Day 1: GnRH produced (5) and release of FSH/LH
______ produces Gonadotropic Releasing Hormone (GnRH) which signals pituitary gland to secrete pituitary gonadotropins: follicle stimulating and hormone (FSH) and luteinizing hormone (LH)
–______ →stimulates growth/dev of OV follicles; follicles produce estrogen which stimulates endometrial growth; as follicles grow, estradiol increases w/in follicle and help OVs respond to LH with ovulation
–______ → maturation of follicles and responsible for follicular rupture causing ovulation; stimulates progesterone production which peaks after ovulation; when fertilization occurs and ovum implants, hCG production from embryo signals the CL to continue secreting progesterone to prevent endometrial shedding. When implantation does not occur, there is NO hCG produced, so progesterone levels decrease permitting sloughing/shedding of the endometrium for the cycle to begin again.
endometrium ovaries hypothalamus FSH LH
Summary of Fluctations of Gonadotropin levels & Ovarian Hormones Mid Cycle
Beginning of Monthly Cycle – non pregnant status
–_____ (Estriol) output by the follicle increases
–______ levels of Estrogen have a + feedback effect on the pituitary gland causing an LH surge (luteinization) about
Day 14
Effects of LH SURGE:
– triggers ______
–Transforms ruptured follicle into a Corpus ______
Function of the Corpus Luteum
Produces: mostly ______ and some Estrogen to inhibit FSH and LH release in case of pregnancy
–______ production has progestational effects – ensures endometrium stability (no shedding) in case of pregnancy
–breast changes occur and Basal Temp spikes during ______ period
–If conception occurs, ______ continues to be produced and hCG production occurs to sustain the pregnancy til the placenta can form and produce the progesterone for pregnancy viability
- -If conception does not occurs, the progesterone and estrogen levels ______ and the Corpus Luteum degenerates
- Ends the blocking of ______ and ______
- The cycle starts over again
estrogen high ovulation luteum progesterone progesterone ovulation progesterone decrease FSH LH
Ovarian Response to Hormones Produced
Under the influence of the Pituitary Hormones, FSH and LH, the ovaries go thru 3 specific phases during a NL cycle:
(1) ______ Phase – Early and Late
(2) ______ Phase
(3) ______ Phase
follicular
ovulation
luteal
1) Follicular Phase (Days 1-14)
Beginning of Menses - Ovulation
Early Phase
–At the beginning of follicular phase, FSH and LH levels are _____; Estrogen and progesterone levels are low; dormant eggs are surrounded by fluid filled follicle which will eventually expand and move to ovarian surface; several follicles develop each month
Follicular Development
–______ FSH levels stimulate 15-20 primordial follicles to develop into primary follicles; one will dominate - Graafian
Ovarian Doppler
–______ resistance, little/no ______ flow
Late Phase
–Approx 8 days into follicular phase, FSH levels ______ and estradiol levels ______
Follicular Maturation
–Dominant follicle (______ follicle) increases to approx. 10mm, will be sono identified; presence of “murule nodule” ; may be imaged sonographically w/in it known as cumulus oophorus suggesting ovulation w/in 36 hours.
increasing increased high diastolic decrease increase graafian
2) Ovulation Phase (DAY 14)
–Ovulation occurs within ___ - ___ hours after onset of the LH surge
–____ stimulates enzymes in the dominant follicle along with the increased pressure causes the follicle to rupture and release the egg (ovulation).
–Phase ends when ______ is released
Sono Findings:
–____-Ovulation – large dominant Graafian Follicle w/murule nodule; increase in flow around OV
–_____ Ovulation: Sudden decrease in follicular size
fluid in PCDS indicating ovulation has already occurred
–Doppler: ______ flow around ovary with low resistance WF
24 36 LH egg pre post increased
3) Luteal Phase (DAYS 15-28)“Post Ovulation”
–After ovulation, the egg-producing-follicle becomes known as a “Corpus ____” or “Corpus Luteal Cyst”; the CL is maintained by LH so that it can produce progesterone to keep the endometrial lining from shedding in case of fertilization; the CL will continue to produce progesterone w/preg until the placenta forms and produces progesterone for pregnancy viablility
Sono Findings of OV/CL w/Pregnancy:
–CL cyst persist to produce ______
to maintain the pregnacy in 1st Trimester
–Early sign of preg; ____ may not show a preg yet
–After ovulation and preg does not occur, the ____ will undergo sono changes due to the absence of implantation/fertilized embryo
–no embryo implantation = no _____ produced
–this sono change in CL is known as “Involution of the
Follicle” –bc of NO hCG, the CL regresses after ____ days normally and the CL will deteriorate and subside
–levels of estrogen and progesterone ______, and a new menstrual cycle begins
Sono Findings w/No Pregnancy:
• Small, irregular follicles
Free fluid in PCDS
luteum progesterone UT CL hCG 14 decrease
Uterine Response to Hormones Produced
_____ is a catabolic process whereby the endometrial lining is shed if implantation of a conceptus has not occurred.
The sonographic changes seen during the menstrual cycle are described by 3 phases which coincide with the Ovarian Cycle:
(1) ______ Phase
(2) ______ Phase
(3) ______ Phase
menstruation
menstrual
proliferative
secretory
1) MENSTRUAL PHASE (DAYS 1 - 5)
Estrogen and Progesterone Levels decrease
Endometrium degenerates, sloughs off ____ layer of myometrium and is expelled as menses/menstruation.
Sonographic Findings:
1) Early Menstrual
- -thicker/complex appearance/mixed echos
- -blood w/in ______ cavity
2) Late Menstrual
- -single line appearance b/c menses endinh
- -Maximum AP diameter of ____ mm
functional
endometrial
2
2) Proliferative Phase (Days 6-14)
- -Middle phase b/t ____ and ____
- -______ Estrogen to regenerate/grow endometrial lining after shedding
Early Proliferative –______ presents as a 3-line appearance
Sono Findings:
Late Proliferative-endometrial thickness increases to approx. ___-___ mm AP
Sono Findings:
–Thickened, isoechoic ______
menses ovulation increasing endometrium 6 8 endometrium
3) Secretory Phase/Post Ovulatory Phase
(Days 15-28) or until the onset of menses
–Progesterone level _____
–Endometrial thickness approx. ____ – ____ mm AP
–Hyperechoic ______ with blurred ML appearance
–Thru transmission w/ ______ enhancement
–Endometrium prepares to accept fertilized ______
increases 10 12 endometrium posterior egg
Menstrual/Ovarian
Cycles
*** Remember the ____/____ Cycle reflects hormonal changes which are occurring during the Ovarian Cycle
uterine
menstrual
Menstrual Phase (Early/Late) Early Follicular Phase - Ovarian
Menstrual Phase
- -Days __-__
- -Onset of menses (fluid seen in ______)
- -Sessation of menses (Single line appearance ______)
- -___ - ___ mm thickness of endometrium
- -______/______ secreted
- -______ Estrogen and Progesterone
Early Follicular Phase
- Days 1-5
- -Small follicles on ______
- -______/______ secreted
- -______ Estrogen and Progesterone
1 5 endometrium endometrium 2 4 FSH LH LOW ovary FSH LH low
Proliferative Phase (Early/Late)- Menstrual Late Follicular Phase- Ovarian
Menstrual (Days 6-14)
- -b/t ____ and _____
- -3-line appearance = Early M.
- -thickness approx. ____-____ mm AP = Late M.
- -Estr. and Prog. ______
Late Follicular
- -Days 6 -14
- -Maturing ______
- -______ occurs; _____ develops
- -_____/____ secreted
- -LH and Estradiol ______ greatly
- -Small amt of ______
- -CL produces ______ for pregnancy
menses ovulation 6 8 increasing follicles ovulation CL FSH LH increases FSH progesterone
Secretory Phase – Menstrual
Luteal Phase - Ovarian
Secretory Phase
- -Days ___-___ or onset of menses
- -____-____ mm endometrial thickness
- -thickened ______ w/ posterior enhancement
- -FSH/LH ______/plateaus to prevent menses in case of pregnancy
Luteal Phase (post ovulatory)
- -Days 15-29 or onset of menses
- -Involution of CL becomes corpus ______ if no pregnancy
- -FF in ______ (b/c ovulation occurred)
- -thickened ______ w/ post enhancement
- -Progesterone ______ in case of pregnancy
- -Estradiol ______/plateaus
–If fertilization DOES NOT occur, CL degenerates (regresses); LH (luteinizing hormone) estrogen and progesterone levels ______, causing vasoconstriction of endometrial arterioles which causes necrosis and menses occur and the cycle begins again.
–If fertilization and implantation DOES occur, CL persists (due to released hCG hormone from the ova) and continues to secrete ______ to prevent shedding of endometrial lining and implantation of fertilized ovum for about 3 mo. until placenta forms, which continues production of progesterone to support the pregnancy and menses does not occur.
15 29 10 12 posterior decreases albicans PCDS endometrium increases decreases decrease progesterone
