Week 3 Introduction to Gynaecological Pathology Book Flashcards
What is the function of LH?
Stimulation of progesterone production - triggering ovulation
What is the function of HCG?
Stimulation of the corpus luteum to continue oestrogen and progesterone production
What is the function of Oestradiol?
Proliferation of the endometrium
What is the function of FSH?
Stimulation of oestrogen production
Stimulation of ovarian follicular development
What is the function of progesterone
Stimulation of the endometrium to secrete glycogen-rich material
What is the function of GnRH
Stimulation of the release of pituitary hormones
True or false Ovulation is triggered by a surge of LH production 12-24h prior to the ovulation.
True
True or false: In case of pregnancy, the corpus luteum starts to produce hCG.
False, hCG is produced by the placenta
True or false: GnRH is controlled by negative feedback of the gonadotropins.
True
True or false: Day 1 of the menstrual cycle is defined as the first day after cessation of the menstruation.
False. Day 1 of the cycle is the first day of the menstrual period
True or false: Changes in oestrogen and progesterone levels cause cyclic changes in the endometrium.
True
How does the uterus, ovaries and endometrium change throughout the menstural cycle?
In the first part of the cycle (proliferative phase) the endometrium has a proliferative appearance and in the ovary you first detect a number of small follicles that have been recruited.
After a few days you can identify the dominant follicle increasing in size until ovulation.
Ovulation usually occurs when the follicle is approximately 20-22 mm, after which you can visualise a corpus luteum in the ovary. The endometrium becomes secretory in appearance.
What hormone do each of the following organs produce:
Pituitary gland
Plancenta
Hypothalamus
Uterus
Ovaries
Pituitary gland - LH, FSH
Plancenta - HCG
Hypothalamus - GnRH
Uterus - does not produce
Ovaries - Oestrogen and Progesterone
Explain why exogenous administration of oestrogen and progestogen inhibits ovulation?
Both oestrogen and progestogen have an inhibitory effect on the hypothalamus and pituitary resulting in an inhibition of gonadotropin production.
Low FSH results in depressed follicular development but the dominant action for contraception is LH inhibition.
If there is no mid-cycle LH peak, ovulation will be inhibited even if follicular development occurs.
Advantages of Tamoxifen?
- Postmenopausal women with breast cancer, tamoxifen reduces mortality by 25 percent and recurrence by 50 percent.
- Healthy women at high risk of developing breast cancer, tamoxifen found to reduce oestrogen receptor positive breast cancer risk by 45 percent.
- Ability of maintaining bone mineral density, lowers incidence of osteoporotic fractures postmenopausal women.
- Reduces cholesterol levels, especially LDL, with possibly a trend in lowering myocardial infarct incidence.
Disadvantages of tamoxifen
- Vaginal dryness and discharge.
- Endometrial changes:
increase in endometrial and endocervical polyps;
increase in endometrial hyperplasia; and
increase in endometrial carcinoma.
What is the role of ultrasound in the monitoring of patients on tamoxifen?
The role of vaginal ultrasound in the monitoring of patients on tamoxifen is limited to the exclusion of pathology by visualising a thin endometrium.
Monitoring should happen pre-treatment and then yearly starting after two to three years of treatment in the asymptomatic patient. Investigation should be done immediately in case of symptoms, such as spotting, bleeding.
Vaginal ultrasound can be done as a first step and is, as said, useful when a thin endometrium is detected (less than 5 mm).
If the endometrium is more than 5 mm (in 75% of asymptomatic patients on tamoxifen), the only way to obtain a correct diagnosis is to do hydrosonography or hysteroscopy.
Describe oestrogen only use
It is very important that patients know why they (who have not had a hysterectomy) need to take a combination of oestrogen and progesterone. Oestrogen will prevent/reduce osteoporosis and solve any menopausal symptoms but increase the risk of endometrial cancer during and after use, unless it is taken with adequate progestogen. Patients usually feel fine without the progesterone and it is only after a reasonably long period of time that problems will occur. Thirty percent of patients will develop atypical endometrial hyperplasia, a premalignant lesion, after three years.
The least you expect to find on Hilary’s ultrasound is a thick hyperplastic endometrium (with or without cellular atypia) but you will need to exclude an endometrium carcinoma (a formal diagnosis is only possible with a biopsy).
What is the ultrasound appearance of adenomyomosis?
Echogenic linear striations (Venetian blind) extending from endometrium into myo.
Hyperechoic islands
Irregular endo-myo junction
Tiny anechoic myo and sub endo cysts reflecting fluid in the glands
Cystic striations
Myosis - muscular hyperplasia +/- hypertrophy may be hypoechoic
Focal/diffuse myometrial bulkiness that can be asymmetrical
Generally increased vascularity
Describe the normal endometrium appearance during the menstural, proliferative and secretory phase
M: 0.5-1mm thin echogenic line
P: 4-8mm, hypoechoic thickening
S: 7-14mm hyperechoic thickening
List the signs of menopause
Fewer follicles grow
Supply depleted
Gonad, FSH, LH raise in an attempt to stimulate follicles.
When these hormones are raised,it is evidence of ovarian failure
List the sonographic appearance of the ovary in the premenopausal woman
Follicular: Many follicles (>5+), increasing in size until day 8/9 in which one follicle become dominant and the other atretic, grows 1-2mm per day
Pre-ovulatory: dominant follicle measures 20-25mm
Luteal phase: corpus luteum, 20mm, irregular hypo/iso cyst often with low level echoes, typical ring of fire vascularity
What is dysmenorrhea
Painful menstural period
What is oligomenorrhoea
Occasional occurrence of menses
