WEEK 7: Reproductive Health Female Flashcards
Reproductive Health: Female
Which of the following hormones is responsible for the maturation of a recruited follicle in the female reproductive system?
- FSH
- LH
- ESTROGEN
- PROGESTERONE
- INHIBIN
1 AND 3
T or F
The female reproductive cycle
is roughly separated into five main phases
F
Three main phases
The female reproductive cycle
is roughly separated into three main phases, namely …
The follicular phase
The ovulatory phase and
The luteal phase
What phase of the female reproductive system am I?
Immature follicles mature and grow under the influence of FSH and later by oestrogen (produced by the granulosa cells)
The follicular phase
What phase of the female reproductive system am I?
lutein cells produce large amounts of progesterone to prepare the uterus for implantation of a fertilised egg.
The Luteal phase
What phase of the female reproductive system am I?
LH production increases to cause the differentiation of granulosa and thecal cells into lutein cells, the resumption of meiosis in the oocyte and rupture of the mature graafian follicle to release the oocyte.
The ovulatory phase
In which phase of the female reproductive cycle would the corpus luteum degrade to form the corpus albicans? (If fertilisation and implantation of an egg does not occur)
The luteal phase
The different phases of the menstrual cycle are controlled by systemic …, … and … concentrations.
oestrogen, progesterone, and inhibin concentrations.
The different phases of the menstrual cycle are controlled by systemic oestrogen, progesterone and inhibin concentrations,
which collectively feed back to the … and …… gland.
hypothalamus and anterior pituitary gland.
When oestrogen, progesterone and inhibin concentrations,
collectively feedback to the hypothalamus and anterior pituitary gland they modulate the release of….
GnRH, FSH and LH.
(Concerning the menstrual cycle)
During the … phase, oestrogen negative feedback dominates.
proliferative
(Concerning the menstrual cycle)
During the proliferative phase, which hormones negative feedback dominates?
oestrogen
During the proliferative phase, low systemic concentrations of oestrogen feed back to the hypothalamus and the pituitary gland to increase oestrogen production by increasing the secretion of GnRH and FSH, why?
To try to stimulate the production or proliferation of granulosa cells which are responsible for producing oestrogen.
Which cells are responsible for producing oestrogen?
proliferation of granulosa cells
Late in the … phase, follicles start to secrete inhibin.
follicular
T or F
Early in the follicular phase, follicles start to secrete inhibin, which feeds back to the pituitary gland via negative feedback to inhibit further FSH secretion.
F
Late
Late in the follicular phase, follicles start to secrete …, which feeds back to the pituitary gland via negative feedback to inhibit further FSH secretion.
inhibin
(High or low in the blanks)
During the pre-ovulatory and ovulatory phase, … oestrogen concentrations in the absence of … inhibin and progesterone concentrations feed back to the hypothalamus and pituitary gland.
high
high
During the … and … phase, high oestrogen concentrations in the absence of high inhibin and progesterone concentrations feed back to the hypothalamus and pituitary gland via positive feedback to further increase … concentrations.
pre-ovulatory
ovulatory
oestrogen
(Considering the menstrual cycle)
Once oestrogen concentrations reach a critical maximum,
… secretion by the … gland is stimulated.
LH
anterior pituitary
During the post-ovulatory phase, negative feedback again dominates, whereby high … concentrations stabilise the uterine endometrium and suppress the secretion of … and … until oestrogen and progesterone concentrations decrease just before the next menstrual cycle.
progesterone
LH
FSH
T or F
LH and FSH also control steroid synthesis.
T
LH stimulates … uptake and … synthesis in the luteal or thecal cells
cholesterol
androgen
LH stimulates cholesterol uptake and androgen synthesis in the … cells
luteal or thecal
Primary control over female hormone production and secretion occurs at the level of the hypothalamus by … neurons.
GnRH
GnRH neuronal bodies reside in the …
hypothalamus
GnRH release is controlled
by the … generator.
GnRH pulse
GnRH is released from … neurons in the …..
GnRH
median eminence
T or F
LH and FSH are contained in different vesicles
T
LH and FSH are contained in different vesicles which respond
differently to different frequencies and amplitudes of … secretion.
GnRH
T or F
LH and FSH are contained in different vesicles which respond
differently to different frequencies and amplitudes of GnRH secretion.
T
What is the barrier layer that separates the hypothalamus from the pituitary gland called?
the median eminence.
GnRH is released from GnRH neurons in the median eminence, where the hormone is then picked up by the …… system and transported into the …
hypothalamic hypophyseal portal
anterior pituitary
T or F
The frequency and amplitude of GnRH pulses does not differ over the course of the menstrual cycle
F
does differ
Why does the frequency and amplitude of GnRH pulses differ over the course of the menstrual cycle?
to dictate whether LH and or FSH is released.
T or F
The pattern of LH and FSH secretion by gonadotroph cells differs considerably.
T
T or F
surges in LH secretion occur at the same time as GnRH pulses.
T
Why can LH concentrations in plasma be used as a surrogate measure of GnRH release?
Because the pattern of LH secretion reflects the pattern of GnRH secretion.
T or F
LH is released continuously and shows no pulsatility.
F
That is FSH
T or F
In order for GnRH to surge, or pulse, all GnRH neurons effectively have to fire at once.
T
One of the main types of neurons that are responsible for signalling to GnRH neurons are the KNDy neurons that are located in the ….. of the hypothalamus.
arcuate nucleus
GnRH neurons synapse with other neurons called … that have the cell bodies located in the hypothalamus (or other areas of the brain that can detect hormone concentrations and external stimuli).
interneurons
Why can’t GnRH neurons respond to changes in hormone concentrations alone?
GnRH neurons do not contain receptors for oestrogen, progesterone or other external signals.
In order for GnRH to surge, or pulse, all GnRH neurons effectively have to fire at once.
This coordinated firing is mediated by … between GnRH neurons.
synapses
What is the most important neuron in the control of the female hormone cycle?
kisspeptin
Why can stress and starvation negatively impact a woman’s ability to conceive?
Kisspeptin neurons (important for estrogen and progesterone) are capable of detecting changes in nutritional status and stress.
By synapsing with GnRH neurons,
they are able to modulate the GnRH pulse generator which thus affects the menstrual cycle.
Which of the following hormones is responsible for stimulating ovulation?
FSH
LH
ESTROGEN
PROGESTERONE
INHIBIN
LH
Which of the following hormones is responsibile for building the endometrial lining after ovulation?
FSH
LH
ESTROGEN
PROGESTERONE
INHIBIN
estrogen and progesterone
Which of the following hormones is responsibile for inhibiting FSH secretion by acting specifically at the anterior pituitary via negative feedback?
FSH
LH
ESTROGEN
PROGESTERONE
INHIBIN
Estrogen and inhibin
Which of the following hormones is responsibile for inhibiting LH secretion by acting on the hypothalamus via negative feedback?
FSH
LH
ESTROGEN
PROGESTERONE
INHIBIN
ESTROGEN and PROGESTERONE
Which of the following hormones is responsibile for stabilising and maintaining the uterine endometrium?
FSH
LH
ESTROGEN
PROGESTERONE
INHIBIN
Progesterone
Pregnancy tests are based on the detection of … in the blood or urine.
Human Chorionic Gonadotropin (hCG)
T or F
Pregnancy commences with fertilisation.
F
Pregnancy commences with implantation.
What is embryogenesis?
Embryogenesis is the first 8 weeks of development after fertilisation.
When does an embryo become a foetus?
After embyrogenesis (after the first 8 weeks of development after fertilisation)
Name the 3 major types of estrogen found in females
Oestradiol, Oestriol and Oestrone
During what stage of her cycle is a woman the most likely to get pregnant?
72 hours before ovulation and 24 hours after ovulation.
T or F
It is possible to ovulate twice during a menstrual cycle
T
T or F
It is possible to release two eggs during a menstrual cycle
T
How long does an unfertilized egg survive in the uterus?
24 hours
After discontinuing the use of COPD contraception, how long does it take for fertility to return?
1-3 months
What is the traditional COCP initiation regimen?
Start “the pill” on the first day of menstruation. If you start an active pill within the first 5 days of menstruation pregnancy protection begins immediately.
What is the quick start COCP initiation regimen?
Start the pill on the day it is prescribed (if the user is unlikely to be pregnant already). With this method you will not be protected from pregnancy until you have taken 7 active pills (7 days).
Missed a Pill:
What precautions and advice (if any) are needed if a patient is 24+ hours late on taking an inactive pill?
No precautions are needed. They are still protected from pregnancy.
Missed a Pill:
What precautions and advice (if any) are needed if a patient is 24+ hours late on taking any of the first 7 days of active pills?
Take the most recently missed pill now.
Take further pills as usual (even if this means taking two pills in one day).
You will not be protected from pregnancy until you have taken 7 active pills.
If you have had unprotected sex within the last 5 days emergency contraception is recommended.
Missed a Pill:
What precautions and advice (if any) are needed if a patient is 24+ hours late on taking any of the middle 7 active pills?
Take the most recently missed pill now.
Take further pills as usual (even if this means taking two pills in one day).
You will not be protected from pregnancy until you have taken 7 active pills.
Missed a Pill:
What precautions and advice (if any) are needed if a patient is 24+ hours late on taking any of the last 7 active pills before the inactive pills?
Take the most recently missed pill now.
Take further pills as usual (even if this means taking two pills in one day).
You will not be protected from pregnancy until you have taken 7 active pills.
Skip the inactive pills in the current pack. Go straight into the first hormonal pills in the next pack.
Missed a Pill:
What precautions and advice (if any) are needed if a patient is less than 48 hours late on taking any of the active pills in their pack?
Take the late pill now (even if that means taking two pills in a day) and further pills as usual. You should still be protected against pregnancy.
The Pill:
What precautions and advice (if any) are needed if a patient is changing to another COCP?
Start taking active pills of the new pack the day after stopping the old pill (on any day of the old pills cycle)
Additional contraception is not required.
The Pill:
What precautions and advice (if any) are needed if a patient is switching POP (progesterone-only pill)?
Start taking active pills without any interval
use additional contraceptive methods until you have used active pills for 7 days
The Pill:
What precautions and advice (if any) are needed after a patient has taken levonorgestrel or ulipristal emergency contraceptive pill (ECP)?
start taking the active pills within 12 hours after taking levonorgestrel
wait at least 5 days before taking the active pills after taking ulipristal
What is withdrawal bleeding when taking the pill caused by?
Caused by the drop in progestogen (from temporarily stoping the active pills)– the endometrial tissue is genetically programmed to shed when the levels of progesterone drop
What is withdrawal bleeding (when taking the pill)?
Withdrawal bleeding mimicks real, monthly menstrual bleeding (“period”) but it is not the real period
While taking inactive pills a withdrawal bleed (similar to a ‘period’) should start.
What advice would you give a patient that has not experienced their withdrawal bleed?
Withdrawal bleeds do not always occur. Continue taking the pills as normal, but consider the possibility of pregnancy if the pill has not been taken correctly or if 2 withdrawal bleeds in a row are missed]
What is breakthrough bleeding when on the pill?
It happens at any time during the cycle when it shouldn’t (i.e. during the active pills)
Commonly it happens in the middle of the cycle
Common at first, but usually settles down after 2–3 months
If breakthrough bleeding doesn’t subside within 3 months the Dr usually changes the pill the patient is on.
What is the general advice given to women who want to use the pill with extended use?
Tricycle. That is, run 3 continuous cycles of the active hormonal pills (or vaginal ring) and omit the inactive pills for 2 out of 3 packs.
What is emergency contraception (EC)?
Emergency contraception (EC) is any form of birth control used after intercourse but before implantation. It is intended to be used as a last resort to prevent an unintended pregnancy.
T or F
Emergency contraception should be given irrespective of a patients time within their menstrual cycle.
T
This is because predicting fertile stage is non-precise and because we simply cannot afford to ‘guesstimate’ in this case.
T or F
For maximum effectiveness, emergency contraceptives should be used ASAP after intercourse.
T
T or F
Emergency contraception is a type of abortion pill.
F
EC does not terminate an existing pregnancy.
T or F
Pharmacists should ask a patient their reason for wanting emergency contraception.
F
There is no practice situation where we would need to know the woman’s reasoning for this decision.
What is the efficacy of the EC levonorgestrel when taken within 72 hours of intercourse?
84%
What are the three types of emergency contraception?
Levonorgestrel, ulipristal and a copper IUD.
T or F
The EC levonorgestrel can only be used once per cycle.
F
Ulipristal acetate ECP should be taken within … hours after sex
120 hours (5 days)
Levonorgestrel needs to be taken within … hours after sex.
72 hours (3 days)
T or F
NB levonorgestrel emergency contraceptive pill should not be used in the same menstrual cycle as ulipristal acetate
T
T or F
Emergency contraceptive pills work by stopping or delaying the release of an egg from a woman’s ovaries (ovulation)
T
T or F
Both ulipristal acetate and levonorgestrel are equally effective emergency contraceptions.
F
Ulipristal acetate is slightly more effective than the levonorgestrel emergency contraceptive pill. They work best if taken as soon as possible after unprotected sex.
What is the most effective emergency contraception method?
A copper IUD (99% effective)
T or F
The copper IUD can cause an abortion
The copper IUD does NOT cause an abortion. Emergency contraception pills do NOT cause an abortion.
T or F
Emergency contraception pills do NOT cause harm if accidentally taken during pregnancy
T
T or F
World Health Organisation (WHO) does not identify any conditions for which the risks outweigh the benefits of EC use.
T
If there is vomiting within … hours of taking the levonorgestrel emergency contraceptive pill or within … hours for the ulipristal acetate pill it may not work. It is recommended to take another pill if vomiting occurs within these hours.
2hrs
3hrs
During a natural menstrual cycle, the risk of pregnancy from unprotected intercourse is greatest during the
… phase of the cycle.
ovulatory
If emergency contraception is taken less than 24 hours after intercourse the efficacy is?
95%
If emergency contraception is taken 24-48 hours after intercourse the efficacy is?
85%
If emergency contraception is taken 48-72 hours after intercourse the efficacy is?
58%
What does “COCP” stand for?
Combined oral contraceptive pill
Contraception is not necessary for the first … days postpartum.
20
An IUD can be inserted … weeks postpartum
6
Why are estrogen contraceptives avoided in breastfeeding women?
Estrogen may decrease milk supply.
What contraception methods are not used in adolescence and why?
IUD is harder to insert and likely to be expelled in those who have not given birth before.
Progesterone because the side effect of reduced bone mineral density more significant than in adults
COCP or implantation is used
Without contraception … in 100 women of reproductive age will get pregnant in a year.
80
