Women's Health Lecture 1 Flashcards
When to start a mammogram
50 y/o
When to begin colonoscopy
45 y/o
When for DEXA scan
65 y/o younger w/risk
LMP
First day of bleeding
When does menopause usually begin
48-55 y/o
What do you suspect with postmenopausal bleeding?
Uterine Cancer
Usual menarche age
9-16
- can take up to an year to become regular
Usual interval between periods
24-32 days
How long is bleeding?
3-7 days
Amenorrhea
Absence of menstrual periods
Oligomenorrhea
infrequent menstrual periods
Menorrhagia
bleeding that lasts more than 7 days
Metrorrhagia
abnormal bleeding
menometrorrhagia
excessive and prolonged uterine bleeding occurring at irregular periods
dysmenorrhea
painful period
polymenorrhea
occurring more frequent than 21 days
the 5 p’s
partner, pregnancy prevention, protection, practices, past STI
When to take a sexual History?
All new patients, patients with symptoms, patient with medical or social problem that may lead to sexual difficulties
GTPAL
Gravidity - total number of pregnancies
T - term
P- Preterm
A- abortion, miscarriage
L - living
Naegele’s rule
first date of LMP + 7 days - 3 months
What does the health exam consist of?
breast, abdominal and pelvic exam
What is followed by ovulation
menstrual bleeding
average age of menarche
12
average age of menopause
51
the average interval between the start and beginning of the next menses
28
Phases of the reproductive cycle
follicular, ovulation and luteal phase
Which phase remains relatively constant
luteal phase
follicular phase
Onset of menses
When does it mark the end of the follicular phase
When the LH surges
How long does the follicular phase last?
14 days
What happens to the endometrium during follicular phase?
proliferate
When does ovulation occur?
With in 30-36 hours of LH surge
purpose of ovulation phase
window to get pregnant and egg to be fertilized
When does the Luteal phase begin
begins the day of LH surge
When does luteal phase end?
onset of menses
How long does the luteal phase lasts?
14 days
What happens to the endometrium during luteal phase
endometrium is in secretory phase
explains the release of the sex hormones from the hypothalamus
hypothalamus release GnRH –> stimulates the anterior pituitary to release FSH and LH –> stimulates the ovaries to release estrogen and progesterone
Purpose of the hypothalamic-pituitary-gonadal axis
stimulates oocyte development and ovulation, endometrial development and menstruation
What is used as an indirect measurement for GnRH
LH levels
Role of the hypothalamus
pulse generator of the reproductive cycle
When does the follicles stop growing except one?
day 7
role of the estrogen
thicken the wall of the uterus to prepare for pregnancy
What stimulates the mid cycle LH surge
Peak estradiol from the dominant follicle
What is left after ovulation?
Corpus luteum - which secretes progesterone
When is considered the first day of menstrual cycle
First day of bleeding is Day 1 of the menstrual cycle
What decline cause menstruation
Decline of progesterone and estrogen
Role of prostaglandin
produce contractions of the uterine vasculature and musculature
- induce endometrial ischemia and cramping
-aid in expulsion of blood and tissue
what induces endometrial healing
rising estrogen levels in early follicular phase
what happens when the estrodiol level rise during follicular phase
- decline in FSH
-cause LH to increase by mid follicular phase
Which follicle becomes the dominant follicle
the one with the greatest number of granulose cells and FSH receptors and highest estradiol production
When does LH usually occur
11-13 of cycle
which cell change during phase 2 of ovulation
granulosa and the theca cells change to produce progesterone
Mittelschmerz
pain associated with ovulation
Where does fertilization occur
in the fallopian tube
What is secreted in the luteal phase
progesterone
Process of luteinization
LH surge stimulates LH receptors and convert cells to produce progesterone
When does progesterone begin to secrete
24 hours before ovulation
lifespan of corpus luteum
9-11 days
What begins to new cycle
rise in FSH
What sustains the corpus luteum when fertilization occurs
human chorionic gonadoropin hormone (hCG)
what replaces the corpus luteum by 9-10 weeks with conception
placenta
What happens to the corpus luteum if no conception occurred
It becomes the corpus albicans
When does the endometrial reach its maximum thickness?
At the time of ovulation
What happens if ovulation does not occur?
Stroma and glands continue to grow, it would eventually outgrows blood supply and sloughs intermittently
What to do if there are concerns of endometrial thickening
possible cancer
- use US to measure the lining
endometrial biopsy
The only way to identify proliferative vs. secretory endometrium
Why is unopposed estrogen not given to women with an intact uterus
will thicken the lining and lead to endometrial hyperplasia or malignancy
What does progesterone do to the uterine lining
thin the endometrial lining
What is the common diagnosis of someone coming in with abnormal uterine bleeding
anovulatory
estrogen cause glands to produces______ mucus
thin, clear, watery mucus
Role of estrogen on breast
necessary for pubertal breast development
