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GYN > Menstrual Cycle > Flashcards

Menstrual Cycle Flashcards

1
Q

Reservoir of follicles

A

Ovary

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2
Q

Cortex of ovary contains

A

Primordial follicle and granulosa cell

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3
Q

Medulla of ovary contains

A

Blood vessels and Theca cells.

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4
Q

When does H-P-O axis become functional

A

@ puberty

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5
Q

Pathway of FSH

A

Hypothalamus produces GnRH which acts on Anterior pituitary which produces FSH.

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6
Q

Role of FSH

A

FSH acts on Granulosa cells which produce Estrogen and Inhibin B

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7
Q

Function of Estrogen

A

Negative feedback on FSH and Positive feedback on LH

Proliferates endometrium.

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8
Q

Role of Inhibin B

A

Negative feedback on FSH

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9
Q

FSH receptors are present on

A

Granulosa cells

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10
Q

Granulosa cell tumor AKA

A

Feminizing tumor

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11
Q

Tumor marker for Granulosa cell or feminizing tumor is

A

Inhibin B

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12
Q

Types of Estrogen - E1

A

Estrone

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13
Q

E2

A

Estradiol

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14
Q

E3

A

Estriol

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15
Q

E4

A

Estetrol

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16
Q

Role of LH

A

Due to positive feedback from Estrogen - LH level inc - Called as LH surge - 200 pg for 48 hrs = LH Surge
LH acts on theca cells to produce Androgens which are converted to Estrogen in granulosa and adipose tissue .
Acts on granulosa cell and small amounts of progesterone is produced before ovulation.

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17
Q

LH surge

A

LH levels above 200 pg for 48 hrs

Leads to Completion of meiosis 1 and conversion of follicle to Corpus luteum. this is called OVULATION.

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18
Q

What is ovulation.

A

Conversion of 1 primary to secondary oocyte and follicle to corpus luteum.

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19
Q

Two Cell Two Gonadotropin Theory

A

both Theca and Granulosa cell are required for production of Estrogen
Theca cells produce Androgens which are then converted to estrogen in granulosa cells

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20
Q

Aromatase enzyme is absent in _____ cell

A

Theca cells

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21
Q

Aromatase enzyme is present in ____ cell

A

Granulosa cell

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22
Q

CYP17 is present in _____ cell

A

Theca cell

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23
Q

CYP17 is absent in _____ cell

A

Granulosa cell

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24
Q

Role of LH on granulosa cell

A

Luteinisation happens - Small amounts of progesterone is produced before ovulation.
This progesterone has positive feedback on LH and FSH.

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25
Q

Follicular or proliferative phase

A

Day 1 - 14
Starts with FSH release from Anterior pituitary and ends with ovulation on Day 14
Pre antral - antral to graafian follicle to corpus luteum
primary to secondary oocyte.
Main Hormone - Estrogen

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26
Q

Ovarian cycle is initiated by

A

FSH

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27
Q

Size of Follicle before ovulation

A

18-20 mm

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28
Q

Time btw LH surge and Ovulation

A

32-36 hrs or 24-36 hrs

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29
Q

Time between LH peak and Ovulation

A

10-12 hrs.

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30
Q

Time between Estrogen peak and LH peak

A

14-24 hrs

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31
Q

Time between Estrogen peak and ovulation.

A

24-26 hrs.

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32
Q

LH surge is maintained by

A

Estrogen and progesterone

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33
Q

LH surge is initiated by

A

Estrogen

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34
Q

Meiosis 1 is resumed by

A

LH surge

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35
Q

Cumulus oophorus

A

Granulosa cells surrounding primary oocyte in antral follicle

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36
Q

Anovulation - Pathogenesis

A

Appearance of LH in antral cavity fluid early in the cycle instead of mid cycle leading to atesia of the follicle and decreased mitotic activity of granulosa cell.

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37
Q

Maintenance of Corpus luteum in a non pregnant female is by

A

LH

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38
Q

Corpus Luteum grows cos of which hormone

A

LH

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39
Q

Corpus luteum attains maximum size on which day

A

D22 of the cycle or 8 days post fertilisation.

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40
Q

Hormones produced by corpus luteum

A

Progesterone, Estrogen and Inhibin B

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41
Q

Function of Progesterone

A

Negative feedback on LH
Secretory action
Supports Uterus

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42
Q

Relaxin

A

Produced by Corpus luteum in pregnancy

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43
Q

At low concentration, Progesterone

A

Inc FSH and LH

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44
Q

At high concentration, Progesterone

A

Dec LH and FSH

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45
Q

Corpus luteum degeneration.

A

Due to dec in LH levels, Support to CL ends and it degenerates leading to dec in levels of Progesterone, estrogen, and Inhibin A.
Dec Progesterone leads to Endometrial shedding and Dysmenorrhoea.
Dec Estrogen - inc levels of FSH cos of dec negative feedback.
FSH again acts on granulosa cells leading to inc estrogen levels and proliferation of endometrium for next cycle.

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46
Q

Enzyme responsible for Endometrial shedding

A

Enz Metalloproteinase

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47
Q

Menstruation

A

Endometrial shedding

48
Q

Dysmenorrhoea

A

Pain at time of menses due to myometrial contraction due to inc PGF2 Alpha due to vasoconstriction

49
Q

Which layer of endometrium is shed during menstruation

A

Superficial layer

50
Q

Layer of endometrium responsible for regeneration of entire endometrium for next cycle

A

Deep layer

51
Q

2nd half of Menstrual cycle is called

A

Luteal or secretory phase

52
Q

DOC for Luteal phase defect

A

Progesterone.

53
Q

Main hormone in 1 st phase of menstrual cycle

A

Estrogen

54
Q

Main hormone in 2nd phase of menstrual cycle

A

Progesterone

55
Q

Which part of the menstrual cycle is fixed

A

Luteal Phase - 14 days

56
Q

How to calculate Day of Ovulation

A

Count 14 days backwards from Day of menstruation.

57
Q

Lifespan of corpus luteum in non pregnant female

A

10-12 days

58
Q

Lifespan of corpus luteum in pregnant females

A

10-12 weeks.

59
Q

Which hormone prevents Corpus luteum from undergoing Luteolysis in a pregnant female

A

HCG

60
Q

LH and FSH peak at

A

Time of ovulation

61
Q

Estrogen peaks at

A

32-34 hrs before ovulation.

62
Q

Progesterone peaks at

A

D22 of cycle.

63
Q

all tests for ovulation are done on

A

Day 22 of cycle

64
Q

Minimum level of FSH and LH found in which phase

A

Secretory phase.

65
Q

MId- Cycle Pain in abdomen

A

Mittelschmerz syndrome.

66
Q

Pain in abdomen at the time of ovulation

A

Mittelschmerz syndrome.

67
Q

Basal body temperature increased at

A

time of ovulation.

68
Q

Most important hormone needed for menstruation

A

Progesterone

69
Q

Priming of endometrium is done by

A

Estrogen

70
Q

Postponing or preponing the menses

A

Start progesterone 2-3 days before the expected date

5mg Primolut - N -TDS

71
Q

Female complains of delayed menses - how to manage

A

If UPT is negative -
Give Progesterone for 3-5 days and stop.
3 days after stoppage - menses should occur
Meprate - BD / TDS

72
Q

Irregular, painless, heavy bleeding

A

Anovulatory cycles.

73
Q

Females with complains of anovulation - Pathogenesis

A

No corpus luteum - dec progesterone
Inc levels of estrogen - Endometrium excessive proliferation leads to Estrogen breakthrough bleeding.
Anovulatory cycles.

74
Q

Dysmenorrhoea

A

Pain at time of menstruation

75
Q

Types of Dysmenorrhoea

A

Primary or secondary

76
Q

Primary Dysmenorrhoea

A

Normal physiologic dysmenorrhoea - no pelvic pathology

Due to PGF2 alpha

77
Q

Spasmodic dysmenorrhoea

A

Primary dysmenorrhoea

78
Q

Secondary dysmenorrhoea

A

Pain due to pelvic pathology

Congestive dysmenorrhoea

79
Q

Congestive dysmenorrhoea

A

secondary dysmenorrhoea

80
Q

Pain that subsides with onset of menses

A

Primary dysm.

81
Q

Pain that does not subside with onset of menses

A

Secondary dysm.

82
Q

Mx of primary dysmenorrhoea

A

NSAIDS - Mefenamic acid or OCP which leads to Anovulatory cycles

83
Q

Mx of secondary dysmenorrhoea

A

Treat underlying pathology

84
Q

OCP’s -

A

Synthetic estrogen and synthetic progesterone

85
Q

DOC in irregular menstrual cycle

A

OCP

86
Q

Low dose estrogen in OCP

A

30-35 mcg

87
Q

Very low dose estrogen in OCP

A

< 20 mcg

88
Q

OCP’s are protective in

A

Hyperestrogenic conditions

89
Q

Hyperestrogenic conditions

A

Endometriosis
Endometrial Cancer
Endometrial Hyperplasia
Fibroids

90
Q

Mx of Excessive bleeding at time of menses

A

Tranexamic acid > OCP’s > Progesterone.

91
Q

Normal length of a cycle

A

24- 38 days

92
Q

Average length of a cycle

A

28 days

93
Q

Number of days of bleeding in a cycle

A

2-7 days

94
Q

Average days of bleeding in a cycle

A

4-6 days

95
Q

Normal blood loss in a cycle

A

5 - 80 ml

96
Q

Average blood loss in a cycle

A

30 > 35 > 50 ml

97
Q

Atypical uterine bleeding is

A

Any deviation from the normal characteristics of a normal cycle.

98
Q

Menorrhagia

A

Excessive bleeding at regular cycle
> 85 ml or > 7 days
Seen in fibroids

99
Q

Hypomenorrhoea

A

Reduced bleeding at regular cycles
< 5ml or< 2 days
Seen in asherman syndrome

100
Q

Oligomenorrhea

A

Longer duration of cycles

Infrequent menstruation

101
Q

Polymenorrhea

A

Shorter duration of cycles

Frequent menstruation

102
Q

Metrorrhagia

A

Irregular bleeding or intermenstrual bleeding

seen in polyps

103
Q

Menometrorrhagia

A

excessive bleeding at irregular intervals

seen in fibroid polyp and anovulatory cycles,

104
Q

Abnormal uterine bleeding

A

Pelvic pathology causing excessive bleeding

105
Q

Dysfunctional uterine bleeding

A

No pelvic pathology involved

106
Q

Causes of AUB

A 
PALMCOEIN 
P- Polyps 
A- Adenomyosis 
L- Leiomyoma - fibroid
M - Malignancy 
C- Coagulation disorder
O-Ovulatory dysfunction
E- Endometrial dysfunction
I- Iatrogenic 
N- Not yet classified
107
Q

Mx of excessive bleeding

A

TVS to be done .
Check for endometrial thickening
In premenopausal women - > 12 mm
In menopausal >5mm
Indication for Biopsy
If uniformly thickened - Endometrial aspiration biopsy using Pipelle device and vibra aspirator
If Localised or focal thickening - Hysteroscopy and biopsy

108
Q

Gold standard for Excessive bleeding

A

Fractional curettage > DnC

109
Q

MCC of DUB in young females

A

Puberty or menarche -

Check TSH, Bleeding disorders , and TVS

110
Q

Causes of DUB in reproductive females

A

Thyroid disorders ,
Bleeding disorders,
Pregnancy complications
premalignant conditions

111
Q

Mx of Mild to Moderate DUB

A

Non hormonal - Tranexamic acid / mefenamic acid

OCP’s > Progesterone ( 5mg * 21 days) >Mirena (progesterone IUD)

112
Q

Mx of Severe DUB

A

If vitals stable - High dose of oral Estrogen for 24 hrs - followed by OCP’s or progesterone
If vitals unstable - D n C then put patient on IV estrogen or OCP or Progesterone.

113
Q

Uncontrollable DUB - MX

A

if above 40 years - TAH or TCRE / endometrial ablation.

114
Q

TCRE

A

Transcervical resection of endometrium

115
Q

what does high dose of estrogen do in DUB

A

leads to over proliferation - filling gaps in the layer .

116
Q

Menstrual blood is

A

Arterial

GYN (19 decks)

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