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3818 > disorders of the menstrual cycle > Flashcards

disorders of the menstrual cycle Flashcards

1
Q

What does LH stand for

A

Luteinising hormone

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2
Q

What does FSH stand for

A

Follicle-stimulating hormone

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3
Q

What is the hypothalamic-pituitary feedback system that leads to endometrial changes and cervical mucus changes?
Hint: involves the release of E, P, LH, FSH

A

Hypothalamus releases GnRH, which stimulates the anterior pituitary to release LH and FSH, which stimulates the ovaries to release E and P, which stimulates the uterus to cause endometrial and cervical mucus changes, before going into a negative feedback loop

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4
Q

What happens to the body when E stimulates LH surge?

A

Ovulation

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5
Q

Stimulation and development of follicle is due to the surge of what hormone?

A

P

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6
Q

What does E/estradiol thicken?

A

Endometrium lining

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7
Q

What does P/progestogen thicken?

A

Cervical mucous

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8
Q

Define dysmenorrhea

A

Period pain - chronic, cyclical, pelvis spasmodic (cramp) pain in absence of other pathologies

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9
Q

Which of these is NOT a risk factor for dysmenorrhoea?
A. Low BMI
B. Smoker
C. Earlier menarche
D. Being an athlete
E. Sexual abuse

A

D - exercise lowers the chances of getting it, so not a risk factor

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10
Q

Which of these DO NOT help with dysmenorrhoea?
A. No previous childbirth
B. First childbirth at younger age
C. Exercise
D. Contraceptives

A

A - no child is a risk factor actually, having a kid young makes pain better

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11
Q

Difference between primary and secondary dysmenorrhoea

A

Primary - getting cramps after onset of normal menstrual cycle with normal pelvic exam
Secondary - not just normal periods cramp, referral needed as something else is going on, some pelvic patholgy

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12
Q

How does primary dysmenorrhoea happen?

A

Secreted E and P stimulate prostaglandin (PGF2 alpha), which stimulates nerve endings that cause pain, ultimately causing myometrial contractions

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13
Q

How is prostaglandin (PGF2 alpha) associated with pain?

A

PGF2 alpha mediates and potentiates pain sensations and stimualtes smooth muscle contractions

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14
Q

MOA if NSAIDs in dysmenorrhoea

A

Inhibits synthesis and activity of uterine prostaglandins

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15
Q

Reason for COCP in dysmenorrhoea?

A

Stops ovulation, so it minimises sx they get with a period

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16
Q

Drugs indicated for dysmenorrhoea (3)

A

NSAIDs, COCP, paracetamol

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17
Q

When does secondary dysmenorrhoea occur?

A

Later in life

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18
Q

What does PMS stand for

A

Pre-menstrual syndrome

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19
Q

When does pre-menstrual syndrome (PMS) happen?

A

10 days before menstruation

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20
Q

Which of these is NOT a physical sx of PMS?
A. Abnormal bloating from fluid retention
B. Loss of libido
C. Acne
D. Breast tenderness and fullness
E. Diarrhoea

A

E - in PMS you get fluid retention, opposite to diarrhoea

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21
Q

Which of these is NOT a psychological sx?
A. Anger issues
B. Mood swings
C. Tension and anxiety
D. Food cravings, binge eating

A

A

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22
Q

Another word for period?

A

Menses

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23
Q

If using an OCP for PMS, what ingredient needs to be in it for it to work?

A

Drosperonine

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24
Q

What does PMDD stand for

A

Premenstrual dysphoric disorder

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25
Q

What are the 4 stages of menses?

A
  1. Menstrual phase
  2. Follicular (pre-ovulatory) phase
  3. Ovulatory phase
  4. Luteal (post-ovulatory) phase
26
Q

Define premenstrual dysphoric disorder (PMDD)

A

Severe form of PMS

27
Q

Most common drug for PMDD, and when to take it?

A

SSRI - can take everyday or cyclically when px knows when period/sx will occur

28
Q

Define menorrhagia

A

Heavy menstrual bleeding (HMB)

29
Q

What are the types of menorrhagia and which is the most common? (4)

A
  • Ovulatory
  • Anovulatory
  • Complication of pregnancy
  • Coagulation disorder (most common)
30
Q

Which of these is NOT a type of menorrhagia?
A. Ovulatory
B. Anovulatory
C. Trauma
D. Complications of pregnancy
E. Coagulation disorder

A

C

31
Q

What occurs due to excessive fibrinolytic activity and increase in PG production in the endometrium?

A

Ovulatory HMB

32
Q

What hormone causes anovulatory HMB

A

the lack of P

33
Q

What are 2 common causes of anovulatory HMB?

A

PCOS and perimenopausal dysfunction uterine bleeding

34
Q

What is the goal of tranexamic acid in HMB?

A

Decrease blood loss in menstrual cycle

35
Q

What is the first-line treatment in HMB management?

A

Levonorgestrel IUD

36
Q

What are the 2 POP medications indicated for HMB?

A

Norethisterone or IM medroxyprogesterone

37
Q

MOA of POP in HMB

A

Reduces endometrial thickness, reduce bleeding by 30%

38
Q

Define amenorrhoea

A

Absence of periods

39
Q

True/False
POP used for HMB can cause amenorrhoea

A

True - can cause amenorrhoea in 70% of women

40
Q

What drug class is tranexamic acid?

A

Antifibrinolytics

41
Q

MOA of antifibrinolytics

A

Inhibits local fibrinolysis and inhibits clot breakdown by preventing activation of plasminogen and plasmin

42
Q

MOA of COCP used in HMB

A

Thins the endometrium

43
Q

MOA of COCP used in HMB

A

Thins the endometrium

44
Q

API of Ponstan?

A

Mefenamic acid

45
Q

When should you start using NSAIDs for HMB?

A

Onset or 3-5 days prior to bleeding

46
Q

MOA of NSAIDs indicated for HMB

A

Decrease PG conc. in the endometrium, ultimately reducing blood loss and reduces inflammation/pain

47
Q

MOA of levonorgestrel-releasing intra-uterine system (the IUD) used for HMB

A

Slowly release progestin that thins the endometrium

48
Q

What are the 2nd line treatments for HMB after the IUD

A

Tranexamic acid, NSAIDs, COCP

49
Q

Why is the IUD the most effective for HMB?

A

Avoids the systemic ADR of po or inj progestins

50
Q

What happens when endometrial cells implant and grow outside of the uterus?

A

Endometriosis

51
Q

What does endometriosis cause? (2)

A
  • Irregular bleeding
  • Problems falling pregnant
52
Q

What disorder of the menstrual cycle is a cause of infertility?

A

Endometriosis

53
Q

Which one is the immune theory on why endometriosis occurs?
A. Altered immune response allows endometrial cells to avoid destruction
B. Metaplasia near pelvic floor

A

A

54
Q

Which one is Meyer’s theory on why endometriosis occurs?
A. Altered immune response allows endometrial cells to avoid destruction
B. Metaplasia near pelvic floor

A

B

55
Q

Which is NOT a sx of endometriosis?
A. Pain/severe dysmenorrhoea
B. Bleeding
C. Bowel and bladder sx
D. Chronic fatigue, nausea, depression, infertility
E. Early onset of menopause

A

E

56
Q

What can be used for pain suppression in endometriosis? (5)

A

Analgesics, OCP, vaginal contraceptive ring (Nuvaring), contraceptive implant (Implanon), IUD (Mirena)

57
Q

MOA of GnRH agonist in endometriosis

A

Reduce activity of the hypothalamic-pituitary axis in order to decrease FSH and LH secretion, consequently suppressing E which shrinks ectopic endometrium

58
Q

SE of GnRH agonist (2)

A

Menopausal sx or loss of bone mineral density

59
Q

What drug class do these belong to?
Nafarelin, goserelin

A

GnRH agonist

60
Q

MOA of aromatase inhibitors in endometriosis

A

Inhibits the conversion of androgen to E (less E)

61
Q

SE of aromatase inhibitors in endometriosis

A

Menopausal sx or loss of bone mineral density

62
Q

What do drugs used for endometriosis aim for?

A

Aim to shrink ectopic endometrium by suppressing E

3818 (8 decks)

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