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TN Gyneco > 2. Menstruation > Flashcards

2. Menstruation Flashcards

1
Q

Name phases of menstruation (2)

A
  • FOLLICULAR/PROLIFERATIVE PHASE (Variable Duration)
  • LUTEAL/SECRETORY PHASE (Fixed Duration - 14 days)
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2
Q

Describe EARLY follicular phase

  • Initiating Events
  • HPO Axis
  • Hormones
  • Feedback on HPO Axis
  • Ovaries
  • Endometrium
  • Cervical Mucus
A
  • Initiating Events: ⬇️ E and ⬇️ P (from end of previous cycle)
  • HPO Axis:
    • ⬆️ GnRH pulse frequency
    • ⬆️ FSH
    • ⬆️ LH pulse frequency
  • Ovaries: ⬆️ FSH -> follicular growth in 3-30 follicles
  • Endometrium: Menses from P withdrawal (from end of previous cycle)
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3
Q

Describe LATE follicular phase

  • Initiating Events
  • HPO Axis
  • Hormones
  • Feedback on HPO Axis
  • Ovaries
  • Endometrium
  • Cervical Mucus
A
  • Initiating Events: Growing follicles continue to secrete E
  • Hormones: ⬆️E from follicles, especially from dominant follicle
  • Ovaries:
    • Dominant follicle persists, remainder undergo atresia
    • Granulosa cells luteinize -> produce
  • Endometrium: E builds up endometrium
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4
Q

Describe MID follicular phase

  • Initiating Events
  • HPO Axis
  • Hormones
  • Feedback on HPO Axis
  • Ovaries
  • Endometrium
  • Cervical Mucus
A
  • Initiating Events: ⬆️ FSH acts on ovarian granulosa cells
  • HPO Axis: ⬆️E from follicles (ovary)
  • Feedback on HPO Axis: Negative feedback E-> ⬇️FSH,⬇️LH
  • Ovaries: follicular growth (by reducing atresia) -> ⬆️E
  • Cervical Mucus: Clear, ⬆️ amount, Spinnbarkeit 8-10 cm, more stringy
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5
Q

Describe EARLY-MID luteal/secretory phase

  • Initiating Events
  • HPO Axis
  • Hormones
  • Feedback on HPO Axis
  • Ovaries
  • Endometrium
  • Cervical Mucus
A
  • Initiating Events: Switch back to negative feedback
  • HPO Axis: ⬇️LH
  • Hormones: ⬆️P from corpus luteum
  • Feedback on HPO Axis: Negative feedback P -> ⬇️FSH,⬇️LH
  • Endometrium: P stabilizes endometrium
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6
Q

Describe OVULATION

  • Initiating Events
  • HPO Axis
  • Hormones
  • Feedback on HPO Axis
  • Ovaries
  • Endometrium
  • Cervical Mucus
A
  • Initiating Events: Sudden switch from negative to positive feedback (E and P now ⬆️FSH & LH)
  • HPO Axis: ⬆️⬆️LH pulse amplitude (LH surge)
  • Hormones: E peaks -> LH surge -> ovulation
  • Feedback on HPO Axis: Positive feedback: E and P -> ⬆️FSH,⬆️LH
  • Ovaries: ~36 h after LH surge, dominant follicle releases oocyte; corpus luteum (remnant of dominant follicle) produces P
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7
Q

Describe LATE luteal/secretory phase

  • Initiating Events
  • HPO Axis
  • Hormones
  • Feedback on HPO Axis
  • Ovaries
  • Endometrium
  • Cervical Mucus
A
  • Initiating Events: No fertilized oocyte
  • Hormones: ⬇️P secondary to degeneration of corpus luteum
  • Ovaries: Cessation of P from corpus luteum
  • Endometrium: Withdrawal of P -> menses
  • Cervical Mucus: Opaque, scant amount, Spinnbarkeit 1-2 cm
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8
Q

Describe duration of:

  • FOLLICULAR/PROLIFERATIVE PHASE
  • LUTEAL/SECRETORY PHASE
A
  • FOLLICULAR/PROLIFERATIVE PHASE: Variable Duration
  • LUTEAL/SECRETORY PHASE: Fixed Duration - 14 days
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9
Q

What is the average age: menarche

A

10-15 yr

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10
Q

At what age does menstruation start on average?

A

12.2 yr

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11
Q

Average menstruation cycle length? (1)

A
  • Entire cycle 28 ± 7 d with bleeding for 1-6 d
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12
Q

What’s the average blood loss per cycle? (1)

A

25-80 mL

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13
Q

Desribe: Estrogen (3)

A
  • the main hormone in the follicular/proliferative phase and is stimulated by FSH.
  • As the level increases it acts negatively on FSH.
  • The majority of estrogen is secreted by the dominant follicle
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14
Q

Describe effects of estrogen (3)

A
  • On the follicles in the ovaries: Reduces atresia
  • On the endometrium: Proliferation of glandular and stromal tissue
  • On all target tissues: Decreases E receptors
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15
Q

Describe: Progesterone (3)

A
  • the main hormone in the luteal/secretory phase
  • and is stimulated by LH.
  • Increased progesterone acts negatively on LH and is secreted by the corpus luteum (remnant of dominant follicle)
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16
Q

Name: Progesterone effects (5)

A
  • On the endometrium
    • Cessation of mitoses (stops building endometrium up)
    • “Organization” of glands (initiates secretions from glands)
    • Inhibits macrophages, interleukin-8, and enzymes from degrading endometrium
  • On all target tissues
    • Decrease E receptors (the “anti-estrogen” effect)
    • Decrease P receptors
17
Q

Define: Adrenarche (2)

A
  • increased secretion of adrenal androgens
  • usually precedes gonadarche by 2 yr
18
Q

Define: Gonadarche (2)

A
  • increased secretion of gonadal sex steroids
  • ~age 8 yr
19
Q

Define: Thelarche (1)

A
  • breast development
20
Q

Define: Pubarche (1)

A
  • pubic and axillary hair development
21
Q

Define: Menarche (2)

A
  • onset of menses
  • usually following peak height velocity and/or 2 yr following breast budding
22
Q

Name: Stages of Puberty (4)

A

“Boobs, Pubes, Grow, Flow”

Thelarche, Pubarche, Growth spurt, Menarche

23
Q

Describe Tanner Stages: Thelarche (5)

A
  1. None
  2. Breast bud
  3. Further enlargement of areolae and breasts with no separation of contours
  4. 2º mound of areolae and papilla
  5. Areolae recessed to general contour of breast – adult
24
Q

Describe Tanner Stages: Pubarche (5)

A
  1. None
  2. Downy hair along labia only
  3. Darker/coarse hair extends over pubis
  4. Adult-type hair with no thigh involvement
  5. Adult hair in distribution and type; extends over thighs. Not all patients achieve Tanner Stage 5.
25
Q

Define: Premenstrual Syndrome (3)

A
  • Physiological and emotional disturbances that occur 1-2 wk prior to menses and last until a few days after onset of menses
  • common symptoms include depression, irritability, tearfulness, and mood swings
  • synonyms: “ovarian cycle syndrome,” “menstrual molimina” (moodiness)
26
Q

Describe etiologies: Premenstrual Syndrome (3)

A
  • multifactorial: not completely understood; genetics likely play a role
  • CNS-mediated neurotransmitter (serotonin, dopamine, GABA) interactions with sex steroids (P, E, and T)
  • serotonergic dysregulation – currently most plausible theory
27
Q

Name: Diagnostic Criteria for Premenstrual Syndrome

A
  • at least one affective and one somatic symptom during the 5 d before menses in each of the three prior menstrual cycles
    • affective: depression, angry outbursts, irritability, anxiety, confusion, social withdrawal
    • somatic: breast tenderness or swelling, abdominal bloating, headache, swelling of extremities, joint or muscle pain, or weight gain
  • symptoms relieved within 4 d of onset of menses and do not recur until at least day 13 of cycle
  • symptoms present in the absence of any pharmacologic therapy, hormone ingestion, drug or alcohol use
  • symptoms occur reproducibly during 2 cycles of prospective recording
  • patient suffers from identifiable dysfunction in social or occupational performance
28
Q

Describe FIRST LINE Premenstrual Syndrome Treatment (3)

A
  • Exercise, cognitive behavioural therapy, vitamin B6 “
  • combined hormonal contraception
  • Continuous or luteal phase (day 15-28) low dose SSRIs (e.g. citalopram/escitalopram 10 mg)
29
Q

Describe SECOND LINE Premenstrual Syndrome Treatment (2)

A
  • Estradiol patches (100 micrograms) + micronised progesterone (100 mg or 200 mg [day 17-28], orally or vaginally) or LNG-IUS 52 mg
  • Higher dose SSRIs continuously or luteal phase (e.g. citalopram/escitalopram 20-40 mg)
30
Q

Describe THIRD LINE Premenstrual Syndrome Treatment (1)

A

GnRH analogues + add-back HRT

31
Q

Describe FOURTH LINE Premenstrual Syndrome Treatment (1)

A

Surgical treatment ± HRT

32
Q

Describe clinical features: Premenstrual Dysphoric Disorder (2)

A
  • irritability, depressed mood
  • breast pain and bloating
33
Q

Name: Diagnostic Criteria for Premenstrual Dysphoric Disorder (4)

A
  • at least 5 of the following 11 symptoms during most menstrual cycles of the last year (with at least 1 of the first 4)
    • depressed mood or hopelessness
    • anxiety or tension
    • affective instability
    • anger or irritability
    • decreased interest in activities
    • difficulty concentrating
    • lethargy
    • change in appetite
    • hypersomnia or insomnia
    • feeling overwhelmed
    • physical symptoms: breast tenderness/swelling, headaches, joint/muscle pain, bloating, or weight gain
  • symptoms cause significant distress and/or interfere with social or occupational functioning
  • symptoms must be present during the week prior to menses and resolve within a few days after onset of menses
  • may be superimposed on other psychiatric disorders, provided it is not merely an exacerbation of another disorder

TN Gyneco (20 decks)

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