Ch 6 Reproductive System Concerns Flashcards
(133 cards)
1
Q
What is the first step in the menstrual cycle?
A
The hypothalamus release GnRH (gonadotropin releasing hormone)
2
Q
Gonadotropin releasing hormone (GnRH) is going to stimulate the…
A
Pituitary gland to produce follicle stimulating hormone (FSH) and luteinizing hormone (LH)
3
Q
What does FSH and LH being secreted do?
A
They stimulate the ovaries to produce estrogen first and then later progesterone
4
Q
In response to estrogen and progesterone being secreted by the ovaries, what will happen?
A
The endometrial lining will proliferate and then shed
5
Q
When does the menstrual cycle regulate?
A
About 1-2 years after puberty
6
Q
What is the most common age for menarche?
A
Ages 9-12
7
Q
What is the most common age for perimenopause?
A
Ages 40s and 50s
8
Q
What is the normal interval for a menstrual cycle?
A
21-35 days
9
Q
What is the normal range for length of flow?
A
2-8 days, average is 4-7 days
10
Q
What is a normal amount of flow?
A
Less than 1 pad or tampon every 3 hours
11
Q
What is considered severe acute bleeding or HMB, heavy menstrual bleeding?
A
More than a tampon or a pad an hour
12
Q
What is considered abnormal uterine bleeding?
A
Irregular bleeding that many be light, heavy, or spotting only
13
Q
Amenorrhea generally =
A
Anovulation
14
Q
Absence of both menarche AND sexual secondary characteristics by…
A
13
15
Q
Absence of absence of menses by age…
A
15, regardless of normal growth and development
16
Q
If someone has normal growth and development but no period by age 15 that would be considered…
A
primary amenorrhea
17
Q
Absence of menstruation within__ years of breast development is primary amenorrhea
A
5
18
Q
6 months of more of absence of period after menses is considered…
A
secondary amenorrhea
19
Q
Primary versus secondary amenorrhea
A
Primary - never had a period
Secondary - they used to but now it’s gone
20
Q
Inner layer of the uterus
A
endometrium
21
Q
Muscular layer of the uterus, middle layer
A
myometrium
22
Q
Outside layer of the uterus
A
perimetrium
23
Q
What structure of the fallopian tubes takes up products of the ovaries?
A
fimbriae
24
Q
Where do sperm and egg usually meet?
A
ampulla in the fallopian tube
25
50% of abnormal uterine bleeding occurs in women over the age of..
45
26
Only 20% of abnormal uterine bleeding occurs in
adolescents
27
What is an anovulatory cycle?
a menstrual cycle in which ovulation, or the release of an egg from the ovaries, does not occur.
28
What is the cause of ovulatory problems?
Problems affecting the release of hormones from the hypothalamus or anterior pituitary
29
What are three primary causes of abnormal uterine bleeding?
Ovulatory problems
Uterine cancer
Endometrial problems
30
What are two potential causes of endometrial problems?
Ectopic pregnancy
| Infection
31
Ovulatory dysfunction makes up only 10% of what?
abnormal uterine bleeding
32
Hormonal causes of ovulatory dysfunction are most commonly due to...
Obesity
PCOS
Perimenopause
Menarche
33
What is the most common cause of ovulatory dysfunction?
PCOS
34
What does iatrogenic mean?
relating to illness caused by medical examination or treatment
35
What are iatrogenic causes of ovulatory dysfunction?
Contraception
Anticoagulant drugs
Some seizure medications
Antipsychotic meds
36
How can antipsychotics cause anovulation?
Blockade of dopamine D2 receptors cause an increase in the levels of prolactin. Elevated prolactin levels can lead to irregular menstrual cycles and anovulation by altering levels of estrogen and FSH
37
How do antipsychosis and some seizure medications cause anovulation?
They interfere with the release of GnRH
38
Endometrial cancer the the __ leading cause of cancer deaths among women
4th
39
Endometrial cancer most often occurs in women who are...
Peri or postmenopausal
| Overweight
40
What race is most likely to get endometrial cancer?
Black women, and they are also less likely to survive
41
What is the FIRST symptom of uterine cancer?
Abnormal bleeding
42
Is pain common with early uterine cancer?
No
43
Pain is a __ sign of uterine cancer
late
44
Abnormal bleeding is a __ sign of uterine cancer
early
45
When are endometrial disorders likely to occur?
In the presence of normal ovulatory function when other abnormalities have been ruled out
46
Endometrial disorders may include...
ectopic pregnancy and infection, endometritis, or UTI
47
What should you ask a patient about if they have heavy menstrual bleeding?
Coagulopathy, family history of bleeding disorders
48
About 13% of women with heavy menstrual bleeding have...
Coagulopathy
49
An adolescent presents with extremely heavy menstrual bleeding but her cycles are regular
Suspicious of undiagnosed bleeding disorder
50
Menopause, menarche, uterine cancer, and uterine infection are all potential causes of what disorder?
abnormal uterine bleeding
51
When a patient presents with amenorrhea, what are the four things you need to assess?
Absence of menarche and secondary sex characteristics by age 13
Absence of menses by 15 regardless of normal growth and development
Absence of menstruation within 5 years of breast development
6 month or more absence of periods after a period of menstruation
52
What are potential causes of primary amenorrhea? List 7
```
Stress
Pregnancy
Premature menopause
Eating disorders
Strenuous exercise
Thyroid disease
Medications that elevate prolactin levels (esp seizure medications)
```
53
Things to test for when a patient has primary amenorrhea
Pregnancy test
UA
CBC
Endocrine test such as FSH, TSH, Estradiol
54
OVULATORY cycles are characterized by... List 6
```
Regularity
Mid-cycle discomfort (Mittelschmerz pain)
Spinbarkeit mucus
Mid-cycle thermal shift
Cramping with menses
Cycle of generally 4-7 days
```
55
What is Spinnbarkeit mucus?
the elastic quality that is characteristic of mucus of the uterine cervix especially shortly before ovulation
56
What is Mittelschmerz pain?
mid-cycle pain
57
How is Spinnbarkeit pronounced?
Spin-bar-keet
58
How is Mittelschmerz pronounced?
Mittel-schmerz
59
When does abnormal uterine bleeding (AUB) most often occur?
A times of anovulation. So, at the beginning of menstrual cycles, and at the beginning of menopause
60
What are the secondary sex characteristics?
Breast and pubic hair developement
61
How can we classify the secondary sex characteristics?
Tanner stages, 1-5
62
What is the definition of secondary amenorrhea:
Absence of menses for 6 months in a women whom normal menstruation has been established (for at least 3 previous cycles)
63
What is thelarche?
Onset of breast development
64
When does thelarche usually begin?
2 years before first menstrual period
65
What is menarche?
First menstrual period
66
When does menarche occur?
Ages 10-16 years in most developed countries
67
The first initial menstrual cycles are...
anovulatory
68
How do we know when a girl's cycles become ovulatory?
Cycles become regular and she starts having cramps
69
Major causes of PRIMARY amenorrhea
Genetic causes such as Turner's syndrome
| Hormonal imbalances such as PCOS
70
What are symptoms of PCOS? 12 listed
Excessive body hair, weight gain, ovarian cysts, irregular or missed periods, low sex drive, alopecia, high testosterone levels, insulin resistance, fatigue, acne, mood changes, trouble conceiving or infertility
71
PCOS is a __ disorder
endocrine
72
In PCOS, there are very high levels or what 3 hormones?
Estrogen, testosterone, and luteinizing hormone (LH)
73
What hormone is decreased in PCOS?
FSH (follicle stimulating hormone)
74
What is Turner's syndrome?
a condition affecting women having only one X chromosome, characterized by distinctive physical characteristics including short stature and webbed neck, and by failure of normal development of the ovaries, uterus, and breasts.
75
What are the major causes of secondary amenorrhea? List 6
```
Pregnancy
Contraception
Asherman's syndrome
Hormonal imbalances
Pituitary tumor
Menopause
```
76
What is Asherman's syndrome?
A rare condition where scar tissue, also called adhesions or intrauterine adhesions, builds up inside your uterus. This extra tissue creates less space inside your uterus.
77
What can cause Asherman's syndrome? 4 listed
Too vigorous myomectomy
Complicated D&C
Abortion
C section
78
What is characteristic of Asherman's syndrome?
Intrauterine band like adhesions that cause pain and interfere with the menstrual cycle
79
An increase in the hormone __ can cause amenorrhea
prolactin
80
What can cause hyperprolactinemia? List 7
```
Hyperthyroidism
Stress
Some medications
Excessive exercise
Excessive sleep
Pituitary adenoma
Weight loss: Anorexia or bulimia
```
81
How does hyperthyroidism cause an increase in prolactin levels?
Thyroid relising hormone (TRH) stimulates prolactin synthesis through the activation of ERK
82
What medications can increase prolactin levels?
OCPs
Phenothiazines
Anti-HTN
Narcotics
83
Most causes of secondary amenorrhea are caused by...
The hypothalamus not the pituitary gland
84
What is a rare syndrome of the pituitary gland that can cause secondary amenorrhea?
Sheehan Syndrome
85
What is Sheehan syndrome?
Postpartum hypopituitarism caused by necrosis of the pituitary gland. It is usually the result of severe hypotension or shock caused by massive hemorrhage during or after delivery.
86
How does postpartum hemorrhage lead to Sheehan syndrome?
Hypovolemia and vasospasm causes cellular swelling. The pituitary gland is surrounded by a bony prominence that inhibits blood flow, which causes the necrosis
87
What is the treatment for amenorrhea when the cause is hypothalamic failure?
GnRH replacement
88
What is the treatment for amenorrhea when the cause is hypothyroidism?
TSH replacement
89
What is the treatment for hyperprolactinemia?
Bromocriptine
90
What is the treatment for amenorrhea when anovulation is the cause?
Cyclic progesterone
91
How is Sheehan syndrome ruled out?
By way of hysteroscopy and hysterosalpingogram
92
What is primary dysmenorrhea?
Prostaglandin released from uterine lining ONLY in ovulatory cycles
93
What is prostaglandin responsible for?
Cramps, N/V, HA and other associated symptoms
94
How can you suppress prostaglandin release?
Use NSAIDS 24-48 hours BEFORE the onset of menses
95
Primary dysmenorrhea is associated with an...
ovulatory cycle
96
Primary dysmenorrhea is most common for women in what age group?
Early teens - early 20s
97
Secondary dysmenorrhea most common causes
Endometriosis
Fibroids
Adenomyosis
98
What is endometriosis?
Presence and growth of endometrial tissue outside of the uterus
99
Endometrial tissue can be as far away from the uterus as the...
Thoracic cavity, heart
100
Endometrial tissues contains...
uterine glands and stroma
101
Uterine glands and stroma that is outside of the uterus will..
respond to the menstrual cycle
102
What happens when the endometrial tissue responds to the menstrual cycle?
Those tissues bleed and cause the inflammatory process. This can cause adhesions and fibrosis to the adjacent tissues and organs
103
What is a well known theory of endometriosis etiology?
Transplantation or retrograde menstruation
104
What is transplantation or retrograde menstruation?
Endometrial tissue that's reflux through the uterine tubes into the uterine cavity where it can implant into the ovaries and other organs
105
Risk factors for endometriosis
```
Increasing age
Family history
Short menstrual cycles (less than 28 days)
Long menstrual flow (over a week)
Age at menarche <12 years
Few or no pregnancies
```
106
What does the provider look for on the exam when assessing for endometriosis?
Nodularity
Retroverted uterus
Pain with exam
107
How is endometriosis diagnosed?
Laparoscopy
108
What is a retroverted uterus?
A uterus that is tilted backwards
109
What are the most common s/s of endometriosis?
Pain and infertility
110
What is dyspareunia?
Pain with intercourse
111
What are other s/s of endometriosis?
dysuria, depression, fatigue, chronic pelvic pain, premenstural vaginal spotting, dyspareunia, pain with bowl movement
112
What are endometriomas?
"Chocolate cysts" that are found on the uterus due to endometriosis
113
Endometriosis lesions can cause distortions of the...
pelvic anatomy that can lead to infertility
114
Endometriosis can NOT be identified through...
ultrasound
115
Pelvic endometriosis can only be identified through...
laparoscopy
116
How else is endometriosis diagnosed besides laparoscopy?
CT scan may localize an incisional lesion and biopsy confirms the diagnosis
117
How is endometriosis treated?
OCP, NSAIDs, GnRH agonist
| Surgery to remove lesions
118
What is the only cure for endometriosis?
Hysterectomy with bilateral oophrectomy
119
What is an oophrectomy?
A surgical procedure to remove one or both of your ovaries
120
What are the two main classes of medications used to treat endometriosis?
GnRH agonist and androgen derivatives
121
How would a GnRH agonist help endometriosis?
It will help to stop the releasing of FSH and LH
122
What is a total hysterectomy?
The uterus and cervix
123
What is a radical hysterectomy?
Uterus with the surrounding lymph nodes/tissue
124
What is a hysterectomy with a bilateral oophorectomy?
Uterus and both ovaries
125
What is a supracervical hysterectomy?
Just the uterus, no cervix or anything else
126
What is PMS?
Physical or mood changes day before menstruation
127
When are mood swings or physical symptoms considered PMS?
Symptoms happen month after month and affect a women's normal life
128
What are 3 potential causes of PMS?
Cyclic changes in hormones
Chemical changes in the brain
Undiagnosed depression
129
Undiagnosed depression is related to PMS...
NOT the cause
130
What is the diagnostic criteria for PMS?
Symptoms must be present within the 5 days leading to her period and for at least 3 cycles in a row
Symptoms must end within 4 days after her period starts
Interfere with some of her normal activities
131
What are dietary considerations for preventing PMS?
Diet rich in complex carbs to reduce cravings
Calcium rich foods instead of salt, sugar, fat
Avoid caffeine to reduce irritability
Eat small meals (6 instead of 3) or add snack in between meals
132
What health considerations for preventing PMS?
Reduce stress with yoga, mindfulness, massage
Aerobic exercise
Get enough sleep
133
What pharmacological considerations for preventing PMS?
OCPs
| Low dose SSRIs (once a month before period)
