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Flashcards in GU midterm Deck (134)
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1

Phases of menstrual cycle=

Phases:
 day 1: menses→follicular→
day 14: ovulation→luteal to day 30

2

Menstrual Cycle Hormonal Sequence of Events=

Sequence of events:

hypothalamus secretes [GnRH] → stimulates anterior pituitary to secrete...

[LH/FSH]→ causes ovarian follicles to mature, secreting...

[estrogen/progesterone]→ ovulation→ if no fertilization→ drop in...

[progesterone]→ menses

3

Name the four primary hormones of the menstrual cycle:

[GnRH]
[LH/FSH]
[estrogen/progesterone]
[progesterone]

4

signs of estrogen excess:

dysmenorrhea; nausea; edema; enlarged uterus, uterine fibroids; fibrocystic breast changes; menorrhagia

5

signs of estrogen deficiency:

scant menses; mid cycle spotting

6

signs of progesterone excess:

edema; bloating; headache; depression; weight gain; fatigue; HTN; varicose veins

7

signs of progesterone deficiency:

symptoms similar to those with anovulatory cycles, endometriosis, adenomyosis, endometrial hyperplasia; prolonged menses; heavy menses; severe cramps; luteal spotting; BTB

8

normal menstrual cycle:

21-35 day cycles

9

normal age of menarche:

in US is 12-13yo

10

Amenorrhea=

absence or abnormal cessation of the menses for more than 3 months

11

Oligomenorrhea=

scanty menstruation; menstrual periods occur at intervals of greater than 35 days, with only 4-9 periods in a year

12

Polymenorrhea=

occurrence of menstrual cycles of greater than usual frequency

13

Menorrhagia (hypermenorrhea)-

excessively prolonged or profuse menses

14

Metrorrhagia-

any irregular, acyclic bleeding from the uterus between periods

15

Menometrorrhagia-

irregular or excessive bleeding during menstruation and between menstrual periods

16

Dysmenorrhea-

painful menses

17

Mittelschmertz-

one-sided lower-abdominal pain that occurs in women at or around the time of ovulation

18

Primary Amenorrhea=

-Primary: 0.3% prevalence; no secondary sex characteristics by age 14; no menses by age 16

19

Secondary Amenorrhea=

Secondary: 1-3% prevalence; no menses per 3 cycles or 6 months, whichever sooner, in a woman w/ previous menses

20

Primary Amenorrhea Causes=

CNS hypothalamic pituitary disorder; membranous blockage of vagina (hymen); drastic weight loss/ malnutrition/ eating disorder; hypoglycemia; extreme obesity; thyroid disease; anemia; congenital abnormalities of genital system

21

Secondary Amenorrhea 4 most common causes=

-normogonadotropic anovulation

-hypogonadotropic hypogonadism

-prolactinoma

-hypergonadotropic hypogonadism

22

hypergonadotropic hypogonadism:

(Causes Secondary Amenorrhea)

high LH/FSH, but unresponsive ovaries; premature ovarian failure

23

prolactinoma:

(Causes Secondary Amenorrhea)

high prolactin; medications, pituitary tumor, hypothyroidism

24

hypogonadotropic hypogonadism:

(Causes Secondary Amenorrhea)

low LH/FSH so lack of stimulation of ovary; psychological and physical stress

25

normogonadotropic anovulation:

(Causes Secondary Amenorrhea)

normal LH/FSH, but cyclic secretion disrupted, therefore, no ovulation and low progesterone; polycystic ovarian syndrome

26

Additional causes of secondary Amenorrhea:

-pregnancy (must rule out)

-weight reduction/ drastic gain

-stress/ depression

-hypothyroidism

-PCOS (elevated estrogen and testosterone)

-obesity (elevated estrogen)

-increased prolactin (inhibits GnRH)

-premature ovarian failure (early menopause)

27

Amenorrhea Medications=

-hormonal contraception, doesn’t require intervention, may consider change to different contraception

-antipsychotics

-antidepressants, inc. tricyclics and MAOIs

-cardiovascular meds inc Ca-blockers, Aldomet, Reserpine, Digoxin

-ovarian toxins (cytoxan, fluorouracin, cisplatin)

28

Hypoestrogenic amenorrhea=

puts woman at higher risk for bone mineral density loss… osteoporosis

29

Amenorrhea evaluation physical exam=

-secondary sex characteristics; imperforate hymen/ normal anatomy; sexual maturity; weight; thyroid, hyperandrogenism signs

30

Amenorrhea evaluation initial labs=

-B-hCG; TSH; PRL; progesterone challenge test, rule out estrogen deficiency,