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Women's Health > Menses > Flashcards

Menses Flashcards

1
Q

Hormone responsible for follicle formation and beginning of follicle maturation

A

FSH

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2
Q

Hormone responsible for follicle maturation and triggering ovulation

A

LH

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3
Q

Role of the hypothalamus in the menstrual cycle

A

produces and releases GnRH to anterior pituitary

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4
Q

In response to GnRH, the anterior pituitray releases

A

TSH, GH, ACTH, Prolactin, FSH, LH

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5
Q

Hormone produced primarily by developing follicles in the ovary and stimulates endometrial cell growth

A

estrogen

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6
Q

Hormone produced by the corpus luteum and prepares the uterus for implantation [Pro-Gestation] → converts proliferative endometrium to secretory endometrium

A

Progesterone

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7
Q

Hormone produced by the ovaries, placenta, and corpus luteum → inhibits FSH release

A

Inhibin

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8
Q

Average duration of the menstrual cycle

A

28 days

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9
Q

Average duration of menses

A

3-8 days

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10
Q

what day in the cycle does ovulation occur?

A

day 14

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11
Q

Average age of menarche

Average age of menopause

A
  1. 7

51. 4

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12
Q

What is the first day of the menstrual cycle?

A

first day of menses

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13
Q

Two phases of the menstural cycle

A

follicular and luteal

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14
Q

This phase begins with the onset of menses and ends on the day of LH surge → average duration is 14 days [can vary → 14-21 days]

A

follicular phase

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15
Q

This phase begins on the day of LH surge and ends at onset of next menses → duration is 14 days

A

luteal phase

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16
Q

what hormones are doing their thing in the follicular phase?

A

estrogen levels low → increse in FSH and LH secretion → follicle develops in the ovaries → follicle produces estrogen and progesterone → increases estrogen turns off the GnRH release from hypothalamus → inhibin also released to decrease FSH release

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17
Q

what anatomy changes in follicular phase?

A

uterus lining thickens

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18
Q

where does fertilization occur?

A

fallopian tube

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19
Q

what occurs hormone wise during ovulation?

A

increase in estrogen → LH surge and FSH spike

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20
Q

Increasing levels of estrogen have been suppressing GnRH, LH, FSH until day 14 when ____ occurs and the process switches from negative feedback control to positive feedback

A

neuroendocrine phenomenon

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21
Q

what is occuring in the luteal phase?

A

empty follicle becomes the corpus luteum → secretes more progesterone → further develops uterus lining → makes it more favorable for implantation

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22
Q

what are somy symptoms that may indicate your patient is in the luteal phase of her menstural cycle?

A

raised basal body temperature, bloating and breast tenderness (dur to water retention)

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23
Q

what causes the eventual decrease in progesterone and estradiol?

A

decrease in LH

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24
Q

If an oocyte Is fertilized what hormone will then be released?

A

hCG (human chorionic gondaotropin)

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25
Q

what causes onset of menses?

A

corpus luteum begins to disintigrate → progesterone levels drop

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26
Q

If embryo develops what prevents menses from occuring?

A

maintained increased progesterone, estrogen, and inhibin levels

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27
Q

Time frame for follicular phase
what develops in this phase?
Dominant hormone?

A

first day of menses to ovulation
follicle develops
estrogen > progesterone

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28
Q

what happens on day 14 that correlates with ovulation?

A

LH surge

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29
Q

Time frame for luteal phase

Dominant hormone?

A

ovulation to menses

Progesterone > estrogen

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30
Q

what syptoms can you see in the proliferative phase?

A

hormones are rising → menstrual symptoms are subsiding → increased libido

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31
Q

Term for pain sometimes felt when a woman ovulates

A

mettelschmerz

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32
Q

Describe vaginal mucus during the ovulation phase

A

high volume and elasticity, thin, clear

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33
Q

Symptoms of the ovulation phase

A

low temperature, nausea, sharp or dull pain, spotting, high libido

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34
Q

Describe the vaginal mucus during the secretory phase

A

low in volume and elasticity, thick, cloudy

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35
Q

Symptoms of the secretory phase

A

temperature spikes, weight gain, bloating, swelling, breast tenderness, anxiety, depression, headache, spotting, constipation, acne

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36
Q

How does primary differ from secondary amenorrhea?

A

primary is complete absence/never have it

secondary is due to some cause (absense for 3+ months)

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37
Q

How long must a woman have amenorrhea to be diagnosed with menopause? What type of diagnosis is this?

A

1 year

retrospective diagnosis

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38
Q

Causes of Primary Amenorrhea

A

anatomic, primary ovarian insufficiency, hypothalamic causes, pituitary causes, physiologic causes, Iatrogenic

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39
Q

term for congenital absense of uterus

A

Mullerian agenesis

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40
Q

Anatomic causes of primary amenorrhea

A

Mullerian agenesis, imperforate hymen, transverse vaginal septum, vagina or cervical agenesis

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41
Q

Congenital causes of primary ovarian insufficiency

A

Turner syndrome, Condala dysgenesis, Ovarian agenesis

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42
Q

Acquired types of primary ovarian insufficiency

A

chemo/radiation, mumps or autoimmune oophoritis

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43
Q

How can the hypothalamus cause primary amenorrhea?

A

reduction in GnRH → reduction in FSH, LH

44
Q

What can cause the hypothalamus to decrease its production of GnRH?

A

psychotic stress, excessive exercise, malnourishment, rapid weight loss, eating disorder

45
Q

What are pituitary causes of primary amenorrhea?

A

pituitary tumors, empty sella syndrome, medications (antidepressants, antipsychotics)

46
Q

what are somy symptoms of primary amenorrhea?

A

headache or visual field abonormalities, pregnancy symptoms, elevated BP, acne, hirsutism, short stature

47
Q

If a patient hasn’t had a period and complains of headahce and visual field abnormalites, what may you want to assess first?

A

pituitary or hypothalamic tumor

48
Q

what labs do you want to order for patient with primary amenorrhea?

A

FSH, LH, PRL, testosterone, thyroid studies, pregnancy test

49
Q

If the prolactin levels are high and the patient is complaining of headache and vision abnormalities what would you want to order?

A

MRI of hypothalamuc and pituitary

50
Q

common causes of secondary amenorrhea

A

pregnancy, hypothalamic/pituitary, androgen disroders (PCOS)

51
Q

Most common cause of amenorrhea

A

pregnancy

52
Q

What will be pertinent in the patient history that may lead you to pregnancy

A

breast fullness, weight gain, nausea

53
Q

How can you confirm pregnancy?

A

hCG assay (urine or serum)

54
Q

Post partum pituitary necrosis secondary to severe hemorrhage and hypotension

A

Sheehan Syndrome

55
Q

Most common cause of ovulatory dysfunction in reprodutive age women

A

PCOS

56
Q

What occurs in PCOS?

A

high insulin → increase GnRH pulse frequency → increased LH and FSH → increase in ovarian androgen production and decrease follicular maturation

57
Q

Early vs Premature Menopause

A

Early → primary ovarian failure before 45

Premature → primary ovarian failure before 40

58
Q

what is going on hormone wise in ovarian failure?

A

FSH and LH increase to stimulate follicle maturation → decrease estrogen and progesterone → no follicle response

59
Q

Signs and symptoms of ovarian failure

A

estrogen deficiency → abnormal hair growth, hot flashes, mood swings, insomnia, vaginal atrophy

60
Q

what are some causes of ovarian failure?

A

autoimmunity against ovaries, chromosomal abnormalities, surgical bilateral oophrectomy, radiation to pelvic area, chemo

61
Q

What is bad about ovarian failure?

A

irreversible

62
Q

why is it important to catch ovarian failure early?

A

save eggs for futre IVF with surrogate

63
Q

intrauterine synechiase → scaring of the uterine cavity → may be secondary to d&c or C-section

A

Asherman Syndrome

64
Q

post partum pituitary necrosis secondary to severe hemorrhage and hypotension

A

Sheehan Syndrome

65
Q

Symptoms of menopause

A

vasomotor symptoms, sleep disturbances, fatigue, headache, diminished libido, depression, irritability, vaginal dryness and atrophy

66
Q

Symptoms of pregnancy

A

fatigue, sore, swollen, tender breast, bloating, weight gain

67
Q

Symptoms of PCOS

A

hisutism and masculine features

68
Q

Diagnostic tests for secondary amenorrhea

A

pregnancy test, TSH, prolactin, FSH and LH, estradiol, serum testosterone

69
Q

While you do not have to do labs in a patient you suspect is in menopause, what would the levels be if you did order it?

A

high FSH and low estradiol

70
Q

what is the progesterone challenge test?

A

administer progesterone (medroxyprogesterone) 10-14 days during menstrual cycle → withdrawal bleeding should occur within a week

71
Q

If bleeding occurs in progesterone challenge test then the patient is

A

anovulatory or oligo-ovulatory → issue with hypothalamic/pituitary axis or abnormal ovaries

72
Q

If no bleeding occurs in the progesterone challenge test the patient

A

lacks estrogen or has genital outflow tract disorder

73
Q

If a patient desires pregnancy, what can induce ovulation?

A

clomiphene citrate, heman menopausal gonadotropins, pulsatile GnRH, aromatase inhibitors

74
Q

what do you primarily use in patients with PCOS?

A

clomiphene citrate

75
Q

Treatment for premature ovarian failure

A

HRT

76
Q

what can be used to suppress prolactin secretion?

A

bromocriptine

77
Q

Conservative treatment for menopause

A

keep cool, medication, exercise, vaginal lubricant

78
Q

nonhormonal treatment for menopause

A

escitalopram (SSRI), venlafaxine (SNRI) → help with anxiety or labile mood
meds for osteoarthritis → calcium and vitamin D

79
Q

If your menopause patient has a uterus what hormone replacement therapy can you give her?

A

conbined estrogen and progesterone

80
Q

if your menopause patient lacks a uterus what hormone replacement therapy can you give her?

A

estrogen only

81
Q

a woman on HRT is at greater risk for

A

blood clots

82
Q

Normal menstrual interval but heavy flow and longer duration

A

menorrhagia

83
Q

intermenstrual bleeding (bleeding between period at irregular intervals)

A

metrorrhagia

84
Q

prolonged and heavy bleeding at irregular intervals

A

menometrorrhagia

85
Q

frequent periods

A

polymenorrhea

86
Q

light flow or “spotting”

A

hypomenorrhea

87
Q

menstrual periods > 35 days apart

A

oligomenorrhea

88
Q

bleeding after intercouse “contact bleeding”

A

postcoital bleeding

89
Q

average length of cycle
amount of blood loss
heaviest days

A

5 days
30 cc
days 1-3

90
Q

What is considered an abnormal blood loss in menstruation

A

> 80 cc

91
Q

what is considered abnormal tampon/pad use?

A

> 6 full pads/tampons a day [normal is >1 pad/tampon per 3hr]

92
Q

three golden rules for abnormal uterine bleeding

A

rule out pregnancy, rule out cancer, assess hemodynamic status

93
Q

what are structural causes of abnormal uterine bleeding?

A

PALM → Polyp, Adenomyosis, Lelomyoma, Malignancy/hyperplasia

94
Q

what the nonstructural causes of abnormal uterine bleeding?

A

COEIN → Coagulability, Ovulatory dysfunctino, Endometrial, Iatrogenic, Not yet classified

95
Q

what are signs of ovulation?

A

cervial mucous becomes stringy/stretchy [Spinnbarkeit], breast tenderness, bloating

96
Q

What do you what to rule out before performing endometrial biopsy?

A

pregnancy

97
Q

In this scan you put water in the uterus and check for any structural abnormalities

A

sonohysterography or hysteroscopy

98
Q

what is the goal for treating abnormal uterine bleeding?

A

control bleeding and treat underlying cause

99
Q

Can you take NSAID with abnormal uterine bleeding?

A

yes → helps with pain

100
Q

what is the goal of hormone manipulation with abnormal uterine bleeding?

A

restore normal cycle

101
Q

Treatment for heavier abnormal uterine bleeding

A

GnRH → shuts down the system by ovarian suppression
OCP → multiple/day
IV progesterone or estrogen

102
Q

If a patient with heavy abnormal uterine bleeding is resistant to medications what two options can you consider?

A

surgery or endometrial ablation

103
Q

Is abnormal uterine bleeding something to be concerned about in adolescent patients?

A

yes → normal to be irregular when starting out

104
Q

Most common cause of AUB in adolescents

A

immaturity of hypothalamic-pituitary-ovarian axis

105
Q

once regular menses is established in adolescence what is the most common cause of AUB?

A

ovulatory dyfunction

106
Q

what do you do in postmenopausal patient with AUB?

A

endometrial biopsy

Women's Health (9 decks)

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