menstrual disorders

Question 1

what part of the brain controls menarche

Answer 1

hypothalamus control due to GNRH pulsatility

Question 2

what is the mean age of menopause

Answer 2

51 years

Question 3

what causes thickening of the endometrium

Answer 3

oestrogen

Question 4

what are the features of the menstrual phase

Answer 4

3-5 days
period
part of follicular phase

Question 5

what are the features of the proliferative phase

Answer 5

period stops 
oestrogen causes endometrium to thicken 
myometrium grows
synthesis of progesterone receptors
10 days 
part of follicular phase 
dominant hormone is estradiol 17b

Question 6

what is the histology of the proliferative phase

Answer 6

repair of epithelia
proliferation of stroma
test tube shaped glands
synthesis of intracellular receptors for progesterone
contractility of the myometrium increases

Question 7

what are the features of the secretory phase

Answer 7

begins after ovulation
endometrium increases secretory activity under influence of progesterone
endometrial glands become coiled and filled with glycogen, sugars and amino acids, angiogenesis- spiral arteries, enzymes accumulate
in order to accept an embryo
part of luteal phase
enlargement of myometrial cells but depressed excitability

12 days

Question 8

what are the features of the ischaemic phase

Answer 8

constriction of spiral arteries
ischaemia of endometrium 
separation of layers
functional layer is shed 
increase in neutrophils

Question 9

how many menstrual cycles will the average woman have in a lifetime

Answer 9

450 if well nourished

Question 10

what causes bleeding without clotting

Answer 10

endogenous fibronolytic activity

Question 11

what is the average volume of menstrual blood lost

Answer 11

30- 80mls

Question 12

why are oestrogen and progesterone low in the menstrual phase

Answer 12

corpus luteum is regressing

Question 13

what hormones are high during the menstrual phase

Answer 13

FSH and LH- causes follicles to mature

Question 14

when does a single follicle become dominant

Answer 14

day 7

Question 15

what structure secretes oestrogen in order to stimulate proliferation of the endometrium

Answer 15

dominant follicle

Question 16

why does LH and FSH decrease during the proliferative phase

Answer 16

oestrogen and inhibin negative feedback

this causes degeneration of non dominant follicles

Question 17

what happens during day 12-13

Answer 17

LH surge induced by oestrogen

oocyte completes meiosis 1

Question 18

what happens in day 14

Answer 18

ovulation mediated by follicular digestive enzymes and prostaglandins

Question 19

what does the corpus luteum do

Answer 19

secretes oestrogen and progesterone
this develops the secretory endometrium
secreation of FSH and LH is inhibited so no new follicles develop

Question 20

what causes sloughing of the endometrium

Answer 20

degeneration of the corpus luteum which causes drop in oestrogen adn progesterone

Question 21

how does the cervical mucus change during the proliferative phase

Answer 21

becomes penetrable by sperm

Question 22

what is oligomenorrhoea

Answer 22

infrequent light periods

Question 23

what is metrorrhagia

Answer 23

irregular bleeding

Question 24

what is dysmenorrhoea

Answer 24

painful periods

Question 25

what is polymenorrhoea

Answer 25

frequent periods

Question 26

what is amenorrhoea

Answer 26

no periods

Question 27

what causes heavy periods

Answer 27

imbalance of prostaglandin and thromboxane | treated with antifibrinolytic

Question 28

what causes dysmenorrhoea

Answer 28

too much prostaglandins produced by endometrium in response to decreased steroid hormones excessive uterine contractions this can also account for nausea, vomiting and headache

Question 29

what is PMS

Answer 29

cyclical symptoms which affect QOL

Question 30

what is PMDD

Answer 30

premenstrual dysphoric disorder | may be very disabling

Question 31

what does anxiolytic mean

Answer 31

reduces anxiety

Question 32

what might cause pms

Answer 32

falling levels of progesterone which is an anxiolytic

Question 33

what are the symptoms of PMS

Answer 33

* anxiety * mood swings * :redness * irritability * depression * a loss in confidence * clumsiness * headaches * feeling bloated * a change in appe:te * joint pain * tender enlarged breasts * abdominal pain

Question 34

what are the primary causes of amenorrhoea

Answer 34

anatomical/ congenital eg absence of uterus/vagina or genetic e.g. turners, AIS, other intersex conditions

Question 35

what are secondary causes of amenorrhoea

Answer 35

``` pregnancy lactation exercise and nutrition menopause PCOS iatrogenic hormonal contraceptives ```

Question 36

what are the symptoms of eostrogen deficiency

Answer 36

hot flushes, vaginal dryness loss of bone mineralisation reduction in bone mass

Question 37

why does lactation cause amenorhoea

Answer 37

to stop the mother getting pregnant temporarily to increase survival chance of the infant -metabolic cost

Question 38

what are the possible symptoms of PCOS

Answer 38

``` • hyperandrogenemia • oligomenorrhea • obesity – depends on the ethnicity of women • hirsutism • infertility • enlarged cystic ovaries acne amenorrhoea ```

Question 39

what are the features of PCOS

Answer 39

elevated oestrogen and testosterone and anti mullerian hormone insulin resistance on ultrasound- black cysts can be seen

Question 40

how is PCOS treated

Answer 40

``` weight control oral contraceptive to regulate cycle anti androgens hair removal ovulation induction ```

Question 41

where is prolactin released

Answer 41

anterior pituritary gland

Question 42

what controls prolacitn

Answer 42

hypothalamic prolactin inhibitory factor (PIF)- dopamine

Question 43

how does stress affect dopamine

Answer 43

inhibits dopamine which allows prolactin levels to rise

Question 44

where is dopamine released

Answer 44

arcuate nucleus

Question 45

what is a pituritary tumour called

Answer 45

macroadenoma

Question 46

what are the effects of a pituritary tumour

Answer 46

prevents PIF reaching the anterior pituritary this causes prolactin levels to rise inhibits FSH and LH causing amenorrhoea inapropriate lactation and loss of libido

Question 47

what are the features of menopause

Answer 47

lack of follicular development leading to low oestrogen and elevated FSH

Question 48

what can cause premature ovarian failure

Answer 48

idopathic, autoimmune, genetic e.g. fragile X, chemo, radiation