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Gynae > Menstruation > Flashcards

Menstruation Flashcards

1
Q

What two hormones are responsible for puberty in females and what stimulated these to be produced? What age does this typically start?

A

Two hormones - FSH + LH
Stimulated by - pulses of GnRH
Starts at - 8yrs

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2
Q

What do the two hormones stimulate?

A

Stimulate oestrogen production from ovaries

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3
Q

What is thelarche?

A

Development of breast (9-11yrs)

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4
Q

What is adrenarche?

A

Growth of pubic hair (11-12yrs)

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5
Q

What is menarche?

A

First period (13yrs). Initially irregular but with increasing oestrogen they become regular

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6
Q

What other hormone is usually associated with puberty?

A

Increased growth hormone (GH)

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7
Q

What are the stages of the menstrual cycle?

A
  • Follicular phase (days 1-13)
    • Menstrual (1-4)
    • Proliferative (5-13)
  • Secretory/luteal phase (15-28)
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8
Q

On what day in a menstrual cycle does ovulation occur?

A

Day 14

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9
Q

What happens in the menstrual phase?

A

Corpus luteum fails and stop producing progesterone and oestrogen = endometrium unsupported = bleed

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10
Q

What occurs in the proliferative stage and what is the main hormone at work?

A

Oestrogen (E).

  • produced by granulosa cells of the follicle. This then suppresses FSH to prevent more than one follicle developing
  • Primes endometrium for progesterone (P) + thickens
  • Suppresses FSH from hypothalamus but peak in (E) causes ^LH = ovulation
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11
Q

What occurs during the luteal/secretory phase and which is the main hormone?

A

Progesterone.
Follicular cells -> corpus luteum.
Corpus luteum supported by LH for 2 weeks. CL produces (P) mainly.
(P) causes secretory changes in endometrium:
- stromal cells swell
-Glands become swollen
- Vascularisation of endometrium
-Accumulation of enzymes and glycoproteins

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12
Q

If there is no corpus luteum what happens to the levels of (E) and (P)? Why does the corpus luteum fail?

A

Production of both is decreased.

CL fails due to lack of hCG present.

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13
Q

What changes occur within the endometrium and myometrium during menstruation?

A
  • constriction of uterine blood vessels = reduced blood supply and nutrients
  • disintegration of endometrial lining
  • Endometrial capillaries filate and bleed through weakened capillaries
  • Myometrium undergoes rhythmic contractions
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14
Q

What age does the menopause typically occur?

A

> 45yrs

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15
Q

What is the average blood loss during in menstruation?

A

<80mls

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16
Q

What is the range of menstrual cycle length?

A

24-38 days

17
Q

What is AUB? Define it:

A

Abnormal Uterine Bleeding. Variation from the normal menstrual cycle including changes in regularity, frequency, duration and amount of blood loss.

18
Q

Give the two categories of causes for AUB and examples of each:

A 
Structural - 
- P - polyps
- A - Adenomyosis
- L - Leiomyomas (fibroids
- M - Malignancy and hyperplasia
Non-structural - 
- C - coagulopathy
- O - ovulatory dysfunction
- E - endometrial haemostasis dysfunction
- I - iaratogenic
- N - not yet specified
19
Q

Give 6 investigations you may do in someone with AUB:

A
  • FBC
  • TFT
  • Coagulation test
  • Urine pregnancy test
  • Cervical smear
  • USS
20
Q

If a patient has one of the following in AUB what would you perform? (USS abnormal, age >40yrs, significant IMB, failed medical Rx, risk factors for endometrial cancer [Obesity, DM, nulliparity, PCOS Hx, FH of HNPCC)

A

Endometrial biopsy

21
Q

What characterised heavy menstrual bleeding (HMB)?

A

> 80mls, interfers with QoL, ^^pads

22
Q

What defines irregular and frequent bleeding?

A

Irregular >38 day intervals

Frequent <24day intervals

23
Q

What would prolonged and shortened bleeding be?

A

Prolonged - >8days

Shortened - <3days

24
Q

List 3 types of non-menstrual bleeding:

A

IMB
PCB
Pre/post- menstrual spotting

25
Q

List 3 types of non-menstrual bleeding:

A

IMB
PCB
Pre/post- menstrual spotting

26
Q

What investigation would be performed on women >40yrs or those <40yrs with significant IMB/endometrial canecer risk factors, with AUB?

A

Pelvic USS + endometrial biopsy or hysteroscopy

27
Q

List relevant treatment of those with AUB and are >40yrs or those <40yrs with significant IMB/endometrial canecer risk factors:

A

If contraception wanted - IUS/COC (to reduce volume)

If regular menses but ^ volume - Tranexamic acid/NSAIDs

Irregular menses - cyclical progestogens

If menopausal - HRT

28
Q

What investigations would you perform in those with postmenopausal bleeding only?

A
  • Urgent USS

- Pipelle biopsy +/- hysteroscopy if endometrium >4mm or recurrent bleeding

29
Q

Ix in those with post coital bleeding alone. Give one cause too

A

Cervical smear/colposcopy - if -ve consider cryotherapy

  • Polyp/invasive cancer
30
Q

What treatment would you give to a female <40years presenting with AUB?

A

If want contraception - IUS/COC

If wanting to conceive - Tranexamic acid or NSAIDs (mefanamic acid)

If the above two fail -> Endometrial biopsy

31
Q

What is the treatment for fibroids?

A

Removal -

  • Trans-cervical-resection of fibroid (TCRF)
  • Myomectomy (fibroid removal)
32
Q

List 2 causes of precocious puberty (early):

A

Central - ^GnRH: meningitis, hydrocephalus, hypothyroidism, tumours)

Adrenal - hormone producing tumours of ovaries/adrenal glands

33
Q

What is Rokitansky syndrome?

A

Absent vagina with/without missing uterus

34
Q

What is Ashermans syndrome?

A

Cervical stenosis due to excess curettage at evacuation of retained product of contraception (ERPC)

35
Q

What effect does prolactin have upon menses?

A

It suppresses the pulsatile GnRH production by the hypothalamus -> no LH-surge inducing ovulation.

36
Q

What inhibits prolactin? And how does this relate to iaratogenic AUB?

A

Dopamine. Drugs which suppress dopamine (antipsychotics) can cause hyperprolactinaemia and thus amenorrhea.

37
Q

Where is prolactin produced?

A

ANTERIOR pitutary

38
Q

Where is GnRH produced?

A

Hypothalamus

39
Q

Where are FSH and LH produced?

A

ANTERIOR pituitary

Gynae (8 decks)

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