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Reproduction & Sexual Health > Menstruation & Uterine Pathology > Flashcards

Menstruation & Uterine Pathology Flashcards

(54 cards)

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1
Q

Name four hormones involved in the menstrual system

A
  • oestrogen
  • progesterone
  • LH
  • FSH
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2
Q

When is the primary follicle formed?

A

Day 5

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3
Q

What is produced by the primary follicle at day 5?

A

Inhibin - causes FSH to fall and oestrogen to rise

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4
Q

What does the oestrogen rise at day 5 stimulate?

A

Proliferative phase in the uterus

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5
Q

Describe the events leading up to ovulation

A

Oestrogen reaches threshold and changes to positive feedback leading to an LH surge and rise in FSH

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6
Q

What does the LH surge cause?

A

Ovulation, oocyte released into the uterine tubes and secretory phase in the uterus

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7
Q

What is left of the follicle after the oocyte has been released?

A

Corpus luteum - produces progesterone causing a progesterone and oestrogen to rise

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8
Q

What happens if implantation occurs?

A

Placenta produces HCG - this maintains the corpus luteum

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9
Q

What happens if no implantation occurs?

A

Corpus luteum will breakdown causing a fall in oestrogen and progesterone

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10
Q

What is the result of the oestrogen and progesterone fall?

A

Menstruation in the uterus

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11
Q

Describe the proliferative phase

A

Stratum basalis proliferates and increases the thickness of the endometrium - pseudostratified columnar epithelium is relatively straight

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12
Q

Describe the secretory phase

A

Glands become coiled with corkscrew appearance and secrete glycogen

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13
Q

Describe the menstrual phase

A

Arterioles in SF constrict causing ischaemia, tissue breakdown and bleeding

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14
Q

What are the two methods of uterine sampling?

A

Pipette

Dilatation and curettage

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15
Q

How thick should the endometrium be?

A

Premenopausal <16mm

Postmenopausal <4mm

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16
Q

What are the indications for uterine sampling?

A 
Abnormal uterine bleeding
Infertility investigation
Pregnancy loss 
Endometrial ablation 
Prior to hysterectomy 
Incidental finding of thickening 
Cancer screening in high risk cases
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17
Q

Define menorrhagia

A

Prolonged and increased menstrual flow

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18
Q

State the local causes of menorrhagia

A 
Fibroids 
Adenomyosis 
Polyps 
Cervical eversion 
Endometrial hyperplasia 
IUCD 
Pelvic Inflammatory Disease (Chlamydia)
Endometriosis 
Malignancy 
Hormone producing tumours 
Endometrial carcinoma
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19
Q

State the systemic causes of menorrhagia

A

Endocrine - thyroid, diabetes mellitus, adrenal disease
Disorders of homeostasis
Liver/renal disorders
Drugs - anticoagulants

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20
Q

What are the symptoms of PCOS?

A

Oligomenorrhoea/amenorrhoea
Weight gain
Facial hirsutism/acne
Hair loss/thinning

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21
Q

What diseases are associated with PCOS?

A

T2DM (insulin resistance), hypercholesterolaemia, hypertension, sleep apnoea (obesity), higher risk of endometrial carcinoma due to high oestrogen

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22
Q

Describe the diagnostic criteria for PCOS?

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A
  1. Oligo/amenorrhoea
  2. Polycystic ovaries (scan appearance)
  3. Clinical and/or biochemical signs of hyperandrogenism
23
Q

Describe the management of PCOS

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A

Lifestyle, statin, COCP, mirena coil, ovarian drilling, metformin

24
Q

Define disordered uterine bleeding

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A

Irregular uterine bleeding that reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining

25
What are the two types of DUB?
Anovulatory | Luteal Phase
26
Describe anovulatory cycle
Corpus luteum does not form as secondary oocyte is not released - lack of control of proliferation leads to irregular breakdown
27
Describe luteal phase deficiencies
Insufficient progesterone or poor response by endometrium. Abnormal follicular development leads to poor corpus luteum
28
What investigations are done in DUB?
FBC, cervical smear, TSH, coagulation, LFT/renal function, transvaginal ultrasound, endometrial sampling
29
What are the treatment options for DUB?
Medical Mirena Coil Endometrial resection/ablation Hysterectomy (total or subtotal)
30
What is the medical management of DUB?
``` Progestogens COCP Synthetic testosterone GnRH analogues NSAIDs Anti-fibrinolytics Transexamic acid (taken while bleeding) ```
31
What medication is required after endometrial resection and hysterectomy?
Endometrial resection - combined HRT | Hysterectomy - oestrogen only HRT
32
What is endometritis?
Abnormal pattern of inflammatory cells (plasma cells in the stroma)
33
What makes the endometrium resistant to infection?
Cervical mucous plug protects the endometrium from ascending infection in addition to cyclical shedding
34
State the infectious causes of endometritis
``` Neisseria Chlamydia TB/CMV HSV Actinomyces ```
35
State the inflammatory causes of endometritis
``` IUD Postpartum/post arbortal Post curettage Chronic endometritis NOS Granulomatous Associated leiomyomata or polyps ```
36
When do endometrial polps most commonly occur?
Around/after menopause
37
What are the products of conception after miscarriage?
Chorionic villi Trophoblast Foetal RBCs Black nucleus - <12 weeks
38
Define molar pregnancy
Abnormal pregnancy where a non-viable fertilised egg implants in the uterus
39
What disease is a molar part of?
Gestational Trophoblastic Disease
40
Describe gestational trophoblastic disease
A mass grows with characteristic swollen chorionic villi and proliferating trophoblasts
41
Describe a complete mole
One or two sperm combine with an egg that has lost DNA to form a egg with 46 chromosomes all of paternal DNA as sperm replicates
42
Describe a partial mole
Egg fertilised by two sperm or one perm with reduplicates to yield 69 chromosomes
43
What is the risk of molar pregnancy?
They can invade the myometrium and risk of transformation into choriocarcinoma
44
What is an adenomyosis?
Presence of endometrial glands and stroma in the myometrium leading to menorrhagia/dysmenorrhoea
45
What is leiomyoma?
Benign tumour of smooth muscle - Fibroid
46
How may fibroids present?
Menorrhagia, infertility, mass effect, pain
47
What hormone stimulates fibroid growth?
Oestrogen
48
Name the malignant subtype of leiomyoma
Leiomyosarcoma - pleomorphism, necrosis, proliferation
49
Define metrorrhagia
Regular intermenstrual bleeding
50
Define polymenorrhoea
Menses occurring at <21 day interval
51
Define polymenorrhagia
Increased bleeding and frequent cycle
52
Define menometrorrhagia
Prolonged menses and intermenstrual bleeding
53
Define amenorrhoea
Absence of menstruation >6 months
54
Define Oligomenorrhoea
Menses at intervals >35 days

Reproduction & Sexual Health (36 decks)

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