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Human development block > Physiology of menstrual cycle and pharmacological interruptions > Flashcards

Physiology of menstrual cycle and pharmacological interruptions Flashcards

1
Q

How many eggs roughly do females have at the following life stages:

  1. ) before birth
  2. )At birth
  3. ) First period
  4. ) Menopause
A
  1. ) 7 million
  2. ) 2 million
  3. ) 0.5 million
  4. )0
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2
Q

Describe the normal development of an ovarian follicle including the relative lengths

A

Primordial follicle=0.4um
Primary follicle= 100um
Secondary follicle= 200um
Early tertiary follicle= 400um

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3
Q

What is the corpus luteum

A

A hormone-secreting structure that develops in an ovary after an ovum has been discharged but degenerates after a few days unless pregnancy has begun.

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4
Q

Describe the 3 phases of the ovulation cycle

A
  1. ) Follicular phase: day 1-10; hormones signal 10-20 follicles to grow on ovary; oestrogen matures one oocyte
  2. ) Ovulation phase : day 11-14; Oocyte undergoes division; follicle wall thins and ruptures, oocyte enters abdominal cavity near fimbrae of fallopian tube
  3. ) Luteal phase: Days 14-28; oestrogen levels drop; egg travels through fallopian tube towards uterus.
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5
Q

When do FSH and LH levels peak?

A

During ovulation

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6
Q

Explain the FSH threshold-window concept

A

FSH is produced in the brain.Increased FSH makes several follicles grow. The bigger the follicles get, the more oestrogen they produce. A certain level of oestrogen makes the FSH level drop. This drop in FSH removes the competition, hence only one follicle grows, leading to one baby.

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7
Q

How is the oocyte propelled through the fallopian tube and into the uterus.

A

By the fallopian tube contractions and the cilia

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8
Q

What do the fimbrae do shortly before ovulation?

A

Sweep over the surface of the ovaries

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9
Q

What is the function of LH

A

Signals to the egg,allowing it to be released

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10
Q

What are the two layers of the endometrium and their function.

A

Stratum functionalis: Thick superficial layer that is sloughed off during menstruation and grows anew during each cycle

Stratum basalis layer is the deepest tissue of endometrium and is adjacent to the myometrium. It is the constant layer of endometrium, that does not undergo conformational changes during the uterine cycle and its purpose is to replace the tissue loss during the menstruation, so it gives rise to the new stratum functionalis.

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11
Q

When does implantation take place?

A

Begins by day 6-7 after ovulation (day 21 of menstrual cycle)

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12
Q

Which reproductive hormone act directly on the ovaries and what do they do?

A
  • Estrogens: promotes maturation of reproductive organs,development during puberty,regulates menstrual cycle, pregnancy
  • Progesterone: helps maintain the uterine lining ( =’pro-gestation’). Promotes breast development, regulates menstrual cycle, sustains pregnancy
  • FSH: regulates ovarian function and maturation of ovarian follicles
  • LH: Assists in production of estrogen and progesterone,regulates maturation of ovarian follicles,triggers ovulation
  • Human chorionic gonadotrophin: helps sustain pregnancy
  • Testosterone: helps stimulate sexual interest
  • Oxytocin: stimulates uterine contractions in child birth
  • prolactin: stimulates milk production
  • prostaglandins: mediates hormone response and stimulates muscle contractions
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13
Q

Describe the follicle-stimulating hormone receptor.

A

A transmembrane receptor that interacts with the follicle-stimulating hormone and which represents a GPCR

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14
Q

What is the menstrual cycle?

A

A series of cyclic changes in the endometrium(inner lining of uterus) in response to changes in the levels of ovarian hormones

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15
Q

What is the function of GnRH?

A

Its found in the hypothalamus. It promotes maturation of the gonads and regulates the menstrual cycle.

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16
Q

List the gonadotrophic hormones

A

LH&FSH

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17
Q

Describe the menstrual phase (day 1-5)

A

The functional layer of the endometrium becomes detached from the uterine wall, resulting in bleeding (menses)

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18
Q

Describe the proliferative phase (day 6-14)

A

Gonadotrophin releasing hormone stimulates release of FSH & LH which cause follicular development. This causes an increase in the levels of oestrogen as they grow and thus the endometrium begins to proliferate and thicken, tubular glands and spiral arteries form. There is also stimulation of progesterone receptors synthesis in endometrial cells.

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19
Q

Describe the secretory phase ( day 15-22)

A

There are rising levels of progesterone.
Enlargement of glands which begin secreting mucus and glycogen in prep. for implantation of the fertilized ovum. Increased fluid (oedema) in the stroma

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20
Q

What day does the progesterone peak occur on?

A

Day 21

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21
Q

Describe the hypothalamic-pituitary-ovarian axis

A

The hypothalamus releases GnRH which stimulates gonadotrophs on the anterior pituitary to release LH/FSH this acts on the ovary to stimulate the release of estrogen/ progesterone to act on the uterus

22
Q

Explain which aspects may give rise to gonadal dysfunction

A
  1. )Problem with the driver:
    - hypothalamic
    - pituitary
  2. )Problem with the functional units(follicles):
    - none
    - limited
    - insensitive
  3. )Problem with the receiver:
    - absent
    - insensitive
    - obstructed
23
Q

What can cause hypoestogenic status?

A
  • anorexia nervosa
  • iatrogenic treatment
  • functional hypothalamic amenorrhea
  • ovarian failure
  • post menopausal women
24
Q

What can cause hyperandrogenic status?

A
  • tumors of the ovary

- PCOS

25
Q

What causes anovulation

A
  • Hypothalamic dysfunction
  • Pituitary dysfunction
  • Thyroid dysfunction
  • PCOS
  • Ovarian failure
26
Q

What are the most common causes of ovulatory dysfunction?

A
  • PCOS ( woman has a lot of follicles but they arent released in a timely manner)
  • hypothalamic amenorrhea (menstruation stops for several months due to a problem involving the hypothalamus)
  • hyperprolactinemia (prolactin produced in the brain at high conc. may suppress ovulation)
  • premature ovarian failure (woman has no eggs)
27
Q

What are the complications of being an obese woman in terms of fertility.

A
  • reduced fertility
  • higher rates of miscarriage
  • require higher doses of ovulation-inducing agents
28
Q

What should be the first line of treatment in obese women with anovulatory infertility and why?

A

Weight loss, because it…

  • restores ovulation
  • achieves spontaneous prgenancy
  • is effective and cheap
  • has no side effects
29
Q

What are central obesity and BMI major determinants of?

A
  • insulin resistance
  • hyperinsulinaemia
  • hyperandrogenaemia
30
Q

What are the effects of clomiphene citrate and how does it work?

A
  • FSH stimulates ovulation
  • clomiphene citrate stimulates endogenous FSH production
  • should be first line of treatement for those with absent/irregular ovulation but who have normal basal levels of endogenous estradiol
  • It’s a blocker of oestrogen receptors in the pituitary gland
  • These people don’t have cyclical FSH
31
Q

How can laparascopic ovarian drilling be used to combat ovulatory dysfunction

A
  • 4 places to a depth of 4-10mm on each ovary
  • disturbs the surfaces of the ovaries so they can start ovulating again
  • the effect isnt long-lasting
32
Q

What factors are associated with hypogonadotropic hypogonadism

A
  • Low BMI (<20)
  • High-intensity exercise
  • Certain dietary patterns including high-fiber low-fat diets
  • excessive stress
33
Q

What complications may result from gonadotrophins therapy?

A

-gonadotrophins may be used to induce ovulation
-complications may include:
OHSS (ovarian hyperstimulation syndrome) and multiple pregnancies
-anovulatory women with PCOS are particularly prone to multiple follicular development when receive gonadotrophins

34
Q

Describe ovulation induction with pulsatile GnRH

A
  • It is tailor made for patients who have an intact pituitary gland
  • an infusion pump, either subcutaneously (15-20mg per bolus) or intravenously,(5-10mg per bolus), once every 60-90mins
  • is safe,simple &effective
  • compared with gonadotrophin treatment: needs little/no monitoring, low multiple pregnancy and OHSS rate
35
Q

What causes hyperprolactinemia?

A
  • A prolactin-secreting pituitary gland tumor
  • The use of psychiatric medications
  • All women with hyperprolactinemia should be tested for: Hypothyroidism and pregnancy
36
Q

Why are dopamine agonists used to treat ovulatory dysfunction?

A
  • treatment of choice for ovulation induction in women with hyperprolactinemia
  • Directly suppress prolactin production by the tumor and cause and increase in endogenous GnRH secretion, which stimulates pituitary gland secretion of LH and FSH and consequently induces follicle development and ovulation
37
Q

What does increased age mean for fertility

A
  • the older you get, fecundity decreases
  • decreased pregnancy rate
  • increased miscarriage rate
  • increase in aneuploidy due to non-disjunction
38
Q

What is the ovarian reserve?

A
  • The number and quality of the follicles left in the ovary at any given time.
  • An accurate measure of the quantitative or would involve the counting of all follicles present in both ovaries
39
Q

What are the reasons for declined fertility?

A
  • Germ cells in the female are not replenished during life so they decline due to utilization & attrition.
  • Quality of existing oocytes diminishes with age
  • intercourse frequency decreases with age
40
Q

How can we measure ovarian reserve

A
  • Using the anti-Mullerian hormone
41
Q

Discuss age related ovulation dysfunction and premature ovarian failure

A
  • Ovarian follicular pool depletes with age
  • The remaining follicles= less capable of fertilisation and establishing a successful pregnancy
  • Inhibin B production by the small follicles decreases with age
  • inhibin suppression of FSH secretion decreases and the pituitary gland secretion of FSH increases
  • An elevated day 3 FSH level in women with menses is highly sensitive and specific for identifying women with a depleted ovarian follicular pool
42
Q

What is the antral follicle count ?

A
  • The count of antral follicles
  • Correlates well with ovarian response
  • Variability between observes can occur
  • best checked in the early follicular phase
43
Q

What significance does AFC & AMH have in IVF predictors?

A
  • Adequate accuracy for predicting poor response in regularly cycling women
  • It hardly has any clinical value for pregnancy prediction
  • May well be used as a screening test for possible poor responders
44
Q

What is the relationship between absent/ fragile X chromosome and ovarian function

A

absent/ fragile X chromosome is associated with impaired ovarian function

45
Q

What are gonadotrophins

A
  • Released by the pituitary gland

- FSH& LH

46
Q

What are the follicles within the ovaries

A
  • small clusters of granulosa cells & theca cells

- These protect the developing egg

47
Q

What does FSH act on within the follicles

A
  • the granulosa cells

- This makes the follicles grew & secrete oestrogen

48
Q

What does LH act on within the follicles

A
  • The theca cells
  • This stimulates them to secrete progesterone and small amounts of androstenedione
  • Androstenedione is a precursor to testosterone
49
Q

Which class of hormones does estrogen, progesterone and androstenedione belong to

A

-Steroids (lipid soluble hormones)

50
Q

What causes fragile X syndrome

A
  • caused by the expansion of a trinucleotide repeat within a gene on the X chromosome
  • Fragile X syndrome can cause premature ovarian failure

Human development block (35 decks)

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