repro 3.2 menstrual dysfunction

Question 1

From when does the proliferative phase occur?

Answer 1

From the onset of menses to ovulation.

Question 2

What’s the order of the blood vessels found within the uterine wall?

Answer 2

uterine artery
radial arteries 
arcuate arteries 
straight arteries 
spiral arteries

Question 3

How long is the average menstrual cycle?

Answer 3

21-35 days

Question 4

What’s the average volume of blood lost per cycle?

Answer 4

37-48 ml/cycle

Question 5

Whats the name given to heavy periods?

Answer 5

Menorrhagia

Question 6

What are some cuases of menorhagia?

Answer 6

fibroids
abnormal clotting
cancer 
progesterone contraception
the coil (IUCD)

Question 7

What are fibroids?

Answer 7

Benign growths of fibrous and muscular tissue that develop in and around the uterus.

Question 8

What are some types of fibroids?

Answer 8

intracavitary
intramural
submucosal
subserosal
pedunculated

Question 9

What does DUB stand for?

Answer 9

Dysfunctional uterine bleeding

Question 10

What is dysfunctional uterine bleeding?

Answer 10

heavy bleeding ewith no recognisable pathology or bleeding disorders. It’s a diagnosis based off the exclusion of other pathology.

Question 11

syggest a method of reducing uterine bleeding.

Answer 11

endomtrial ablation, using a laser to singe some of the blood vessels.

Question 12

What’s a long term fix for treatment of menorrhagia?

Answer 12

removal of the uterus, but should only be considered in women who are sure they dont want any more children.

Question 13

What’s a major cause irregular bleeding?

Answer 13

contraceptives

Question 14

What’s ammenorrhoea?

Answer 14

Abscence of periods.

Question 15

What are the different classifications of ammenorrhoea?

Answer 15

Primary- never had a period

secondary- eg had periods before but have since stopped

Question 16

What are some causes of secondary ammenorrhoea?

Answer 16

pregnancy
weight loss
some contraceptives
PCOS
Menopause
pituitary tumours
certain drugs, eg for cancer. 
severe stress

Question 17

What broad impacts can menstrual disorders have?

Answer 17

physical- eg anaemia, tiredness

psychological-depression, anxiety, mood swings, irritability

Social- sports, swimming

Question 18

Whats is dysmenorrhoea?

Answer 18

Painful periods

Question 19

What is oligomenorrhoea?

Answer 19

irregular periods more than 35 days apart

Question 20

What is PMS?

Answer 20

pre-menstrual syndrome- physical and emotional symptoms experiences during the second half of the cycle, so a week or so before menses which can lead to irritability, mood swings, breast tenderness, bloated, headaches, sleep problems etc.

Question 21

What is primary ammenorrhoea?

Answer 21

the absense of menses without secondary characteristics by 14, or with secondary characteristics by the age of 16.

Question 22

What’s the definition of seondary ammenorrhoea?

Answer 22

ceasing of menses, for more than 3 months in a woman who has regular periods, or 9 months in a woman who has irregular periods.

Question 23

What are the 3 broad causes of primary amenorrhoea?

Answer 23

• problems with the outflow tract
• problems with the gonad/end organs
• problems with the hypothalamus/ pituitary.

Question 24

What are some causes of outflow obstruction causing primary ammenorrhoea?

Answer 24

• mullerian agenesis,
• vaginal atresia
• imperforate hymen

Question 25

What is Asherman's syndrome?

Answer 25

-fibrosis of the endometrium leading to lack of hormonal control response.

Question 26

What is an outflow obstruction cause of secondary amenorrhoea?

Answer 26

Asherman's syndrome.

Question 27

What are some ovarian/end organ causes of primary amenorrhoea?

Answer 27

- ovarian dysgenesis (eg Turners syndrome) - androgen insensitivity - FSH/LH receptor insensitivity - congenital adrenal hyperplasia

Question 28

What does hypergonadotrophic hypogonadism mean?

Answer 28

The gonads are underdevelopped, or have diminished functioning, which leads to less oestrogen production, so less negative feedback, causing an increase in the release of FSH and LH (hypergonadotrophic)

Question 29

What happens in androgen insensitivity?

Answer 29

This is a condition of males, XY genotype, but the receptors for androgens including testosterone dont work. This causes lack of masculinisation of the external genitalia so the child will be phenotypically male, but will not have a uterus, ovaries etc.

Question 30

What are some ovarian/end organ causes of secondary amneorrhoea?

Answer 30

- PCOS - pregnancy - menopause

Question 31

What are some hypothalamic/pituitary causes of primary amenorhoea?

Answer 31

-Kallman's syndrome

Question 32

What is Kallmann's syndrome?

Answer 32

There is a chromosomal abnormality leading to malfomraiton of the hypothalamus.

Question 33

What are some hypothalamic causes of secondary amenorrhoea?

Answer 33

- excersize amenorrhoea - stress ammenorrhoea - weight related (eg anorexia nervosa)

Question 34

What are some pituitary causes of secondary amenorrhoea?

Answer 34

- Sheehan's syndrome - Hyperprolactinaemia - haemachromotosis

Question 35

What is Sheehan's syndrome?

Answer 35

necrosis of the pituitary gland following hypovolemic shock after childbirth.

Question 36

How is prolactin related to the menstrual cycle?

Answer 36

It inhibits oestrogen production | it acts on the mammary glands for milk production

Question 37

How is prolactin secretion controlled?

Answer 37

Dopamine inhibits. | TRH stimulates.

Question 38

What are the 3 broad categories that hyperprolactinaemia can be a cause of?

Answer 38

physiological- eg sleep, stress, pregnancy pharmacological- any dopamine antagonists will remove inhibition pathological- prolactin secreting adenoma of pituitary gland, hypothyroidism

Question 39

How does hypothyroidism cause hyperprolactinaemia?

Answer 39

Low levels of T3/4 lead to reduced negative feedback, so the they hypothalamus releases more TRH. as well as stimulating the release of TSH, it also stimulates the release of prolactin, causing hyperprolactinaemia.

Question 40

Give examples of drugs that inhibits dopamine action.

Answer 40

- opiates - anaesthesia - H2 antagonists

Question 41

What are the 3 main things seen in patients with PCOS?

Answer 41

- secondary amenorrhoea - Physical signs including hirsutism and acne - enlarged ovaries with many cysts on them.

Question 42

What is the beleived cause of PCOS?

Answer 42

increased frequency of GnRH pulses leading to increased LH pulses and therefore increased androgen secretions. These androgens are commonly converted to testosterone.

Question 43

In PCOS, why doesn't menstruation happen?

Answer 43

follicles get stimulated for development but no dominant follicle is chosen. They may still secrete inhibin (FSH inhibited)

Question 44

What investigations do you do for PCOS?

Answer 44

- high testosterone levels - hypersecretion of LH - polycystic ovaries

Question 45

Why might someone who has PCOS not show high levels of LH when you take a blood sample?

Answer 45

Because of the pulsatile nature.