The Menstrual Cycle

Question 1

What are the 3 phases of puberty in females?

Answer 1

Thelarche - breast development Adrenarche - Increase in adrenal androgen secretion Menarche - Beginning of menstrual cycles

Question 2

At what points in a female’s life are FSH levels highest?

Answer 2

Fetus

Infancy

Senescence

Question 3

At what point in a female’s life is LH at its highest?

Answer 3

Fetus

Infancy

Monthly during reproductive years

Senescence

Question 4

What phase of oocyte maturation marks gonadotropin dependency?

Answer 4

Formation of secondary oocyte (contains antrum)

Question 5

The dominant follicle is the one that has the most ___ receptors

Answer 5

FSH

Question 6

The time from the onset of the LH surge to ovulation is known as what? Lasts how long?

Answer 6

Periovulatory period

32-36 hours

Question 7

What does the corpus luteum produce? When?

Answer 7

Large amounts of progesterone and some estrogen

A few days after ovulation

Question 8

During the LH surge, ___ is released from ____ which lead to the breakdown of the follicle wall, tunica albuginea, and surface epithelium at the follicular stigma.

Answer 8

Inflammatory cytokines and hydrolytic enzymes from the theca and granulosa cells

Question 9

What stimulates the oocyte to release TGF-B-related factor GDF9?

Answer 9

LH

Question 10

What is the function of GDF9?

Answer 10

Stimulates cumulus cells to secrete hyaluronic acid and other extracellular matrix components to cause expansion of oocyte complex and make it easier to catch

Question 11

What protein signals to the corpus luteum to remain viable for pregnancy?

Answer 11

Human chorionic gonadotropin (hCG)

Question 12

During follicular atresia, what cells undergo apoptosis and what cells persist?

Answer 12

Apoptosis: granulosa cells, oocytes

Persist: Thecal cells - repopulate celluar stroma of the ovary

Question 13

Rapid rise in what hormone(s) will eventually trigger the LH surge?

Answer 13

Estradiol and GnRH

Question 14

In the HPO axis, what cells secrete both inhibins and activins?

Answer 14

Granulosa cells

Question 15

Progestins and Estrogens have what effect on the hypothalamus and anterior pituitary?

Answer 15

Both positive and negative feedback

Question 16

What is the effect of estradiol on the gonadotrophs in the late follicular phase?

Answer 16

Enhance sensitivity of gonadotrophs to GnRH => larger and larger releases of LH

Question 17

After ovulation, what cells does LH act upon?

Answer 17

Cells of corpus luteum

Question 18

In the female, both LH and FSH receptors are present on what steroid-producing cell?

Answer 18

Granulosa cells

Question 19

What is the relationship of FSH and estrogen levels during the menstrual cycle?

Answer 19

Inversely related

More FSH released in response to low estrogen

FSH inhibited in response to high estrogen

Question 20

In the late luteal phase, the demise of the corpus luteum causes a decrease in what hormones?

Answer 20

Progesterone

Estradiol

Inhibin

Question 21

In females, where is estradiol synthesized?

Answer 21

Ovaries

Question 22

What enzyme mediates the conversion of estrone to estradiol?

Answer 22

17B-Hydroxysteroid dehydrogenase (17B-HSD)

Question 23

What structure of the ovary synthesizes estrogen during the follicular phase?

Answer 23

Follicle

Question 24

What structure of the ovary synthesizes estrogen during the luteal phase?

Answer 24

Corpus luteum

Question 25

What phase of the menstrual cycle lowers basal body temperature? Due to what?

Answer 25

Follicular phase High levels of estrogen

Question 26

What phase of the menstrual cycle raises basal body temperature? Due to what?

Answer 26

Luteal phase? High levels of progesterone

Question 27

Disintegration of the corpus luteum causes what to happen to the basal body temperature?

Answer 27

Decrease, signifies onset of next menstruation

Question 28

The demise of the corpus luteum signals the beginning of what phase of the menstrual cycle?

Answer 28

Menstrual phase

Question 29

What is the action of progesterone on the epithelial cells of the endometrium?

Answer 29

Inhibitory

Question 30

What is the action of estrogen during the proliferative phase of the menstrual cycle?

Answer 30

Proliferation and differentiation of the endometrial stroma and epithelium Synthesis of progestin receptors (to inhibit too much proliferation)

Question 31

What hormone stimulates the early secretory phase?

Answer 31

Progesterone

Question 32

What is the action of progesterone in the middle to late secretory phase?

Answer 32

Pregnancy: promotes differentiation of stromal cells into predecidual cells to decidual cells Non-pregnancy: orchestrate menstruation

Question 33

What is the action of contraceptive steroids?

Answer 33

Inhibit secretion of GnRH and FSH/LH and abolish folliculogenesis and ovulation

Question 34

What is the progestin effect of the oral contraceptive?

Answer 34

Causes cervical mucus to thicken and impair sperm penetration into uterus Impair mobility of uterus and oviducts, decreasing transport of ova and sperm

Question 35

What defines menorrhagia?

Answer 35

Loss of \>80 mL of blood

Question 36

What defines dysmenorrhea?

Answer 36

Painful periods

Question 37

What defines oligomenorrhea?

Answer 37

Existence of few, irregular periods

Question 38

What disorders of menstruation will occur with dysfunction of HPO axis?

Answer 38

Oligomenorrhea and amenorrhea

Question 39

What disorder is the most common cause of female sterility?

Answer 39

Endometriosis

Question 40

What characterizes endometriosis?

Answer 40

Presence and growth of endometrial glands and stroma outside of the uterus instead of inside =\> bleeding, inflammation, and scarring

Question 41

What organs/tissue does endometriosis normally involve?

Answer 41

Ovaries, bowel, or tissue lining the pelvis

Question 42

A patient with chronic pelvic pain, dysmenorrhea, dyspareunia, rectal pain/constipation, and infertility may be diagnosed with what?

Answer 42

Endometriosis

Question 43

What disorder is the most common cause of female infertility?

Answer 43

Polycystic Ovarian Syndrome (PCOS)

Question 44

When does PCOS typically manifest?

Answer 44

During adolescence

Question 45

What are some common symptoms of PCOS?

Answer 45

Unexplained hypreandrogenism Anovulation Polycystic ovary (duh)

Question 46

What are the physiological characteristics of PCOS?

Answer 46

Abnormal ovarian steroidogenesis and folliculogenesis Dominant follicles did not shed and instead became cysts

Question 47

In PCOS, what do the levels of LH, FSH, and testosterone look like?

Answer 47

Elevated LH and testosterone Decreased FSH

Question 48

A young, obese, hirsute female of reproductive age presents with oligomenorrhea and infertility. What is her diagnosis?

Answer 48

PCOS

Question 49

What disorder is the most common cause of female congenital hypogonadism?

Answer 49

Turner syndrome

Question 50

What is the most common genotype of Turner Syndrome?

Answer 50

45, X

Question 51

What hormone is elevated in Turner syndrome? Why?

Answer 51

FSH Germ cells of the ovaries did not develop, so the ovaries are CT-filled streaks with no follicles to act upon

Question 52

A female pt with short stature, absent secondary sex characteristics, webbed neck, shield-like chest, normal but infantile internal and external genitalia most likely has what diagnosis?

Answer 52

Turner syndrome

Question 53

Due to a reduction in estrogen and inhibin, a patient undergoing menopause would most likely have elevated levels of what hormones?

Answer 53

FSH and LH (no negative feedback)

Question 54

Menopause is officially diagnosed after how long?

Answer 54

12 months after the last menstrual period

Question 55

What is the average age of a menopausal patient?

Answer 55

51.4 years

Question 56

A menopausal patient with mood changes and hot flashes may be placed on what to treat her symptoms?

Answer 56

Antidepressants Gabapentin