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Module 1: The Physiology of Women's Hormones & Reproductive Health > The Physiology of the Menstrual Cycle > Flashcards

The Physiology of the Menstrual Cycle Flashcards

1
Q

What does the menstrual cycle refer to?

A

The entire biological ovulatory monthly cycle, not just the experience of menstruation.

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2
Q

How long is a healthy cycle?

A

25 - 35 days

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3
Q

What is the average length of menstruation?

A

5-7 days

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4
Q

Where do women’s immature eggs hang out?

A

In the ovarian follicles until they are ready to mature for ovulation.

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5
Q

What do you call the eggs waiting to mature for ovulation and the eggs that reach ovulation?

A

oocytes until they reach ovulation until at which point they are referred to as ovum

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6
Q

What are primordial follicles?

A

A series of follicles within the ovaries waiting to be selected to mature.

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7
Q

What is the AMH?

A

The Anti-Mullerian Hormone whose responsibility is to sort through the primordial follicles and select a single follicle to mature along with an egg for ovulation.

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8
Q

How does the AMH select a single follicle to mature along with an egg for ovulation?

A

By having an inhibitory effect on all of the other primordial follicles

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9
Q

What causes a positive feedback loop to the hypothalamus during the follicular phase?

A

The combination of low estrogen levels and declining Inhibin A.

This positive feedback loop triggers it to produce & secrete GnRH in a slow pulsation.

An inhibitory hormone produced from the ovaries after ovulation.

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10
Q

What is Inhibin A?

A

An inhibitory hormone produced from the ovaries after ovulation.

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11
Q

What tells the pituitary gland to produce and secrete Follicle Stimulating Hormone?

A

The slow pulse of GnRH.

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12
Q

What is GnRH?

A

Gonadotropin-releasing hormone

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13
Q

What is the role of estrogen in the menstrual cycle?

A
  • Stimulate the proliferation of the blood and nutrient rich uterine lining, also known as the endometrium, or endometrial lining
  • Help to grow the antral follicle, or the most mature follicle, in preparation for ovulation
  • Stimulate cervical mucus production in the cervical crypts
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14
Q

During the follicular phase, how is estrogen produced?

A

The combo of low estrogen levels and declining Inhibin A causes a positive feedback loop to the hypothalamus, triggering it to produce and secrete GnRH in a slow pulsation.

The slow pulse of GnRH is what tells the pituitary gland to produce and secrete Follicle Stimulating hormone which then gets sent to the ovaries to stimulate ovarian follicle growth.

At the same time, a small amoutn of LH is released, which stimulates the out cells of the follicles known as the theca cells, to produce androgens.

These androgens are then converted into estrogen through an enzyme called aromatase.

The aromatase enzymes triggers an enzymatic process called aromatization, which converts the androgens into estrogen within the Granulosa cells, which can be found on the inside of the follicles.

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15
Q

What are theca cells?

A

Outer cells of the follicles

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16
Q

Where are the Granulosa cells found?

A

On the inside of the follicles

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17
Q

When is a woman’s fertile window?

A

5-6 days before ovulation occurs.

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18
Q

When do women experience cervical mucus?

A

Common to experience this in response to rising estrogen during the fertile window, 5-6 days before ovulation occurs.

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19
Q

When is a woman the most fertile?

A

The day before ovulation, the day of ovulation, and the day after ovulation.

They are considered feritle for 6 days total due to the protection of fertility-quality cervical mucus.

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20
Q

How long does an egg have to be fertilized by sperm?

A

About 24 hours, but in the presence of fertile quality cervical mucus, sperm can live up to 5 days in the reproductive system, elongating the fertile window to about an average of 6 days.

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21
Q

What is the ovulatory phase?

A

As the follicles grow in the follicular phase, they begin to compete for ovulation with the assistance of AMH.

Once the antral follicle has been chosen, the transition to ovulation occurs.

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22
Q

What is the LH surge?

A

The LH surge plays a role in helping the mature egg to burst from the ovarian follicle, resulting in ovulation.

Elevated estradiol in tandem with kisspeptin activation creates a positive feedback response to the hypothalamus, which then responds by sending out a faster pulsation of GnRH, triggering the pituitary to send out LH.

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23
Q

When do estrogen levels begin to drop rapidly?

A

Just prior to the LH surge and following the positive feedback response to the hypothalamus.

This hormonal pattern often presents in female cycle charts and can be a source of confusion as it is frequently discussed that high estrogen levels is what triggers the LH surge.

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24
Q

Why does estrogen tend to drop prior to ovulation?

A

FSH levels decreasing as a result of the suppression from increasing Inhibin B.

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25
Q

What is Inhibin B?

A

Inhibin B is a hormone produced from the granulosa cells of the growing ovarian follicles and plays a role in the gonadotropin suppression.

The drop in estrogen itself is not said to trigger the LH surge alone, a

26
Q

How long does the egg have to ovulate?

A

Roughly 20-48 hours afer the LH surge if a follicle is prepped with a mature egg

27
Q

How long does an egg have to be fertilizing?

A

24 hours before traveling down the fallopian tubes and into the womb for implantation.

28
Q

What is Mittelschmerz?

A

Experiencing pain, cramping, and spotting around ovulation.

This is esp. true if they tend to experience a lot of systemic inflammation in general. This is due to the mildly inflammatory process of ovulation as a whole.

29
Q

What is luteinization?

A

The process of producing a corpus luteum

30
Q

What does LH do?

A

It begins the process of corpus luteum formation, which produces a very tiny amount of progesterone before ovulation fully takes place.

31
Q

How does the ovum burst from the follicle during ovulation?

A

The combination of lH & progesterone stimulates the production of prostaglandins and proteolytic enzymes, which work together to break downt he collagen matrix of the cell walsl, which wears them down enough for this to happen.

32
Q

During the ovulatory phase, what is peaking?

A

Sex hormones. Estrogen, LH and Testosterone are all high.

33
Q

What is the role of Testosterone in women’s health?

A
  • Supports a healthy libido
  • Boost energy levels
  • Improves confidence and motivation
  • Supports skin health
  • Improves bone mineral density
  • Supports cardiovascular health
  • Supports cognitive health and function
34
Q

What can happen if a woman has too much testosterone?

A
  • Ovulatory failure
  • Unwanted facial hair
  • acne
  • male-pattern balding
35
Q

What is the corpus luteum?

A

A temporary endocrine gland that forms from the follicle that the egg ovulated from.

36
Q

What produces the sex hormone Progesterone?

A

The corpus luteum

37
Q

What phase is the longest of the menstrual cycle?

A

The luteal phase or premenstrual phase which lasts an average of 12-16 days.

38
Q

Progesterone has what kind of effect on the body?

A

Thermogenic, stimulating the production of thyroid hormone and a rise in body temperature.

39
Q

Why can you confirm ovulation through a sustained thermal shift in basal body temperatures?

A

Because that means there is progesterone being secreted by the ovarian corpus luteum

40
Q

Where does progesteron get its name?

A

From pro-gestation. One of progesterone’s primary jobs is to hold the uterine lining intact in preparation for implantation of a fertilized egg.

41
Q

Progesterone in tandem with Inhibin A (also produced by the corpus luteum) does what?

A

Slows down the GnRH pulsation, inhibiting LH & FSH further in an attempt to stop the production of estrogen and its proliferative effects.

42
Q

In the 2nd part of the luteal phase, if not pregnant, what can happen?

A

The hormones begin to drop fairly steadily, which may make women feel lazier, sleepy, and potentially more introverted than usual. This is also when most women experience PMS symptoms, about a week before their period.

43
Q

In the luteal phase, if a woman is pregnant, what happens?

A
  • Progesterone is going to continue to rise as an embryo begins to form.
  • Human chorionic gonadotropin hormone (HCG) rises, resulting in a positive pregnancy test.
  • Their basal body temperatures will begin to rise thanks to an increase in progesterone production
  • Their luteal phase will extend longer than 18 days.
44
Q

In the luteal phase, if a woman is not pregnant, what can happen?

A

The corpeus luteum begins to deteriorate, causing progesterone and Inhibin A to decrease, allowing GnRH to increase its pulsation, telling the pituitary to begin producing FSH again in prep for the next cycle.

45
Q

On the final day of the cycle, what happens to progesterone?

A

It drops steadily, signaling the release of prostaglandins.

46
Q

What do prostaglandins do?

A

They are inflammatory chemcials that trigger the smooth muscle contraction of the uterus to shed the endometrial lining resulting in menstruation.

47
Q

What should be the total accumulated blood loss?

A

About 30-60 ml or about 6-12 fully soaked regular tampons

48
Q

What can PMS be an indiction of?

A

When there is not enough progesterone and/or there is too much estrogen.

49
Q

Spotting before menstruation can be a sign of what?

A

Low progesterone as progesterone is dropping sooner than it’s supposed to.

For some spotting may not be problematic, but if it lasts longer than 1-2 days, this may be worth addressing.

50
Q

What can spotting after menstruation (esp. if it’s brownish color) or appear a more brownish-red in color be a sign of?

A

Uterine malposition such as with a retroflexed or retroverted uterus.

51
Q

What can cramping be a sign of?

A

AKA primary dysmenorrhea, can be a sign of increased inflammation, as inflammation is going to trigger an increase of prostaglandins, which result in more camping and menstrual pain.

52
Q

Severe pelvis or period pain can be a cause of?

A

AKA secondary dysmenorrhea can be a cause of external influence such as endometriosis, adenomyosis, fibroids, ovarian cysts, or pelvis infection.

53
Q

What can the signs of a heavy flow be?

A
  • More than 80ml or 16 fully soaked tampons.
  • Excess estrogen or low thyroid hormone
54
Q

Why can excess estrogen cause a heavy flow?

A

Estrogen can be considered a growth hormone, so when there is too much around, esp. if there isn’t enough progesterone to opposite it in the luteal phase, it can lead to excessive growth of the endometrial lining, resulting in a heavy period.

55
Q

Why can thyroid hormone imbalance cause heavy periods?

A

Thyroid hormone plays an important role in helping to stimulate ovarian follicle development, corpue luteum health, and progesterone production, and is also necessary for helping the liver to clear excess estrogen, therefore conditions like hypothyroidism can impact menstrual health.

Low thyroid hormone can impair the body’s clotting factors, leading to heavier periods with an increased prevalance of clots.

56
Q

What can prolonged periods (longer than 7 days) be a sign of?

A

Uterine polyps or fibroids, Von Willebrand disease (clotting disorder)

57
Q

What can shortened periods be a sign of?

A

Usulaly shorter than 3 days, or a total blood loss of less than 30ml (hypomenorrhea) can be a sign of lower estrogen levels.

Estrogen is needed for proper ovulation and endometrial lining production.

Also a symptom of the beginning stages of amenorrhea or anovulation

58
Q

Extreme fatigue, dizziness, fainting can be a sign of?

A

Sign of anemia, esp when paired with a heavy flow

59
Q

Nausea, vomiting, aches, pains can be a sign of?

A

Result of excess estrogen and/or low progesterone and an increase of prostaglandins around menstruation.

If they don’t go away after menstruation is over, could be a sign of a pelvic infection or toxic shock syndrome

60
Q

Headaches/migraines can be a sign of?

A

Excess estrogen and are initiated by a sharp drop in estrogen levels right before menstruation.

They can also be caused by deficiencies in magneiusm and/or potassium, dehydration or of a histamine intolerance issue.

Module 1: The Physiology of Women's Hormones & Reproductive Health (4 decks)

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