Menstruation Flashcards Preview

ESA 4 - Reproductive System > Menstruation > Flashcards

Flashcards in Menstruation Deck (64):
1

What does the menstrual cycle involve? 

The interaction of many endocrine glands, as well as a responsive uterus 

2

What interacts in the menstrual cycle? 

  • The central nervous system; the hypothalamus and pituitary 
  • The ovaries

 

3

What does the interaction between the CNS and the ovaries result in? 

Cyclic and ordered sloughing of the uterine endometrial lining

4

What are the key hormones in the control of the menstrual cycle? 

  • Gonadotrophin releasing hormone (GnRH) 
  • Follicle stimulating hormone (FSH)
  • Luteinising hormone (LH)
  • Estradiol 
  • Progesterone

5

What are the stages of the menstrual cycle? 

  • Proliferative stage
  • Ovulation
  • Secretory phase

 

6

When does the proliferative stage of the menstrual cycle begin? 

At the onset of menses

7

When does the proliferative phase end? 

When ovulation takes place

8

What takes place during the proliferative phase of the menstrual cycle? 

Folliculogenesis

9

What happens in folliculogenesis? 

A dominant follicle is selected from a pool of growing follicles that will be destined to ovulate

10

What does the growth of follicules during the proliferative stage depend on? 

Pituitary hormones

11

What does the growth of a follicle during the follicular phase lead to? 

Production of estradiol from the layers of the granulosa cells surrounding it

12

What is estradiol responsible for in the proliferative phase? 

The proliferation of the endometrial lining of the uterus 

13

When does ovulation occur? 

At the peak of follicular growth 

14

What does ovulation occur in response to? 

LH surge

15

What size to follicles grow to prior to ovulation? 

Sizes greater than 20mm in average diameter 

16

By what mechanism is LH released following follicular growth? 

In a positive feedback mechanism from the anterior pituitary, due to prolonged exposure to estradiol 

17

What levels of estradiol are required for positive feedback to take place? 

Above 200pg/mL for approximately 50 hours

18

What is required for the oocyte to be released from the follicle in ovulation? 

Several proteolytic enzymes and prostaglandins are activated, leading to digestion of the follicle wall collagen

19

What happens once an oocyte has been released in ovulation? 

The fallopian tube is responsible for picking it up to await fertilisation 

20

What happens during the secretory phase? 

The remaining granulosa cells that are not released within the oocyte during the ovulation process enlarge and acquire lutein 

21

What colour is lutein? 

Yellow

22

What are the granulosa cells that have acquired lutein called? 

Corpus luteum 

23

What does the corpus luteum do? 

Predominantly secretes progesterone

24

When is peak progesterone production noted? 

1 week after ovulation takes place

25

What does the life span of the corpus luteum, and hence progesterone production, depend on? 

Continued LH support from the anterior pituitary

26

What happen to the corpus luteum if pregnancy takes place? 

hCG (human chorionic gonadotrophin) will maintain the corpus luteum

27

What happens to the corpus luteum if pregnancy fails to happen? 

Luteolysis takes place, and the corpus luteum is converted to a white scar, the corpus albicans

28

Draw a diagram illustrating the blood supply of the endometrium 

29

What happens to the radial arteries as menses occur?

They shrink and compress, so blood supply to the innermost layer of the womb is affected

30

What happens to the innermost layer of the womb after the radial arteries have been compressed?

It dies and gets sloughed off

31

How long does mensturation last?

24-32 days, but variable

32

When is regularity of menstruation best? 

Between 20 and 40 years

33

How does the length of the menstrual cycle change depending on age? 

  • Longer in menarche
  • Shorter in pre-menopause

 

34

What is the median blood loss per menstrual cycle? 

37-43ml

35

When does most of the blood loss during menses occur? 

In the first 48 hours 

36

What % of women loose >80ml per cycle? 

9-14%

37

What % of those who loose >80ml/cycle are anaemic due to significant blood loss?

60-70%

38

What is menorrhagia?

Heavy periods

39

What are the causes of menorrhagia? 

  • Abnormal clotting
  • Fibroids
  • IUCD
  • Cancer

 

40

What are fibroids? 

Benign growths found in the uterine cavity 

41

What are fibroids often present with?

Heavy periods

42

What can very large fibroids present as? 

Pregnancy/tumour

43

In what locations are fibroids found? 

  • Intracavity
  • Subserosal
  • Submucosal
  • Intramural
  • Pedunculated (on a stalk)

 

44

What kind of cancer can cause heavy periods? 

Endometrial cancer

45

What is the problem with endometrial cancer? 

Low detection rate

46

Why does endometrial cancer have a low detection rate? 

  • A lot of male doctors are reluctant to ask questions, or to follow up
  • Political correctness
  • Problems obtaining chaperones

 

47

How can endometrial cancer be detected? 

  • Ultrasound scan
  • Hysteroscopy
  • Pelvic MRI

 

48

What % of cases of heavy periods are caused by dysfunctional uterine bleeding? 

60%

49

What is dysfunctional uterine bleeding? 

No recognisable pelvic pathology, pregnancy, or general bleeding disorders. No cause has been found to account for heavy periods

50

What may a person opt for in the case of dysfunctional uterine bleeding? 

Hysterectomy

51

What can cause irregular bleeding? 

Hormone contraceptives

52

When is bleeding between periods common with hormone contraceptives? 

During the first three months

53

What hormonal contraceptives can lead to irregular bleeding? 

  • Combined oral contraceptive pill
  • Progesterone only pill
    Contraceptive patch (transdermal patch)
  • Contraceptive implant or injection
  • Intrauterine system (IUS)

 

 

54

When are menstrual problems with hormone contraceptives possible? 

  • Missed combined pills/progesterone only pills
  • If certain prescription medicines or St John's Wort are taken when using the pill, patch, ring, or implant
  • When have vomiting/diarrhoea whilst on COCP

 

55

Why does missed combined pills/progesterone-only pills cause menstrual problems? 

Disrupts control of periods

56

Why can vomiting/diarrhoea cause menstrual problems when taking the pill?

Causes a dip in hormone levels in the blood

57

How can heavy periods be treated? 

Endometrial ablation of the endometrium 

58

What happens in endometrial ablation of the endometrium?  

Use a Nd-YAG laser to burn the lining of the endometrium to reduce the thickness of the layer

59

How effective is endometrial ablation of the endometrium? 

Relatively good success rate. Sometimes works, sometimes needs repeating

60

What is amenorrhea? 

No period

61

What are the causes of amenorrhea? 

  • Pre-pubertal
  • Pregnancy
  • Menopause
  • Uterine/endometrial
  • Ovarian
  • Pituitary
  • Hypothalamic

 

62

What are the physical impacts of menstrual disorders? 

  • Tiredness
  • Anaemia

 

63

What is the psyschological impact of menstrual disorders? 

  • Depression
  • Irritability
  • Mood swings
  • Anxiety

 

64

What is the social impact of menstrual disorders? 

Impact on ability to socialise/swim/perform sports