Term
| Define the normal menstrual cycle. |
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Definition
| The normal menstrual cycle is 28 days with a flow lasting 2-7 days. The variation in cycle length is set at 21-34 days. |
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Term
| In a normal menstrual cycle, when does ovulation typically occur? |
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Definition
| Ovulation in a 28 day cycle occurs on day 14. The luteal phase of the cycle is normally 14 days long. The estrogenic (proliferative) phase of the cycle can be variable. |
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Term
| Name the hormones, and their source, that are involved in maintaining a normal menstrual cycle. |
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Definition
| From the ovary: Estrogen and progesterone.From the pituitary: FSH and LH. From the hypothalamus: Gonadotropin releasing hormone (GnRH). (Prolactin and TSH are also vital in maintaining a normal menstrual cycle). |
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Term
| Describe the effect of estrogen on the endometrium. |
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Definition
| Estrogen causes growth of the endometrium. The endometrial glands lengthen and the glandular epithelium becomes pseudostratified. Mitotic activity is present in both the glands and the stroma. |
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Term
| When does implantation of the fertilized ovum typpically occur? |
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Definition
| At approximately postovulatory day 9 (day 23). |
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Term
| What is the life-span of a normal corpus luteum in the absence of pregnancy? |
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Definition
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Term
| In a women of reproductive age, what is the first step in the evaluation of abnormal uterine bleeding following the history and physical examination? |
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Definition
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Term
| What is the action of oxytocin? |
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Definition
| It stimulates uterine contractions during labor and elicits milk ejection by myoepithelial cells of the mammal ducts. |
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Term
| What is the function of FSH? |
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Definition
| It stimulates maturation of the graafian follicle and its production of estradiol. |
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Term
| What is the function of LH? |
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Definition
| It causes follicular rupture, ovulation and establishment of the corpus luteum. |
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Term
| The ovarian luteal phase corresponds to what phase of the uterus? |
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Definition
| The secretory phase. The luteal phase begins after ovulation. At this time, the expelled follicle is called the corpus luteum. The corpus luteum secretes estradiol and progesterone whichh cause secretory ducts to develop in the endometrial lining. |
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Term
| What does a biphasic curve on a basal body temperature (BBT) chart of a 25 year old woman indicate? |
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Definition
| Normal ovulation and the effect of progesterone. A monophasic BBT curve indicates an anovulatory cycle. A temperature that remained elevated following a normal biphasic curve would indicate pregnancy. |
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Term
| What is the most accurate test of ovulation? |
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Definition
| Endometrial biopsy. This will show if there is a secretory phase, thereby indicating ovulation. |
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Term
| What is the cause of mid-cycle spotting or light bleeding? |
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Definition
| The decline in estrogen that occurs immediately prior to the LH surge. |
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Term
| Decline in which hormone heralds the onset of menses? |
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Definition
| Normal menses occurs because of progesterone withdrawal. |
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Term
| What levels of FSH and LH would you expect in a 63 year old woman who is not on estrogen replacement therapy? |
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Definition
| High levels of both FSH and LH. The ovarian response to FSH and LH is decreased in menopause. Consequently there is less estrogen and progesterone being produced. Hence, no negative feedback to inhibit the rising FSH and LH. |
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Term
| What is the function of prolactin? |
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Definition
| It initiates and sustains lactation by the breast glands and it may influence synthesis and release of progesterone by the ovary and testosterone by the testis. |
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Term
| What is the main physiological stimulus for prolactin release? |
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Definition
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Term
| What is the most common presenting symptom of prolactinoma in a woman? |
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Definition
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Term
Match the words with their definitions.
1. Menorrhagia,
2. Metrorrhagia,
3. Menometrorrhagia,
4. Polymenorrhea,
5. Oligomenorrhea
a. bleeding between menstrual periods,
b. Excessive amount of vaginal bleeding or duration of bleeding,
c. Excessive amount of blood at irregular frequencies,
d. Menstrual periods >35 days apart,
e. Menstrual periods <21 days apart. |
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Definition
Answers:
Menorrhagia: Excessive amount of vaginal bleeding or duration of bleeding;
Metrorrhagia: Bleeding between menstrual periods;
Menometrorrhagia: Excessive amount of blood at irregular frequencies;
Polymenorrhea: Menstrual periods <21 days apart;
Oligomenorrhea: Menstrual periods >35 days apart. |
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Term
| What is secondary amenorrhea? |
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Definition
| No menstruation ffor 6 months or more in a woman who previously had regular menses. |
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Term
| What is the most common cause of secondary amenorrhea? |
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Definition
| Pregnancy. The second most common cause is hypothalamic hypogonadism which can be due to weight lsos, anorexia nervosa, stress, excessive exercise, or hypothalamic disease. |
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Term
| What are some causes of premature menopause? |
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Definition
| Smoking, radiation, chemotherapy, and anything else that limits the ovarian blood supply. |
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Term
| A 26 year old with secondary amenorrhea and an essentially normal workup is given an IM injection of 100mg of progesterone and responds with a normal menstrual period. What does this tell you? |
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Definition
| She has a functional endometrium and a normal production of estrogen. Patients producing less than 40 pg/mL of estrogen will not bleed. This test is called the progesterone challenge. |
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Term
| What are the 2 major differential diagnoses in a 26 year old woman with secondary amenorrhea, a normal workup, and a possitive progesterone challenge? |
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Definition
| Premature ovarian failure and hypothalamic dysfunction. Premature ovarian failure can be diagnosed if the serum LH level is greater than 25 mIU/ML; otherwise, the diagnosis is most likely hypothalamic dysfunction. |
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Term
| A patient with secondary amenorrhea failos the progesterone challenege and has a high FSH level. What is the problem? |
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Definition
| Gonadal failure. A low FSH level would be more indicative of hypothalamic dysfunction. |
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Term
| What is the most common cause of dysfunctional uterine bleeding in children? |
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Definition
| Infection. In teenagers, it is most commonly due to anovulation. |
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Term
| In hyperprolactinemia, the serum prolactin level is higher than ____. |
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Definition
| 400 ng/mL. Hyperprolactinemia is caused by pituitary adenomas, hypothyroidism, or drugs, such as reserpine, methyldopa, phenothiazine, or oral contraceptives. Clinically, patients do not menstruate, and they have galactorrhea. |
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Term
| what is the most frequent gynecologic disease of children? |
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Definition
| Vulvovaginitis, the cause of which is poor perineal hygiene. |
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Term
| List the differential diagnosis of persistent vaginal bleeding in a preadolescent female. |
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Definition
| Neoplasia, precocious puberty, ureteral prolapse, trauma, sexual assault, vvulvovvaginitis, exposure to exogenous estrogen, shigella infection, Group A & Beta hemolytic streptococcal infection, foreign body in vagina. |
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Term
| Without therapy, approximately 50% of females with precocious puberty will not reach what height? |
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Definition
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Term
| What blood tests would be appropriate in the evaluation of a female child with precocious puberty? |
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Definition
| Serum levels of FSH, LH, prolactin, TSH, estradiol, testosterone, dehydroepiandrosterone sulfate (DHEAS) and HCG. |
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Term
| Breast hyperplasia is a normal physiologic phenomenon in the neonatal period an dmay persist for how many months? |
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Definition
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Term
| Retrospective historical data derived from adults imply that what percent of women are believed to have been sexually abused as children? |
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Definition
| 15-25%. 80% of all cases of sexual abuse of children involve a family member. |
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Term
| What is the most common cause of aginal bleeding in childhood? |
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Definition
| A foregin body. Patients will have a bloody, foul smelling discharge. |
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Term
| What is the median age for menopause? |
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Definition
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Term
| A 37 year old woman, G2 P2 presents with a history of lengthening menses and acquired dysmenorrhea. This problem had been subbtly going on for 2 years and now is a quality of life issue. Examination reveals a top normal size globular shaped uterus. What is the most likely diagnosis? |
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Definition
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Term
| What is the most common cause of postmenopausal bleeding? |
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Definition
| Atrophic endometrium and/or atrophic vaginitis. |
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Term
| What is Halban's Syndrome? |
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Definition
| This is the persistence of a corpus luteum. Patients commonly present iwht delayed menses, pelvic mass and negative pregnancy test. Clinically, this is often associated with polycystic ovaries. |
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Term
| How does progesterone work at the cellular level to control dysfunctional uterine bleeding when prescribed in pharmacologic doses? |
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Definition
| Progestins are powerful anti-estrogens. They stimulate 17b hydroxysteroid dehydrogenase and sulfotransferase activity. This results in conversion of estradiol to estrone sulfate which is rapidly excreted in the urine. Progestins also inhibit augmentation of estrogen receptors. Additionally progestins suppress estrogen mediated transcription of oncogenes. |
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Term
| A 27 year old woman presents with secondary amenorrhea for 6 months. Appropriate initial evaluation should include? |
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Definition
| Pelvic examination, PAP smear, pregnancy test, prolactin and progestin challnge, plus a TSH level. |
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Term
| What are the expected changes in gonadotropin levels after menopause? |
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Definition
| FSH increases 10-20 fold and LH increasess 3 fold, reaching a maximum 1-3 years after menopause. |
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Term
| Which hormones decline as a result of menopause? |
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Definition
| Estrogen and androstenedione. |
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Term
| What happens to progesterone production in menopause? |
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Definition
| Progesterone is nmo longer produced. |
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Term
| What hormone is secreted more by the postmenopauseal ovary than the premenopausal ovary? |
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Definition
| Testosterone. Prior to menopause, the ovary contributes 25% of circulating testosterone, and in menopause the ovary contributes 40% of circulating testosterone. |
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Term
| What is the cause of mild hirsutism in menopause? |
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Definition
| Increased free androgen to estrogen ratio as a result of decreased SHBG and estrogen. |
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Term
| What is hte leading cause of death for women? |
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Definition
| Heart disease, followed by malignancies, cerebrovascular disease, and motor vehicle accidents. |
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Term
| How many deaths are attributed to cardiovascular disease in women over 50? |
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Definition
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Term
| How many deaths are attributed to cardiovasculr disease in women over 50? |
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Definition
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Term
| After menopause, what is the percent of bone loss per year? |
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Definition
| 2.5% for the first four years, then 1-1.5% annually. |
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Term
| What risk factors are associated with bone loss and osteoporosis? |
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Definition
| White and Asian race, thin women, sedentary lifestyle, smoking, coexisting endocrine disease, and age of menopause. |
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Term
| How does estrogen therapy help maintain bone mass? |
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Definition
| Estrogen has a direct effect on osteoblasts, improves intestinal absorption of calcium, and decreases renal excretion of calcium. |
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Term
| Why does vaginitis increase during hte postmenopausal years? |
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Definition
| due to estrogen deficincy, the vaginal pH increases from 3.5-4.5 to 6.0-8.0, predisposing to colonization of bacterial pathogens. |
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Term
| What is the origin of breakthrough bleeding in continuous hormone replacement therapy? |
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Definition
| Progestational dominance resulting in an atrophic endometrium. |
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Term
| What effect does estrogen therapy have on colorectal cancer? |
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Definition
| It significantly decreases the risk of colorectal cancer. |
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Term
| What are contraindications to estrogen therapy? |
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Definition
| Estrogen sensitive cancers, chronically impaired liver function, undiagnosed genital bleeding, acute vascular thrombosis, neurophthalmologic vascular disease, and known or suspected pregnancy. |
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Term
| What effect does estrogen have on Alzheimer's disease? |
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Definition
| Alzheimer's disease is less frequent among HRT users and cognitive function in affected individuals is improved. |
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