Hormone predominating follicular phase

FSH 

What gonadotropin leads to ovulation? 

LH spike 

Hormone predominating during luteal phase

LH 

what hormones do the Corpus Luteum produce?

Progesterone, estradiol and inhibin

What hormones stimulates the theca cell to produce androgen from cholesterol? 

LH 

What hormone stimulates Granulosa cells? 

FSH

What happens in granulosa cells?

Aromatization

androgens ---------------------> estradiol

Is inhibin a steroid? 

What does it do? 

It's a glycoprotein produced from Corpus Luteum and it provides negative feedback to decrease FSH. 

*We will see this lil' sucker in the menopause lecture

What two layers of the endometrium change during the menstrual cycle and eventually slough off? 

Stratum functionale: compactum + spongiosum

What causes the endometrial lining to slough off? 

Withdrawal of progesterone

What are some causes of HPG axis dysfunction? 

eating d/o, exercise, stress, rx use, weight change, Kallmann syndrome

What is endometriosis? 

presence of endometrial glands & stroma outside the endometrial cavity or uterine musculature

What are some risk factors of endometriosis? 

• frequent or prolong menses
• infertility
• pelvic pain
• family history 

Endometriosis age of onset? 

in 20 and 30s

Teens: more dysmenorrhea, ovarian path, abuse, STDs

> 40: think Fibroids, ovarian Neoplasma, infections

What is retrograde menstruation? 

Possible cause of endometriosis; menstrual fluid spill out of the tube and implants in the peritoneum

Why can altered immunity cause endometriosis? 

Decreased NK cell activity, increased concentration of leukocytes and macrophages, increased IL 1, 6 & 8. 

What are some physical findings of endometriosis? 

pain on uterosacral ligament, pain with uterine movement, tender enlarged adnexal mass, fixed uterus/adnexa

What is the only way to dx endometriosis with complete confidence? 

Laparoscopy 

What is the mechanism of pain in endometriosis? 

• cytokines in peritoneal cavity
• focal bleeding from endometriosis implants --> blood in peritoneum hurts!
• irritation or direct inflammation of pelvic floor

What does the severity of symptoms say about the amount of endometriosis? 

NOTHING, there is no relationship btw the amount of endometriosis and the severity of the dz. 

Does endometriosis decrease fertility?

Endometriosis appears to decrease fertility to the extent of the severity of the dz. 

Which type of pelvic pain is less likely to improve? 

Chronic Pain 

Acute pain: needs to be worked up acutely and good chance of improvement. chronic pain can mean cancer. 

Is daily pelvic pain usually Gyn related. 

No, it's more likely that cyclic be GYN related but not always. 

What is something that should always be Rule out when a woman presents with pelvic pain? 

PREGNANCY! 

*pts are correct about their last period only about 2/3 of the time. 

What is the best tool to evaluate pelvic pain? 

Sonogram