2. Gynecology (physiology and hormone response)
they can migrate and perforate out of the uterus
How are IUD's complicated?
to tell the pituitary gland to release FSH and LH in order to stimulate a cycle
Why does the hypothalamus release FSHRF and LHRF?
also to stimulate a cycle, but plays an effect mainly in early pregnancy
Why does the hypothalamus release GnRH?
Absence of mensturation
amenorrhea:
12-50
at what age does menses start and stop?
occurs at intervals painful periods
dysmenorrhea:
until onset of menses
how long are ova dormant for?
from days 1-5
how long is the menstrual phase?
9-11 days; causes progesterone to decrease
how many days after ovulation does the corpus luteum start to degenerate?
400k (200k for each ovary)
how many ova do females have when they are born?
irregular bleeding in frequency and volume
menometrorrhagia:
heavy, long menses
menorraghia:
irregular, frequent menses
metrorrhagia:
occurs are intervals more than 35 days apart, abnormally short, light menses
oilgomenorrhea:
occurs at intervals less and 21 days, frequent menses
polymenorrhea:
procedures: tubal ligation and essure
what are considered permanent contraceptions?
follicular, ovulatory, and luteal
what are the 3 phases in the ovarian response?
-copper coated: paraguard ~does not have hormones; just prevents implantation; acts as a blockade -safety coil -lippe's loop -hormonal: mirena, kyleena ~prevent ovulation by producing estrogen and progesterone
what are the different types of IUDs and how are they different?
menstural phase, proliferative phase, and secretory phase
what are the three phases in the uterine response?
FSH and LH
what are the types of gonadotropins?
getting pregnant
what can women with irregular periods have trouble with?
induces ovulation
what does LH do?
2 cm
what does a graafian follicle measure before ovulation?
zona basalis (ant/pos) and echogenic central line representing the endometrial cavity
what does each line represent in the 3 line sign?
-primary regulator of hypothalamus-pituitary activity (tells hypothalamus to stop sending FSH) -stimulates endometrial thickening -fallopian tube muscle control -stimulates growth of ductal system
what does estrogen do?
the do not develop dominant follicles or ovulate; endometrial growth is suppressed (will not see phases of endometrial changes)
what does not happen when patients use contraception pills?
follicle stimulating hormone releasing factor (FSHRF), luteinizing hormone releasing factor (LHRF), and gonadotropin releasing hormone (GnRH)
what does the hypothalamus produce?
FSH and LH
what does the pituitary gland produce?
estrogen is produced
what happens as follicles develop?
FSH is secreted by the pituitary gland which causes follicles to develop
what happens in the follicular phase?
ruptured graafian follicle begins to involute and results in the formation of the corpus luteum
what happens in the luteal phase?
contains decreased levels of progesterone and sheds the zona functionalis
what happens in the menstrual phase?
FSH stimulates follicular growth which stimulates the zona basalis to regenerate. The endometrium gets thicker and thicker in this phase to get ready for implantation
what happens in the proliferative phase?
corpus luteum is degenerating, progesterone levels are decreasing
what happens in the secretory phase?
tubes are tied; we would not want this because patient can still get pregnant (would be ectopic)
what happens in tubal ligation? why would we not want this?
it will continue to degenerate until it completely goes away leading to a drop in progesterone and estrogen, causing disintegration of endometrium triggering menstruation
what happens to the corpus luteum if there is no implantation of a pregnancy?
estrogen
what hormone is responsible for female gender characteristic development?
for the ripening of the graafian (dominant) follicle
what is FSH responsible for?
appendicitis
what is a differential diagnosis from ovulation of the right side?
pre/perimenopausal
what is an uncomfortable elongated period of time for women before their period officially stops?
Graafian follicle
what is another name for a mature follicle?
one-sided pelvic pain and cramping from ovulation
what is mittelschmerz?
the explosive release of an ovum from the ruptured graafian follicle
what is ovulation?
prepuberty, after reaching puberty, and cessation (when periods have stopped)
what is premenarche, menarche, and menopause?
the corpus luteum
what is progesterone secreted by?
hypothalamus, pituitary and ovarian response
what is the HPO axis?
the dominant follicle that has ovulated (now an empty sac sitting in the ovary)
what is the corpus luteum formed from?
3 endocrine sources (HPO axis)
what is the menstrual cycle dependent on?
estrogen and progesterone for 20-21 days
what is the most common combination in the US of contraception?
the essure procedure is the most permanent because a device is placed in the fallopian tube which causes scarring and a permanent blockage of the tube
what is the most permanent form of contraception? why?
ovarian response to FSH is the production of estrogen; the ovarian response to LH is the production of progesterone
what is the ovarian response to FSH and LH?
to keep an early pregnancy viable until the placenta is developed; it does this by secreting progesterone
what is the purpose of the corpus luteum?
less than 5 mm
what should the endo measure for postmenopausal women who are not on HRT?
up to 8 mm
what should the endo measure for postmenopausal women who are on HRT/tamoxifen?
endometrium should look isoechoic with the myometrium and measures about 6-8 mm
what should the endometrium look like before ovulation?
thin echogenic line
what should the endometrium look like for women on BCP and postmenopausal women?
thin echogenic line
what should the endometrium look like in the early proliferative phase?
endometrium should measure about 4-8mm; 3 line sign
what should the endometrium look like in the proliferative phase?
where endometrium is its thickest; measures 7-14 mm; echogenic (blurry 3 line sign)
what should the endometrium look like in the secretory phase?
hypotalamus
what structure in the brain regulates menstration?
decrease in progesterone
what triggers mesnstruation?
LH surge
what triggers ovulation?
when there is an increased amount of estrogen from the developing follicles; this increased amount of estrogen inhibits FSH from being produced.
when does FSH stop getting released from the pituitary gland?
when FSH is inhibited by increased estrogen levels
when does LH get released from the pituitary gland?
24-36 hours before ovulation; peaks 10-12 hours before ovulation (LH surge)
when does LH rapidly increase? when is it at its peak?
with the first day of menstrual bleeding
when does the average cycle start?
begins with menses and ends until ovulation
when does the follicular phase begin and end?
from day 5-ovualtion (day 14)
when does the proliferative phase last till?
rapidly increases after ovulation (when the corpus luteum is formed); peaks 7 days post ovulation
when is progesterone produced? when does it peak?
day 14
when is the ovulatory phase?
from after ovulation -the onset of menses
when is the secretory phase?
into the anteromedial upper arm
where are birth control implants placed
in the cul-de-sac; due to the ruptured follicle during ovulation
where is it common to see trace fluid? why?
