ARRT-Chapter 19- the menstrual cycle
U/s of endometrium during secretory phase
7-14mm Your endo is thiccccccc girl and echogenic
Common terms related to abnormal normal uterine bleeding
Amenorrhea— absence of menstruation Cryptomenorrhea— monthly symptoms of menstruation w/o bleeding Dysmenorrhea — painful or difficult menstruation Menorrhagia (hypermenorrhea)— abnormally heavy and prolonged menstruation Metrorrhagia (intermenstrual bleeding)—irregular menstrual bleeding between periods Menometrorrhagia —excessive or prolonged bleeding at irregular intervals Oligomenorrhea —irregular cycles greater than 35 days apart Polymenorrhea— frequent regular cycles but less than 21 days apart Hypomenorrhea — regular timed menses but light flow
Fertilization or conception typically occurs on what day?
Day 15
Two phases of proliferative phase:
Early ad late Late proliferative phase = periovulatory phase
Which hormone released by the ovary during the proliferative phase stimulates endometrial thickening?
Estrogen
Estrogen throughout the menstrual cycle
Estrogen is initially produced by the theca internal cells of the secondary follicles during the first part of menstrual cycle Estrogen initiatives proliferation and thickening of endometrium by encouraging the growth and expansion of the spiral arteries and glands w/n functional layer of endo Other roles: regeneration of endometrium after menses Induction of alt and water retention Stimulates contractile motions within the uterine myometrium and the Fallopian tubes
Disruption of the menstrual cycle by pregnancy :
Fertilization/conception — day 15 Union of egg and sperm in Fallopian tube Cells that surround the blastocyst ,trophoblastic cells, then begin to produce hCG hCG maintains corpus luteum Allows corpus luteum to continue producing progesterone , which keeps endometrium thick So implantation can take place Pregnancy progresses normally
When the sonographic three line sign is present, the functional layer of the endometrium typically appears :
HYPOECHOIC * the outer echogenic basal layer surrounds the , hypoechoic functional layer, is separated by the echogenic endometiral stripe
The two hormones produced by the anterior pituitary gland that impact the menstrual cycle are:
LH & FSH
Day 14 of ovarian cycle:
LH produced by anterior pituitary gland , stimulates ovulation Graafian follicle ruptures and expels a small amount of fluid and the ovum into the peritoneum Ovuym is picked up by the fimbria of Fallopian tube, propelled up Fallopian tube , either to be fertilized, resorbed by body or passed w/menstruation
During which phase of the endometrial cycle would the endometrium yield the three line sign?
Late proliferative
The second phase of the ovarian cycle is called the:
Luteal phase
luteinizing hormone (LH)
The hormone of the anterior pituitary glad Gland that surges around day 14 of the menstrual cycle and results in ovulation
Follicle-stimulating hormone (FSH)
The hormone of the anterior pituitary gland that causes development of multiple follicles on the ovary
Gonadotropin-releasing hormone (GnRH)
The hormone released by the hypothalamus that stimulates the pituitary glad to release the hormones that regulate the female menstrual cycle
Estrogen
The hormone released by the ovary during the proliferative phase that initiates the proliferation and thickening of the endometrium
Causes of abnormal uterine bleeding (AUB)
Uterine fibroids Adenomyosis Cervical polyps Endometrial polyps Endometrial hyperplasia Endometrial cancer Hypothyroidism Anovulation
Progesterone during menstrual cycle
During second half of cycle, following ovulation Progesterone is produced by the corpus luteum Responsible for maintaining the thickeness of the endo and inducing its secretory activity as endo prepares for possible implantation
The hormone produced by the hypothalamus that controls the release of the hormones for menstruation by the anterior pituitary gland is :
GnRH (gonadotropin-releasing hormone)
Primary amenorrhea
If an individual does not experience menarche before age 16 May be caused by congenital abnormalities or congenital obstructions , such as imperforate hymen
Layers of endometrium
Innermost portion , the functional layer Outermost portion, basal layer
The ovary produce two hormones during the menstrual cycle:
Estrogen Progesterone
Secondary amenorrhea
My be associated with endocrinologic abnormalities or pregnancy The cessation of menstruation If not assoc w/ pregnancy it is characteristically diagnosed in the postmenarchal women who has had 3 to 6 months without a menstrual cycle
"Ovaries Freely Let Every Period Start"
O vary F ollicular L uteal E ndometrium P roliferative S ecretory
Luteal phase:
Second phase of ovarian cycle Days 15-28 After Graafian follicle ruptures, temporarily turned into endocrine elf and in the form of corpus luteum Corpus luteum produced progesterone primarily (to maintain thickness of endo & prepare for fertilized ovum), and small amts of estrogen All other follicles undergo atresia
Menarche
The first menstrual cycle Can occur at diff end ages
Functional layer of endometrium
The layer that is stimulated by the hormones of the ovary to undergo changes throughout menstrual cycle Location for the implantation of the products of conception
The corpus luteum primarily releases:
progesterone
Endometrial atrophy
the degeneration of the endometrium with advancing age; most often seen in postmenopausal women
Pituitary gland
"Master gland" An endocrine gland within the brain that consists of an anterior and posterior lobe
Anterior pituitary gland
-The anterior segment of the pituitary gland, which is responsible for releasing follicle-stimulating hormone (FSH) and luteinizing hormone(LH) during the menstrual cycle
U/s of endometrium during periovulatory (late proliferative) phase
6-10 mm Distinct "three-line" sign
Abnormal uterine bleeding (AUB)
A change in menstrual bleeding patterns caused by either endocrine abnormalities or lesions within uterus
Imperforate hymen
A vaginal anomaly in which the hymen has no opening, resulting in an obstruction of the vagina
A change in menstrual needling associated with lesions within the uterus relates to :
AUB
Anovulatory cycle
Abscence of ovulation Caused by polycystic ovary syndrome Is a common cause of DUB
LH isi produced by the :
Anterior pituitary gland
Menstrual cycle :
Avg cycle is about 28 days w/ ovulation occurring on day 14 First day of the menstrual cycle is said to occur on the first day of bleeding
Theca internal cells
Cells of the follicle that produce estrogen
Endometrial thickness (mm) during phases of endo cycle
During menses : up to 4mm Early proliferative phase : 4-8 mm periovulatory (late proliferative) phase : 6-10 mm Secretory phase : 7-14 mm
The hormone of the pituitary gland that stimulates follicular development of the ovary is :
FSH
Role of the hypothalamus in menstrual cycle
Is to regulate the release of. Hormones by the anterior pituitary gland Achieves this function by releasing GnRH Which in turn stimulates the release of hormones by the anterior pituitary gland
The hormone that surges at ovulation is :
LH
Days 1-5 =
Menses , at which time endometrium is shed
Menses
Menstrual bleeding
Secretory phase
Occurs after ovulation n Is stimulated by progesterone Progesterone maintains the thickness of the endometrium in prep for implantation n Should fertilization not take place, menses begin on day 1 of cycle If it does occur the endo thickness is maintained by continues production of progesterone by corpus luteum of pregnancy
What structure produces hormones that directly act upon the endometrium to produce varying thicknesses and u/s appearances ?
Ovary
Days 1-14 =
Ovary — follicular phase Endometrium — proliferative phase
Day 14
Ovulation
What is said to be a common cause of DUB?
Polycystic ovary syndrome
What hormone is released by the ovary during the second half of the menstrual cycle?
Progesterone
What. Hormone maintains the thickness of the endometrium AFTER ovulation?
Progesterone
Endometrial cycle has two phases:
Proliferative phase Secretory phase
The second phase of the endometrial cycle?
Secretory phase
The arteries within the functional layer of the endometrium that are altered by the hormones of the ovary and are shed with menstruation are :
Spiral arteries
Proliferation
The multiplication of similar forms
U/s of endometrium during menses
Up to 4mm Thin and echogenic
When is DUB diagnosed?
Usually when all other causes of irregular bleeding are ruled out
Dysfunctional uterine bleeding (DUB)
a change in menstural bleeding patterns May be idiopathic Usually related to hormonal balances resulting in endometrial changes ,w/ subsequent irregular bleeding
Three- line sign
a periovulatory endometrial sonographic appearance in which the outer echogenic basal layer surrounds the more hypoechoic functional layer, while the functional layer is separated by the echogenic endometrial stripe
Endometrial hyperplasia
an increase in the number of endometrial cells
Periovulatory phase
another name for the late proliferative phase of the endometrial cycle, which occurs around the time of ovulation
FSH is produced by the :
anterior pituitary gland
The temporary endocrine gland that results from the rupture of a Graafian follicle is the:
corpus luteum
The hormone produced by the trophoblastic cells of the early placenta is :
hCG
Which hormones maintains the corpus luteum during pregnancy?
hCG
The first phase of the endometrial cycle is the:
proliferative phase
Progesterone
A hormone that prepares the uterus for pregnancy , Maintains pregnancy, And promotes the development of the mammary glands Primarily produced by the ovary and placenta
Hormones of the anterior pituitary gland :
Follicle stimulating hormone (FSH) Luteinizing hormone (LH)
The first phase of the ovarian cycle is the
Follicular phase
The ovarian cycle has two phases:
Follicular phase Luteal phase
Days 15-28 =
Ovary— luteal phase Endometrium— secretory phase
When the ovary is in the luteal phase the endometrium is in the :
Secretory phase
Endometrial polyps
Small nodules of hyperplastic endometrial tissue
Hypothalamic-pituitary-gonadal axis
The complex interactions that take place between the hypothalamaus, pituitary glad, and ovaries as part of the female reproductive cycle
Proliferative phase
The first phase of the endometrial cycle Occurs after mensuration and lasts until ovulation Estrogen stimulation Proliferation of the endometrium occurs b/c functional layer increases i theickenss
Follicular phase:
The first phase of the ovarian cycle Begins on day 1 and lasts until day 14 Ending with ovulations Anterior pituitary gland secretes FSH Many follicles manifest Graafian follicle will be maintained