Biology of women chapter 5

Cryptomenorrhea

"silent" menstruation

Be able to calculate when a woman ovulated and will ovulate if given the length of her cycle.

-A woman with a 28 day cycle should ovulate on day 14 -A woman with a 21 day cycle should ovulate on day 7 (not halfway through her cycle) -A women with a 35 day cycle should ovulate on day 21 (not halfway through her cycle)

Understand the following treatments for severe abnormal/dysfunctional uterine bleeding:

A) Endometrial Ablation: Usually prevents regeneration of the endometrium and the recurrence of DUB, at least temporarily; Results in amenorrhea •Can eliminate the possibility of future pregnancies because there is usually not enough endometrium left to allow implantation -not a method of contraception - o Endometrial Resection- removes the endometrial lining of the uterus •reduces a woman's chances of becoming pregnant o Operative Hysteroscopy- surgically removes small polyps which might be causing excessive bleeding from the inside of the uterus o Hysterectomy -Hysterectomy: surgical removal of the uterus •Advantage = there is no risk of having to repeat the procedure •Relatively safe surgery

Which hormone is the cause of functional hypothalamic amenorrhea?

Functional Hypothalamic Amenorrhea = hypothalamus stops releasing GnRH-

Which phase of the cycle is more variable = pre-ovulatory or post-ovulatory?

It is usually the pre-ovulatory phase (proliferative) in the cycle that is more variable vs. the post-ovulatory phase

How does estrogen affect bone density?

Low estrogen leads to a reduction in bone density

PMDD: Be familiar with the similarities and differences from PMS. Know the specific symptoms and causes of PMDD.

Premenstrual Dysphoric Disorder (PMDD) •Dysphoric = extreme discomfort, unpleasant, or ill at ease •PMDD is asevere form of PMS; ~5 - 8% of women suffer from PMDD •Symptoms are similar to those of PMS but are extreme enough to interfere with a woman's normal activities -mental disorder need 5 to 10 of these Physical: bloating, breast tenderness, headaches, joint or muscle pain Emotional: sad and suicidal thoughts, anxiety, panic attacks, mood swings/ crying, irritability and anger that effects others, disinterest in activities and relationship, trouble thinking or focusing, tired, food cravings/ binge eating, feeling out of conrol •Causes of PMDD: Now thought to be because of an abnormal response to normal reproductive hormonal changes •Treatment: •Lifestyle changes like PMS •Medical treatments like PMS •Birth control pills: to regulate hormones and reduce symptoms •Antidepressants: SSRIs to increase serotonin levels in the brain

Prostaglandins

Prostaglandins are produced by the cells of the body and have several important functions: promote inflammation necessary for healing (also results in pain and fever), support blood clotting, and protect the lining of the stomach from the damaging effects of acid

Understand the following diagnostic tools/tests for abnormal/dysfunctional uterine bleeding:

Sonogram- Sonohystogram: an ultrasound probe is inserted into the vagina and abnormalities are easier to identify o Hysteroscopy- Hysteroscopy: uses fiber optics inserted through the cervix and into the uterus to visualize the endometrium o Dilation and Curettage (D&C)): dilates the cervix and uses a tool called a curettage to scrape away sections of the endometrium for testing o Transvaginal Ultrasonography- used to determine the thickness of the endometrium and check for tumors or fibroids

Metrorrhagia-

bleeding of a normal amount occurring at irregular intervals(regular period)

What are prostaglandins and how do they affect the uterus? What medications have a prostaglandin-inhibiting effect? What does NSAID mean

compounds in the body that can promote uterine contractions- Cramps, makes uterus contract so you can shred lining •Prostaglandins also cause a reduction in the normal blood flow to the uterus, can contribute to menstrual cramping •Prostaglandins are produced by the cells of the body and have several important functions •NSAIDs block the production of prostaglandins = reduces prostaglandins throughout the body so ongoing inflammation, pain, and fever are reduced •HOWEVER, it can cause ulcers in the stomach and increased bleeding •Over-The-Counter (OTC) NSAIDs in the U.S. •Aspirin (Bufferin, Bayer, and Excedrin) •Ibuprofen (Advil, Motrin, Nuprin) •Naproxen (Aleve) NSAID means: Non- steroidal anti-inflammatory drug

What are prostaglandins and how do they affect the uterus? What medications have a prostaglandin-inhibiting effect? What does NSAID mea

compounds in the body that can promote uterine contractions- triggers intense contractions of the smooth muscle of the myometrium during menstruation to facilitate the shedding of the stratum functionalis •Some women have significantly elevated levels of prostaglandins in their menstrual blood •Prostaglandins also cause a reduction in the normal blood flow to the uterus (uterine ischemia) - can contribute to menstrual cramping •Prostaglandins are produced by the cells of the body and have several important functions:promote inflammation necessary for healing(also results in pain and fever), support blood clotting,and protect the lining of the stomach from the damaging effects of acid •NSAIDs block the production of prostaglandins = reduces prostaglandins throughout the body so ongoing inflammation, pain, and fever are reduced •HOWEVER, the prostaglandins that protect the stomach and support blood clotting also are reduced so NSAIDs can cause ulcers in the stomach and increased bleeding •Over-The-Counter (OTC) NSAIDs in the U.S. •Aspirin (Bufferin, Bayer, and Excedrin) •Ibuprofen (Advil, Motrin, Nuprin) •Naproxen (Aleve) NSAID means: Non- steroidal anti-inflammatory drug

hypomenorrhea-

decreased amounts of menstrual bleeding or decreased length of menstrual bleeding during your regularly occurring menstrual cycle ("light period")

hypermenorrhea or menorrhagia,

excessive amounts of menstrual bleeding or excessive length of menstrual bleeding during your regularly occurring menstrual cycle ("heavy period")

Polymenorrhea-

frequent menses occurring in cycles no more than 21 days apart (short cycle)

intermenstrual bleeding-

irregular vaginal bleeding(usually not caused by menses and not excessive in amount) occurring between regular menstrual cycles

oligomenorrhea

light menstrual bleeding or infrequent menses occurring in cycles at least 35 days apart(long cycle)

Osteoporosis

means "porous bone"; bone disease that occurs when the body loses too much bone, makes too little bone, or both; causes weak and brittle bones that are prone to fracture, even with only mild stress (e.g., bending over, coughing, sneezing, minor bump)

Know when it is normal for a woman to experience amenorrhea.

normally occurs only while a woman is pregnant or breastfeeding

Mittelschmerz

ovulatory pain- normal

Dysmenorrhea

pelvic pain or cramps that occur during menstruation •usually just before or on the first day of menstruation •pain generally lasts 24 hours •Felt in the lower pelvic area together with pain in the thighs/backache •Intensity of the pain ranges from minor discomfort to incapacitating •Primary Dysmenorrhea: woman experiences painful menstrual periods since menarche •Secondary Dysmenorrhea: when the condition first arises years after menarche •Severe dysmenorrhea, accompanied by headache, nausea, and vomiting may not indicate a disease BUT if these symptoms are new, or if they seriously disrupt a woman's life, a healthcare provider should be seen

How long is the post-ovulatory phase?

secretory; which is usually between 13 - 15 days = 14 days)

Neurectomy

the autonomic nerves (both motor and sensory) to the uterus are severed - relieve dysmenorrhea but permanently disrupts the normal functioning of the uterus and should only be considered for alleviation of pain if other methods are are not effective

Know the three components of the female athlete triad and their causes.

•(1) Abnormal Eating Pattern: athlete does not take in enough calories to meet the calories expended through exercise •(2) Functional Hypothalamic Amenorrhea: brought about by a lack of adequate nutrition •(3) Osteoporosis: •brought about by a reduction in bone density due to low estrogen

Know the average and the normal values for length of cycle, duration of flow, and amount of flow.

•(1) Frequency of Cycles = length of cycle •The menstrual cycle is typically described as 28 days in length •only 10-15% are exactly 28 days •Normal range = 20 - 40 days •Average is 25 - 30 days •(2) Duration of Flow: number of days bleeding occurs •Average duration of menstrual flow = 4 - 6 days •Normal duration = from 2 - 8 days •(3) Amount of Flow: amount of bleeding •Normal amount of menstrual blood lost at each period ranges from 20 mL- 80 mL •Average flow is 50 mL (2 ounces or 1/4 cup)

What is abnormal uterine bleeding? What are some of the possible causes? What is immediate medical attention required?

•A variation in the normal pattern of menstrual cycles (in terms of timing and amount of flow) •Example: bleeding in-between otherwise regular periods might be of concern •Causes of Abnormal Uterine Bleeding: •1) Same factors that contribute to dysmenorrhea = presence of an IUD, benign uterine fibroids, endometriosis, hormonal imbalances •2) Acute infection •3) Blood or liver disease which interferes with clotting factors •4) Side effect of medication •5) Malignant growth in the reproductive tract (e.g., endometrial or cervical cancer) •6) Complications of pregnancy (e.g., miscarriage or ectopic pregnancy) medical attention is needed •If a woman has completed menopause (not had a period for 12 consecutive months) and experiences bleeding = may indicate endometrial or cervical cancer •Experiencing severe menstrual pain (may be a rupturing tubal pregnancy) - soak a pad or tampon every hour

What is the most common cause of cryptomenorrhea?

•Cryptomenorrhea: "silent" menstruation •normal hormone cycles, ovulation, and menstrual bleeding occur, but the menstrual flow is blocked from exiting the cervix or vagina--most commonly due to imperforate hymen •can also be the result of scar tissue formation in the vagina or cervix that was caused by a previous infection •rarely, due to absence of the vagina - caused by a genetic disorder or malfunction of the reproductive tract during development •usually diagnosed several years after signs of puberty appear (e.g., breast development and other secondary sexual characteristics); usually treated surgically (hymen is cut)

Understand dysfunctional uterine bleeding and its probable cause. What types of menstrual cycles is it usually associated with? What is an anovulatory cycle and how does it differ from an ovulatory cycle?

•Dysfunctional Uterine Bleeding (DUB) •DUB is a diagnosis of unpredictable, excessive, frequent, and/or prolonged bleeding from the uterus •Believed to be due to hormonal abnormalities •Usually associated with menstrual cycles during which ovulation does not occur = Anovulatory Cycles •SO....if ovulation does not occur, periods can be delayed=allows the lining to grow thicker (this is why delayed periods are often heavy ones) •Obese women are particularly prone to DUB because excess adipose tissue creates excess estrogen

PMS: when does it most likely occur in a woman's cycle? How common is it? What are the causes? Be familiar with the physical/emotional and behavioral symptoms of PMS. BE familiar with the treatments for PMS.

•Experienced by ~75% of menstruating women = very mild to moderately uncomfortable symptoms during the days preceding their menstrual periods •PMS: physical, psychological, or behavioral premenstrual changes that some women experience which can disrupt their usual activities Physical: breast tenderness, weight gain, bloating, joint and muscle pain, headache, pimples, cant poop or diarrhea, tiredness, emotional: mood swings, anxiety, depression, sleep problems, poor concentration, crying spells, appetite changes, and food cravings. •Causes of PMS Treatments- •Non-Medical Treatment •Keep a Women's Daily Health Diary: daily reporting of physical, behavioral, and emotional changes in a journal for several months can be used to determine if symptoms may cluster around the luteal phase (last 14 days) of the menstrual cycle •Exercise to reduce stress •Eat healthy: •Consume high glycemic index carbohydrates: may increase serotonin in the brain - can moderate mood swings •Avoid excess salt and water intake: reduces water retention and bloating •Avoid excess caffeine, alcohol, and high-sugar foods •Get enough rest •Medical Treatment •Diuretics: reduces premenstrual edema •Hormonal contraceptives: prevent ovulation and stabilize extreme hormonal fluctuations •Prescription antidepressants •Anti-anxiety medications

Know the treatments for mild/moderate abnormal uterine bleeding.

•NSAIDs: their anti-prostaglandin effect may improve blood clotting and reduces blood flow to the blood vessels in the uterus •Hormonal treatments: (1) oral contraceptive pills containing estrogen and progestins mimic normal cycles and can reduce abnormal bleeding or (2) progesterone-releasing IUDs

Understand the difference between primary and secondary amenorrhea in terms of onset and causes.

•Primary Amenorrhea:no menarche by age 16 •Causes: •1) Chromosomal abnormalities •2) Hormonal Disorders of the thyroid, adrenal cortex, or pituitary gland •3) Severe reduction in body fat •4) Cryptomenorrhea: "silent" menstruation •Secondary Amenorrhea: cessation of menstrual periods any time between menarche and menopause (when the cause is not pregnancy or breastfeeding) •Causes: •1) Hormonal Disorders of the Thyroid, Adrenal Cortex, or Pituitary Gland •Hyperprolactinemia: over-secretion of prolactin from the pituitary gland •2) Polycystic Ovary Disease (PCOD) and its associated hormone irregularities •PCOD: enlarged ovaries that contain small collections of fluid (cysts) •3) Psychogenic factors = stress, fear, anxiety, trauma •great fear or desire for pregnancy •major change in environment (moving or travel) •emotional events (e.g., death in the family) •usually resolves itself within a few months •4) Extreme malnutrition or eating disorders (e.g., anorexia nervosa) •5) Functional Hypothalamic Amenorrhea 6) Extreme exercise = Athletic Amenorrhea

What percent body fat must a girl have to start menarche? What percent body fat is necessary to sustain regular menstrual cycles? How does adipose tissue affect estrogen?

•in general, 17% body fat is necessary to start menarche and 22% body fat is necessary to sustain regular menstrual cycles •Why? •Adipose tissue chemically converts androgens produced by the ovaries to estrogen (so body fat is an additional source of estrogen) •Body fat influences the way estrogen is metabolized (broken down by the body) - lean women make more of a less potent form of estrogen

Understand how different amounts of exercise affect a woman's risk of developing osteoporosis.

•moderate exercise decreases risks of osteoporosis = weight-bearing exercises

amenorrhea

•the lack of menstruation during a woman's reproductive years •Amenorrhea is a symptom, not a disease •symptom: a physical or mental feature that is regarded as indicating a condition of disease, particularly such a feature that is apparent to the patient •signs — things you or your doctor can see or measure •symptoms — things that you notice or feel