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