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Questions and Answers
What is the primary hormone that contributes to the selection of the dominant follicle during the follicular phase?
What is the primary hormone that contributes to the selection of the dominant follicle during the follicular phase?
How many primordial follicles remain by the time of puberty from the original 6-7 million formed during embryonic life?
How many primordial follicles remain by the time of puberty from the original 6-7 million formed during embryonic life?
Which developmental stage occurs first before reaching the preantral follicle?
Which developmental stage occurs first before reaching the preantral follicle?
What key development occurs in the oocyte during the preantral follicle stage?
What key development occurs in the oocyte during the preantral follicle stage?
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During which phase is the follicle determined to be dominant and ready for ovulation?
During which phase is the follicle determined to be dominant and ready for ovulation?
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What factor influences the development of preantral follicles independently of FSH?
What factor influences the development of preantral follicles independently of FSH?
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What is the average number of follicles that are ovulated throughout a woman's reproductive life?
What is the average number of follicles that are ovulated throughout a woman's reproductive life?
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What is the primary treatment focus for anovulatory cycles after ruling out organic causes?
What is the primary treatment focus for anovulatory cycles after ruling out organic causes?
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Which of the following is NOT a considered approach when treating menorrhagia due to anovulatory cycles?
Which of the following is NOT a considered approach when treating menorrhagia due to anovulatory cycles?
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Which condition is most closely linked to the irregular shedding seen in anovulatory cycles?
Which condition is most closely linked to the irregular shedding seen in anovulatory cycles?
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In treating adolescents with anovulatory bleeding, which medication is typically administered?
In treating adolescents with anovulatory bleeding, which medication is typically administered?
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What is the leading cause of dysfunction in anovulatory patients that results in bleeding?
What is the leading cause of dysfunction in anovulatory patients that results in bleeding?
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What is a potential mechanism behind the degeneration of the corpus luteum?
What is a potential mechanism behind the degeneration of the corpus luteum?
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Which of the following is NOT a recognized cause of abnormal uterine bleeding?
Which of the following is NOT a recognized cause of abnormal uterine bleeding?
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Hypomenorrhea is characterized by which of the following?
Hypomenorrhea is characterized by which of the following?
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What is the minimum volume of menstrual bleeding defined for menorrhagia in research settings?
What is the minimum volume of menstrual bleeding defined for menorrhagia in research settings?
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Metrorrhagia is best described as what type of bleeding?
Metrorrhagia is best described as what type of bleeding?
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Which hormone is critical for the formation of progesterone receptors in the endometrium during the luteal phase?
Which hormone is critical for the formation of progesterone receptors in the endometrium during the luteal phase?
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Bleeding described as 'open-faucet' can signify which of the following?
Bleeding described as 'open-faucet' can signify which of the following?
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In dysfunctional bleeding, what percentage of cases typically show no pathological findings upon examination?
In dysfunctional bleeding, what percentage of cases typically show no pathological findings upon examination?
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What potential cause can lead to hypomenorrhea in users of birth control pills?
What potential cause can lead to hypomenorrhea in users of birth control pills?
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What role does estradiol play in the context of the corpus luteum during the luteal phase?
What role does estradiol play in the context of the corpus luteum during the luteal phase?
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What is the primary characteristic of polymenorrhea?
What is the primary characteristic of polymenorrhea?
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What condition is characterized by menstrual periods that occur at intervals longer than 35 days?
What condition is characterized by menstrual periods that occur at intervals longer than 35 days?
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What is the primary effect of GnRH on the anterior pituitary gland?
What is the primary effect of GnRH on the anterior pituitary gland?
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Which of the following is NOT a cause of amenorrhea?
Which of the following is NOT a cause of amenorrhea?
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In the case of postcoital bleeding, which potential condition must be considered until proven otherwise?
In the case of postcoital bleeding, which potential condition must be considered until proven otherwise?
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Which of the following hormones is secreted by granulosa cells to inhibit FSH secretion?
Which of the following hormones is secreted by granulosa cells to inhibit FSH secretion?
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Which diagnostic method is least likely to help determine the cause of abnormal vaginal bleeding?
Which diagnostic method is least likely to help determine the cause of abnormal vaginal bleeding?
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What is the result of the LH surge during the menstrual cycle?
What is the result of the LH surge during the menstrual cycle?
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What role does follistatin play in the regulation of FSH?
What role does follistatin play in the regulation of FSH?
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Which symptom would suggest the presence of myoma during a physical examination?
Which symptom would suggest the presence of myoma during a physical examination?
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What is the significance of maintaining a record of the bleeding pattern in patients?
What is the significance of maintaining a record of the bleeding pattern in patients?
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Which event occurs in the oocyte under the influence of LH during the preovulatory phase?
Which event occurs in the oocyte under the influence of LH during the preovulatory phase?
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What can cause menometrorrhagia?
What can cause menometrorrhagia?
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What is the role of estradiol in ovulation?
What is the role of estradiol in ovulation?
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Which condition is related to a significant acute loss of body weight affecting menstrual function?
Which condition is related to a significant acute loss of body weight affecting menstrual function?
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During the luteal phase, what transformation occurs in granulosa cells after ovulation?
During the luteal phase, what transformation occurs in granulosa cells after ovulation?
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What significant change happens in the corpus luteum post-ovulation?
What significant change happens in the corpus luteum post-ovulation?
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Which type of examination can be used for direct observation of lesions in the cervix?
Which type of examination can be used for direct observation of lesions in the cervix?
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How does the half-life of GnRH compare in the early and late follicular phase?
How does the half-life of GnRH compare in the early and late follicular phase?
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Study Notes
Menstrual Cycle Control
- Understanding and treating menstrual cycle abnormalities requires knowledge of the normal menstrual cycle's mechanisms.
- The cycle is appropriately examined in three sections: the follicular phase, ovulation, and the luteal phase.
Follicular Phase
- This is the process of selecting a dominant follicle for ovulation.
- It lasts approximately 10-14 days.
- The follicle's recovery from atresia(programmed cell death) is due to FSH hormone increase during the luteal phase of the previous cycle.
- The time from a primordial follicle to a preovulatory follicle is 85 days.
- Primordial follicle: 20 μm
- Preantral follicle: 50–200 μm
- Antral follicle: 200–80 μm
Ovulation
- LH is not present in the follicle fluid until the middle of the cycle.
- In the presence of FSH, estrogen is concentrated in the follicle fluid.
- In the absence of FSH, androgens dominate the follicle fluid.
- High androgen levels suppress aromatase activity.
- The result is an androgenic environment inducing follicle atresia.
- The success of a follicle depends on its ability to transform a follicle from an androgen-dominated microenvironment to an estrogen-dominated one.
Luteal Phase
- Before ovulation, the granulosa cells enlarge, contain lipid inclusion bodies, and the vacuoles and vascular structures increase in theca cells.
- After ovulation, the granulosa cells continue growing and forming the corpus luteum, with participation from theca cells around the follicle.
- Capillaries enter the granulosa cells, reaching the follicle cavity.
- The cavity fills with blood, and in this period, the corpus luteum is known as the corpus hemorrhagicum.
- 8–9 days after ovulation the corpus luteum's vasculature peaks, as does progesterone.
- The luteal phase does not indefinitely prolong even with continued LH stimulation, indicating corpus luteum degeneration (luteolysis) with an active luteolytic mechanism.
- In anovulatory cycles, there is irregular shedding of the endometrium, which might occur due to various organic causes: thyroid, pituitary, or adrenal dysfunction. Then, to control the bleeding, the patient is given oral contraceptives and progesterone.
- Abnormal findings during the luteal phase can point to possible organic causes or hormone issues needing further investigation.
Inhibin, Activin, Follistatin
- These peptides are secreted by granulosa cells, influenced by FSH.
- Inhibin inhibits FSH secretion (reciprocal relationship).
- Activin stimulates FSH secretion.
- Follistatin binds to activin and suppresses FSH secretion.
Abnormal Uterine Bleeding (AUB)
- AUB is a common reason for women of reproductive age to seek medical help.
- 60% of cases are not caused by underlying pathology.
Definitions related to AUB
- Menorrhagia: Excessive, prolonged menstrual bleeding, generally over 80 mL.
- Hypomenorrhea: Deficient or absent menstrual bleeding, often with spotting.
- Polymenorrhea: Frequent, often shorter than 21-day menstrual cycles.
- Metrorrhagia: Bleeding between menstrual periods.
- Oligomenorrhea: Infrequent menstruation, generally longer than 35 days between periods.
- Amenorrhea: Absence of menstruation for more than 6 months.
Postcoital Bleeding
- Postcoital bleeding (PCB) suggests possible cervical cancer until proven otherwise.
- Other contributing factors can include infection, cervical polyps, cervical eversion, and atrophic vaginitis.
FIGO 2011 Classification System
- A classification system to categorize abnormalities in the uterine lining and/or bleeding patterns.
Diagnostic Tests for AUB
- Detailed anamnesis
- Physical examination
- Cytological examination
- Pelvic ultrasound
- Blood tests
- Endometrial biopsy
- Hysteroscopy
- Dilation and curettage (D&C)
Non-Gynecological Causes of AUB
- Myxoedema (thyroid disease)
- Hypothyroidism
- Liver disease
- Blood dyscrasias
- Excessive weight gain or loss
- Heavy exercise
- Drug use (anticoagulants, adrenal steroids)
Anovulatory (Dysfunctional) Uterine Bleeding
- Bleeding that is not related to ovulation abnormalities.
- Causes include estrogen breakthrough, estrogen withdrawal, progesterone breakthrough, and progesterone withdrawal bleeding.
- In anovulatory cycles, irregular shedding occurs in the endometrium after the exclusion of potential organic (e.g., thyroid, pituitary) causes. Oral contraceptives and progesterone are helpful treatments in such cases.
Treatment of AUB
- Adolescent patients often experience anovulatory cycles and irregular bleeding during the first years after menarche. Hormonal therapies (e.g., estrogen) are generally successful treatments in this case, while, under exceptional circumstances, curettage (surgical cleaning) of the uterine lining may be needed.
- Oral contraceptives can be used in excessive bleeding, with a conjugated estrogen dose. The dosage decreases gradually as bleeding improves and then remains the same.
- If a biopsy reveals proliferative endometrium, medroxyprogesterone acetate (MPA) is given for 10 days.
Postmenopausal Bleeding
- Bleeding occurring 12 or more months after a woman's last menstrual period.
- Usually indicative of a pathological issue, often related to hormone replacement therapy (HRT) or endometrial abnormalities.
Other Diagnostic and Treatment Considerations
- Ultrasound (a diagnostic and treatment instrument with many details of the physical examination).
- Sonohysterography
- Endometrial biopsy.
- Hysteroscopy.
Other Notes
- The exact causes of anovulation are still unknown.
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Description
Test your knowledge on key concepts related to the female reproductive system and hormonal regulation. This quiz covers topics such as follicle development, ovulation, and anovulatory cycles. Perfect for students in biology or health sciences!
