12- MENSTRUAL CYCLE REGULATION AND ABNORMAL BLEEDING Quiz
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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?

  • Follicle Stimulating Hormone (FSH) (correct)
  • Estrogen
  • Progesterone
  • Luteinizing Hormone (LH)

How many primordial follicles remain by the time of puberty from the original 6-7 million formed during embryonic life?

  • 400 thousand (correct)
  • 600 thousand
  • 1 million
  • 2 million

Which developmental stage occurs first before reaching the preantral follicle?

  • Mature follicle
  • Primordial follicle (correct)
  • Antral follicle
  • Dominant follicle

What key development occurs in the oocyte during the preantral follicle stage?

<p>Formation of the zona pellucida membrane (D)</p> Signup and view all the answers

During which phase is the follicle determined to be dominant and ready for ovulation?

<p>Follicular phase (C)</p> Signup and view all the answers

What factor influences the development of preantral follicles independently of FSH?

<p>GDF9 and BMP15 (B)</p> Signup and view all the answers

What is the average number of follicles that are ovulated throughout a woman's reproductive life?

<p>400 (B)</p> Signup and view all the answers

What is the primary treatment focus for anovulatory cycles after ruling out organic causes?

<p>Oral contraceptives and progesterone (A)</p> Signup and view all the answers

Which of the following is NOT a considered approach when treating menorrhagia due to anovulatory cycles?

<p>Endometrial resection (C)</p> Signup and view all the answers

Which condition is most closely linked to the irregular shedding seen in anovulatory cycles?

<p>Unopposed estrogen levels (C)</p> Signup and view all the answers

In treating adolescents with anovulatory bleeding, which medication is typically administered?

<p>Estrogen (B)</p> Signup and view all the answers

What is the leading cause of dysfunction in anovulatory patients that results in bleeding?

<p>Hypothalamic-pituitary axis disorders (B)</p> Signup and view all the answers

What is a potential mechanism behind the degeneration of the corpus luteum?

<p>Induction of apoptosis by nitric oxide (B)</p> Signup and view all the answers

Which of the following is NOT a recognized cause of abnormal uterine bleeding?

<p>Stress-related eating habits (B)</p> Signup and view all the answers

Hypomenorrhea is characterized by which of the following?

<p>Lack of bleeding or only spotting (D)</p> Signup and view all the answers

What is the minimum volume of menstrual bleeding defined for menorrhagia in research settings?

<p>80 ml (A)</p> Signup and view all the answers

Metrorrhagia is best described as what type of bleeding?

<p>Bleeding between menstrual periods (A)</p> Signup and view all the answers

Which hormone is critical for the formation of progesterone receptors in the endometrium during the luteal phase?

<p>Estradiol (B)</p> Signup and view all the answers

Bleeding described as 'open-faucet' can signify which of the following?

<p>A potential pathological condition (C)</p> Signup and view all the answers

In dysfunctional bleeding, what percentage of cases typically show no pathological findings upon examination?

<p>60% (B)</p> Signup and view all the answers

What potential cause can lead to hypomenorrhea in users of birth control pills?

<p>Hormonal alterations resulting in reduced bleeding (C)</p> Signup and view all the answers

What role does estradiol play in the context of the corpus luteum during the luteal phase?

<p>It promotes luteolysis by increasing prostaglandin F2-alpha production (A)</p> Signup and view all the answers

What is the primary characteristic of polymenorrhea?

<p>Menstrual cycles shorter than 21 days (D)</p> Signup and view all the answers

What condition is characterized by menstrual periods that occur at intervals longer than 35 days?

<p>Oligomenorrhea (D)</p> Signup and view all the answers

What is the primary effect of GnRH on the anterior pituitary gland?

<p>Stimulates the release of stored reserves of FSH and LH (B)</p> Signup and view all the answers

Which of the following is NOT a cause of amenorrhea?

<p>Anovulation (C)</p> Signup and view all the answers

In the case of postcoital bleeding, which potential condition must be considered until proven otherwise?

<p>Cervical cancer (A)</p> Signup and view all the answers

Which of the following hormones is secreted by granulosa cells to inhibit FSH secretion?

<p>Inhibin (A)</p> Signup and view all the answers

Which diagnostic method is least likely to help determine the cause of abnormal vaginal bleeding?

<p>Urinalysis (C)</p> Signup and view all the answers

What is the result of the LH surge during the menstrual cycle?

<p>Initiates ovulation after 10-12 hours (D)</p> Signup and view all the answers

What role does follistatin play in the regulation of FSH?

<p>Binds to activin and suppresses FSH secretion (D)</p> Signup and view all the answers

Which symptom would suggest the presence of myoma during a physical examination?

<p>Palpable mass in the pelvic region (B)</p> Signup and view all the answers

What is the significance of maintaining a record of the bleeding pattern in patients?

<p>To determine if the bleeding is normal or abnormal (A)</p> Signup and view all the answers

Which event occurs in the oocyte under the influence of LH during the preovulatory phase?

<p>Meiosis progresses towards reduction division (A)</p> Signup and view all the answers

What can cause menometrorrhagia?

<p>Pregnancy complications (D)</p> Signup and view all the answers

What is the role of estradiol in ovulation?

<p>Initiates LH secretion with positive feedback (A)</p> Signup and view all the answers

Which condition is related to a significant acute loss of body weight affecting menstrual function?

<p>Amenorrhea (D)</p> Signup and view all the answers

During the luteal phase, what transformation occurs in granulosa cells after ovulation?

<p>They become vacuolated and accumulate lutein (D)</p> Signup and view all the answers

What significant change happens in the corpus luteum post-ovulation?

<p>Its vascularization peaks after 8-9 days (A)</p> Signup and view all the answers

Which type of examination can be used for direct observation of lesions in the cervix?

<p>Colposcopy (D)</p> Signup and view all the answers

How does the half-life of GnRH compare in the early and late follicular phase?

<p>GnRH half-life decreases from early to late follicular phase (B)</p> Signup and view all the answers

Flashcards

Follicular Phase

The part of the menstrual cycle where a single dominant follicle is selected for ovulation, lasting 10-14 days. The follicle group's recovery from atresia is triggered by rising FSH levels in the previous cycle's luteal phase.

Preantral Follicle

A follicle stage showing growth of the oocyte, zona pellucida formation, multiple granulosa cells, and theca cells development. Its growth occurs independent of FSH.

Primordial Follicle

The earliest stage of the follicle, containing an oocyte surrounded by a single layer of granulosa cells. Formed in embryonic development.

Ovarian Stromah

The connective tissue layer surrounding the follicles within the ovaries, crucial for the growth and function of the follicle.

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Ovulation

The release of a mature egg from the ovary.

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Atresia

Process of follicle degeneration before reaching maturity.

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FSH

Follicle-stimulating hormone; an important hormone regulating follicle development.

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GnRH (Gonadotropin-releasing hormone)

A hormone that stimulates the release of FSH and LH from the pituitary gland.

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FSH (Follicle-stimulating hormone)

A hormone that stimulates follicle development in the ovaries and sperm production in the testes.

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LH (Luteinizing hormone)

A hormone that triggers ovulation and stimulates the production of progesterone and testosterone.

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Corpus Luteum

A temporary endocrine structure that develops from the remnants of the ovarian follicle after ovulation and produces important hormones like progesterone.

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Inhibin

A hormone that suppresses FSH secretion.

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Activin

A hormone that stimulates FSH secretion.

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Follistatin

A protein that binds to activin, reducing its effect on FSH secretion.

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Positive Feedback (hormones)

A process where hormone X stimulates the production of more hormone Y, and more hormone Y stimulates more X continuing the process.

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Anovulatory Cycles

Menstrual cycles that occur without ovulation, resulting in irregular shedding of the endometrium (lining of the uterus).

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Dysfunctional Uterine Bleeding

Bleeding from the uterus that occurs outside of a normal menstrual cycle; often caused by anovulatory cycles.

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Causes of Anovulatory Cycles

Most often caused by disorders affecting the hypothalamus-pituitary axis, which disrupts hormone balance and leads to anovulation.

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Treatment of Anovulatory Bleeding

Typically involves hormone therapy, often using oral contraceptives or progesterone, to regulate the menstrual cycle and control bleeding.

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Hysterectomy as a Last Resort

Surgery to remove the uterus is generally considered a last resort for severe uterine bleeding, usually only after other treatment options have been exhausted.

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Polymenorrhea

Menstrual cycles shorter than 21 days. Often caused by lack of ovulation, but can also be due to a short follicular or luteal phase.

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Menometrorrhagia

Irregular bleeding with varying amount and duration. Can be caused by pregnancy complications or cancer.

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Oligomenorrhea

Menstrual cycles longer than 35 days. Usually caused by lack of ovulation.

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Amenorrhea

No menstruation for more than 6 months. Can be caused by pregnancy, hormonal problems, weight loss, or menopause.

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Postcoital bleeding

Bleeding after intercourse. Cervical cancer should be ruled out first, but other possibilities include infection, polyps, and vaginal atrophy.

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Cervical Smear

A test to detect abnormal cells in the cervix. It's a routine screening for cervical cancer.

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Colposcopy

A procedure using a magnifying device to examine the cervix for abnormalities. It helps in diagnosing cervical cancer.

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Endometrial Biopsy

A tissue sample taken from the lining of the uterus to identify any abnormalities.

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Hysteroscopy

A procedure using a thin, flexible tube to examine the inside of the uterus. It's used to diagnose and treat problems like uterine fibroids.

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Dilation and Curettage (D&C)

A procedure to widen the cervix and gently scrape the lining of the uterus. It's done to treat abnormal bleeding, to remove tissue for biopsy, or to remove a miscarriage.

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Luteal Phase Degeneration

The corpus luteum, after ovulation, doesn't persist indefinitely. It starts to break down about 9-11 days after ovulation.

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Luteolysis Mechanism

The process by which the corpus luteum breaks down. The exact mechanism is still unknown but nitric oxide and estradiol have been implicated.

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Nitric Oxide's Role in Luteolysis

Nitric oxide (NO) contributes to luteolysis by inducing apoptosis, programmed cell death, in the luteal cells.

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Estradiol's Role in Luteolysis

Estradiol, produced locally in the corpus luteum, increases prostaglandin F2-alpha synthesis, ultimately leading to luteolysis.

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Abnormal Uterine Bleeding

A common reason for reproductive-age women to seek medical attention. Irregular or excessive menstrual bleeding, often called dysfunctional bleeding if no underlying cause is found.

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Menorrhagia

Heavy and prolonged menstrual bleeding, typically exceeding 80 ml in total. Can be clinically diagnosed based on the patient's description.

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Hypomenorrhea

Rare, light, or absent menstrual bleeding. It may be caused by physical blockage in the reproductive tract or hormonal imbalances.

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Metrorrhagia

Bleeding between menstrual periods, often caused by underlying conditions like polyps or cancer. Spotting after ovulation is also common.

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Open-Faucet Bleeding

Abnormal uterine bleeding characterized by constant, squirting, or leaking blood from the vulva.

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Submucous Myoma

A uterine fibroid located within the uterine wall, which can cause abnormal bleeding.

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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.
  • 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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Menstrual Cycle Regulation and Abnormal Bleeding PDF

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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!

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