Intro, Reproductive Cycle, & Menstruation

What are the two types of women's health history?

gynecologic and obstetric Hx

These are part of what type of history?

◦GYN diseases and treatment

◦Sexually transmitted infections

◦Breast disease

◦Infertility

◦Urinary tract/bowel complaints

◦Personal hygiene

◦Health maintenance

◦Exposure to diethylstilbesterol (DES)

Last Pap and results, Regular breast exams, Mammogram, Colonoscopy, DEXA scan

gynecologic hisotory

What has to do with a risk for clear cell adenocarcinoma?

DES

What age should PAP smears be started?

21

What age should mammograms be started?

40

What age should a colonoscopy be started?

45

What age should a dexa scan be started?

65 or younger if risk factors

What is the average age for menopausal symptoms?

48-55yo (avg = 51)

What is the term for # of days between the first day of the first or second period?

cycle length

What is the term for # days of bleeding?

length of bleeding

What is the term for how may tampons/pads per x hours?

estimated blood loss

When asking about the last menstrual period, what do you need to know?

first day of bleeding

*ask “when was the first day of your last menstrual cycle?”

What characterizes menopause?

12 full months with no bleeding

What characterizes postmenopausal bleeding?

12 full months with no bleeding → bleeding (endometrial CA until proven otherwise!)

What is the average age for menarche?

9-16yo

What is the interval between period range?

24-32 days (average 28)

How long does bleeding typically last during menses?

3-7d

What is the term for menstruation that has never occurred?

primary amenorrhea

What is the term for menses has occurred at least once and has been absence for at least 6 months?

secondary amenorrhea

What is the term for:

absence of menstruation

amenorrhea

What is the term for:

scanty menstrual flow

oligomenorrhea

What is the term for:

excessive menstrual bleeding

menorrhagia

What is the term for:

bleeding between periods

metrorrhagia

What is the term for:

irregular or excessive bleeding other than during menstruation

menometorrhagia

What is the term for:

painful menstruation

dysmenorrhea

What is the term for:

the occurrence of menstrual cycles more frequently than normal

polymenorrhea

What are the 5 P's when obtaining a sexual history?

Partners: Number and gender

Pregnancy Prevention: TTC vs what is being used for prevention

Protection: STI protection, % time used

Practices: oral, anal, vaginal

Past: STIs (what, when, tx, current concerns)

What are 3 cases when to take a sexual history?

-all new pts

-pts present with a problem that is likely to be sexually related (ex: dysuria, urethral discharge)

-pt has medical or social problems that may lead to sexual difficulties (ex: HTN, DM, Divorce)

Explain the GTAL for obstetric Hx.

Gravidity total

Parity (TPAL)

Term, Preterm, Abortion/miscarriage, Living

What is the term for:

total # of pregnancies regardless of outcome

gravidity

What is the term for:

# of births after 20 wks

parity (TPAL)

Term, Preterm, Abortion/miscarriage, Living

What is the formula for expected date of delivery (EDD)-- Negele's Rule?

First date of LMP + 7 days - 3 months

What is the term that calculates the expected date of delivery?

Negele's rule

What are the three components for a women's health PE?

◦Breast exam

◦Abdominal exam

◦Pelvic exam

in the reproductive cycle, ovulation is _____ ___ menstrual bleeding, in a cyclic predictable fashion, if pregnancy does not occur

followed by

The duration of an adult reproductive cycle from the beginning of menses (day 1) to the beginning of next menses (day 1), averages ____ days.

28 days (+/- 7d)

The 3 phases of the reproductive cycle are referring to what?

status of the ovaries

What are the three phases referring to the ovary?

follicular, ovulation, luteal

What are the phases that refer to endometrium?

proliferative and secretory

What phase of the reproductive cycle remains relatively constant?

luteal phase

What phase of the reproductive cycle varies?

follicular phase

In the reproductive cycle, ovulation is _______ menstrual bleeding, in a cyclic predictable fashion, if pregnancy does not occur.

followed by

What phase of the reproductive cycle is described:

-Begins with onset of menses (1st day)

-Ends day of luteinizing hormone (LH) surge

-Lasts about 14 days

- Endometrium in proliferative phase

follicular

What stage of the repro cycle ENDS the day of LH surge?

follicular

What stage of the repro cycle does the LH surge START?

luteal

What phase is the endometrium when in the follicular phase of the repro cycle?

proliferative phase

What phase of the reproductive cycle is described:

-Occurs within 30-36 hours of LH surge

-Window to get pregnant and egg to be fertilized

ovulation

What phase in the repro cycle is the window for the egg to be fertilized?

ovulation

What phase of the reproductive cycle is described:

-Begins the day of LH surge

-Ends with onset of menses

-Lasts about 14 days

- Endometrium in secretory phase

luteal phase

What stage of the repro cycle is shown and what endometrial phase ?

follicular phase

endometrium= proliferative phase

What stage of the repro cycle is shown?

luteal phase

endometrium= secretory phase

What phase is the endometrium when in the luteal phase of the repro cycle?

secretory

What 3 complexes regulate the reproductive cycle?

hypothalamus

pituitary

ovaries

Trace the pathway of regulation of hormones for the reproductive cycle.

Hypothalamus releases Gonadotropin Releasing Hormone (GnRH) -->

stimulates anterior pituitary to release FSH and LH -->

stimulates the ovaries to produce follicles (which release estrogen) & progesterone

What hormone released by the hypothalamus-- stimulates the gonadotropins in the ant. pituitary and is a pulse generator of the repro cycle?

GnRH

What two hormones are released from the ant pit in response to GnRH?

FSH and LH

What hormone is decreased during menopause?

estrogen

(FSH = elevated)

Trace Ovarian Follicle Development.

◦Ovary contains 1-2million follicles at birth

◦Each follicle contains an oocyte in the first stage of division

◦Every month the pituitary gland tells the ovaries to produce several fluid-filled cysts called follicles

◦As the follicles grow, they secrete estrogen

◦Estrogen works to thicken the wall of the uterus in preparation for pregnancy

◦On day seven of the cycle, the follicles stop growing except for one

--->This follicle continues to grow and to nourish a maturing egg (oocyte) within

What is needed to induce ovulation?

LH surge

In late follicular phase, _____ ______ from dominant follicle sends message to pituitary to stimulate mid-cycle LH surge, starting ovulation.

peak estradiol

What is a progesterone secreting ovarian cyst that develops due to a follicle leaving behind remnants?

corpus luteum

What can you check to confirm that ovulation has happened?

progesterone

What produces contractions of the uterine vasculature and musculature?

prostaglandins

What leads to menstrual cessation?

rising estrogen levels in early follicular phase

____ is high during the follicular phase and _____ is high during the luteal phase.

estrogen, progesterone

What is the term that means pain associated with ovulation?

Mittelschmerz

During conception the zygote secretes what hormone that sustains the corpus luteum for 6-7 wks?

hCG

During conception adequate _______ production by the corpus luteum is necessary to sustain early pregnancy.

progesterone

By 9-10 weeks the ______ assumes progesterone production.

placenta

When conception does not happen the CL stops producing progesterone and becomes a white fibrous steak within ovary called a ____ _____.

corpus albicans

What are some clinical manifestations of hormonal changes to:

breasts

breast tenderness or nodules

What are some clinical manifestations of hormonal changes to:

vaginal epithelium

variation in secretions

What are some clinical manifestations of hormonal changes to:

endocervix

variations in secretions

What are some clinical manifestations of hormonal changes to:

endometrium

proliferative or secretory on histologic eval

What are some clinical manifestations of hormonal changes to:

hypothalmus

basal body temperature changes

What phase of the endometrium has predominant estrogen switch to progesterone?

secretory phase

What is the only way to ID proliferative from secretory endometrium?

biopsy

The endocervix under estrogen influence secretes what?

thin, clear, watery mucus

What can you monitor to optimize timing of intercourse or to avoid conception?

cervical mucus

progesterone or estrogen:

influences ductal elements of the breast, nipple, and areola causing tenderness and fullness during luteal phase

progesterone

progesterone or estrogen:

aids in lubrication and growth of the vaginal epithelium

estrogen