4 Menstrual cycle:Days 1-5: Estrogen Falls, FSH Rises.Menstrual bleeding begins on Day 1 of the cycle and lasts approximately 5 days. During the last few days prior to Day 1, a sharp fall in the levels of estrogen and progesterone signals the uterus that pregnancy has not occurred during this cycle. This signal results in a shedding of the endometrial lining of the uterus.
5 Days 6-14: Estrogen Is Secreted, FSH Falls. Estrogen is secreted by the follicle during this phase of the menstrual cycle. It stimulates the endometrial lining of the uterus suppresses the further secretion of FSH.At about mid-cycle (Day 14), the estrogen helps stimulate a large and sudden release of luteinizing hormone (LH).This LH surge, which is accompanied by a transient rise in body temperature, is a sign that ovulation is about to happen.The LH surge causes the follicle to rupture and expel the egg into the Fallopian tube.
6 Days 14-28: Estrogen And Progesterone Secretion First Rise, then Fall. After rupture of the follicle, it is transformed into the corpus luteum and produces progesterone.P supports to prepare the endometrial lining for implantation of the fertilized egg.(If the egg is fertilized, a small amount of human chorionic gonadotrophin (hCG) is released that stimulates further progesterone production.)
7 After implantation, the trophoblast will secrete human Chorionic Gonadotropin (hCG) into the maternal circulation.HCG keeps the corpus luteum viable. The corpus luteum continues to produce estrogen and progesterone, which keep the endometrial lining intact.By about week 6 to 8 of gestation, the newly formed placenta takes over the secretion of progesterone.
8 If the egg is not fertilized, the corpus luteum shrinks, and the levels of estrogen and progesterone drop, the uterus sheds its lining, and menstruation begins.In addition, with no estrogen to suppress it, FSH levels again start to rise. Thus, one cycle ends and another begins.Normal Menses:Flow lasts 2-7 daysCycle days in lengthTotal menstrual blood loss mLThe menstruation must be regular, painless.
9 puberty is the process of physical changes by which a child's “body becomes an adult body capable of reproduction.menarche - A woman's first menstruation is termed, and occurs typically around age 12. The menarche is one of the later stages of puberty in girls.menopause - the end of a woman's reproductive phase, which commonly occurs somewhere between the ages of 45 and 55.Climacteric: yearsMenopausePostmenopause starts 1 year after menopausePremenopause: 5 years beforePerimenopause: transitional phase between pre- and postmenopause: 2 years before and 1 year after
10 Menstrual cycle irregularities: 1. abnormal frequency Kaltenbach chart:Duration: 28 d 5Amount: 3-5 pads or tampons (35 mL)Normal cycleAbnormal frequency: oligomenorrheaDuration > 35 daysAbnormal frequency: polymenorrheaDuration < 22 days
11 Menstrual cycle irregularities: 2. abnormal amount of duration Kaltenbach chart:Duration: 28 d 5Amount: 3-5 pads or tampons 35 mL)Normal cycleHypomenorrheaAmount < 2 per dayHypermenorrheaAmount > 5 per dayMenorhagiaDuration 7-14 daysat regular intervals
15 Polycystic Ovary Syndrome (PCOS) The ovaries contain many small follicles or cysts. Each has an egg, but they do not grow normally and shrink before ovulation. Each month, new follicles develop and shrink into cysts.The fertility is reduced.Most PCOS cases are unexplained.The disorder may be inherited.Deficiency in luteinizing hormone (LH)Resistance to insulin. A similar effect on the ovaries can occur in women with eating disorders (anorexia or bulimia), or women whose bodies do not properly make estrogen and other steroids (for example, women with congenital adrenal hyperplasia).
16 Polycystic Ovary Syndrome (PCOS) Clinical consequences of persistent anovulation1. Infertility2. Menstrual dysfunction3. Hirsutism, Alopecia, Acne4. Risk of endometrial cancer , breast cancer5. Risk of CVS disease6. Risk of DM in patients with insulin resistance
17 Prolactin Secreting Adenoma Most common pituitary tumor50% identified at autopsyDisruption of the reproductive mechanismAmenorrhea -Visual field defectGalactorrhea -HeadacheTreatmentMedical : dopamine agonistSurgical
18 Surgical Treatment Dilation and Curettage quickest way to stop bleeding in patients who are hypovolemicappropriate in older women (>35)to exclude malignancy but is inferior to hysteroscopyfollow with medroxyprogesterone acetate, OCP’s, or NSAID’s to prevent recurrence
20 Sheehan’s syndrome Postpartum hemorrhage Acute infarction and necrosis Hypopituitarism= early in the PP periodFailure of lactationLoss of pubic and axillary hairDeficiencies :GH, Gn (FSH,LH),ACTH, TSH (in frequency)
21 Turner’s Syndrome Gonadal dysgenesis associated with 45,XO Most common chromosomal abnormality in spontaneous abortionCharacteristicsSexual infantilism -Less commonShort stature AutoimmuneWebbed neck CVS anomaliescubitus valgus Renal anomaliesMosaicismTreatmant
26 3. Androgen Insensitivity (Testicular Feminization) Male PseudohermaphroditeGonadal Sex :46xyPhenotype FemaleBlind vaginal canalUterus absentAbsent or meager pubic and axillary hairMalignancy,Hormone :T or slightlyLH
28 Case 20 year old Jessica Episodes of irritability and moodiness Lead to huge arguments with her boyfriend.Sleeps away the day and miss school or workHer boyfriend jokes and makes off-the-wall remarks about PMS. She comes to you for advice.Bloated, tired and hungry during the days just prior to menses.