Menstruation (15%) – 7
GTPAL
o Gravida
o Term
o Preterm
o Abortion
o Living
Normal Physiology
Phase 1 – Follicular phase
... [Show More] [proliferative phase] Days 1-14
o ESTROGEN predominates
Endometrium thickens = proliferation
GnRH FSH & LH
o Ovaries
FSH = follicle stimulating hormone follicle & egg maturation
LH = stimulates follicle to produce estrogen
o ESTROGEN Causes NEGATIVE FEEDBACK to HPO system Stops new follicles from maturing
OVULATION Days 12-14
o Switch from negative positive feedback = estrogen, FSH & LH
o LH surge causes ovulation = egg release
Ruptured follicle becomes corpus luteum
Phase 2 – Luteal Phase [secretory phase] Days 14-28
o PROGESTERONE predominant
LH surge causes ruptured follicle to become corpus luteum
Corpus luteum secretes progesterone & estrogen to main endometrial lining
Negative feedback again
o EGG FERTILIZED = pregnancy
Blastocyte [maturing zygote] keeps corpus luteum functional
Secreting progesterone & estrogen keeps endometrial thick for implantation
o Menstruation = 1st day of follicular phase EGG NOT FERTILIZED
Corpus luteum deteriorates decline in progesterone & estrogen endometrium sloughs
off LT menstruation
Negative feedback switched to positive feedback GnRH
CYCLE REPEATS
Dysfunctional [Abnormal] Uterine Bleeding
o Abnormal frequency or intensity of menses due to nonorganic causes
o Normal Cycle 24-38 days
o Normal menstruation
4.5-8 days
Average loss 30 ml – 80 ml
o Terms
Amenorrhea = Absence of period
Cryptomenorrhea = light flow or spotting
Menorrhagia = HEAVY or PROLONGED bleeding @ normal menstrual intervals
Metrorrhagia = irregular bleeding BETWEEN EXPECTED CYCLES
Menometrorrhagia = irregular, EXCESSIVE bleeding BETWEEN cycles
Oligomenorrhea = infrequent periods: prolonged cycles > 35 days but less < 6 months
Polymenorrhagia = frequent cycle intervals < 21 days
o Etiology
Chronic anovulation – 90%
Disruption of hypothalamus-pituitary [Show Less]