What Goes Around Comes Around

Zoulikha Zair29th April 2013

Follicular Phase

• Early Follicular phase• Hypothalamus and pituitary free from feedback inhibition• FSH and LH have begun to rise, particularly FSH due to lack of inhibin• FSH stimulates the granulosa cells• LH binds to theca cells• Follicles begin to grow

• Mid follicular phase• As follicles grow and develop they secrete more and more oestrogen and inhibin• Inhibin has selective inhibition on FSH• No more follicles recruited and FSH begins to fall more than LH• Oestrogen dominant

• End of follicular / pre-ovulatory phase• Follicles have continued to develop, one becoming dominant• Oestrogen levels are rising rapidly• POSITIVE FEEDBACK on LH• LH SURGE, disrupts mature follicle and releases egg

Luteal Phase

• Luteal Phase– Disrupted follicle forms Corpus Luteum– Corpus Luteum secretes oestrogen and

progesterone… levels rise rapidly– LH, FSH, GnRH remain suppressed– Corpus luteum lasts 14 days– Dominated by Progesterone

Categories of Abnormal Bleeding:• No bleeding

– Amenorrhea

• Abnormal uterine bleeding– Menorrhagia-heavy and regular– Metrorrhagia-heavy and irregular– Polymenorrhea-frequent– Oligomenorrhea- infrequent– Dysmenorrhea

• Dysfunctional uterine bleeding– IMB-Intermenstrual bleeding

• Early pregnancy complications– Pregnancy related

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Dysmenorrhea• Painful periods• Prostaglandins- causes peristalsis of tubes

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Primary Dysmenorrhea

• No pathology• Common in adolescents 60-90%• Missed school• Rx-NSAIDS, Birth control pills in order to stop

the cyclic release of endometrium to stop cramping, time

Secondary Dysmenorrhea

• Due to pathology• Middle reproductive years• Common eg endometriosis

Absent bleeding - Amenorrhoea

• Primary – never had menses by age 16• Secondary – ( >3mths) or (>6mths)- texts vary• Two categories: Physiological and Pathologic

• Physiological– Pre-puberty– Pregnancy– Puerperium (3 – 4 weeks after baby is born)– Lactation– Menopause

• Pathological– Hypothalamus anorexia/stress/severe systemic illness– Pituitary tumour/ pituitary infarct – Ovary dysgenesis/damage/premature ovarian failure– Uterus absent/scarred (through inflammation)– Cervix / Vagina present/patent/perforate– Which of the three fundamentals is affected? HPO axis

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Endometriosis - ectopic endometrial glands and stroma

• Common condition • great variety in symptoms; cyclical

– mainly dysmenorrhoea, dyspareunia– irregular menses

• Hypotheses– retrograde menstruation- metaplasia- iatrogenic

• association with infertility if disproportion of tubes and oviducts are such that fertility is impaired

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Endometriosis

Questions