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What Goes Around Comes Around

What Goes Around Comes Around. Zoulikha Zair 29 th 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

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What Goes Around Comes Around

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  1. What Goes Around Comes Around ZoulikhaZair 29th April 2013

  2. 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

  3. 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

  4. Categories of Abnormal Bleeding: • No bleeding • Amenorrhea • Abnormal uterine bleeding • Menorrhagia-heavy and regular • Metrorrhagia-heavy and irregular • Polymenorrhea-frequent • Oligomenorrhea- infrequent • Dysmenorrhea • Dysfunctionaluterine bleeding • IMB-Intermenstrualbleeding • Early pregnancy complications • Pregnancy related

  5. Dysmenorrhea Primary Dysmenorrhea • Painful periods • Prostaglandins- causes peristalsis of tubes Secondary 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 • Due to pathology • Middle reproductive years • Common eg endometriosis

  6. 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

  7. 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 Endometriosis

  8. Questions

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