This document provides an overview of the menstrual cycle and factors that influence it. It discusses the roles of the hypothalamus, pituitary gland, ovaries, and other organs. Key points include how hormones like GnRH regulate the cycle, causes of irregularities, and clinical considerations around menstruation, contraception, fertility treatments, and disorders.
This document provides an overview of the menstrual cycle and factors that influence it. It discusses the roles of the hypothalamus, pituitary gland, ovaries, and other organs. Key points include how hormones like GnRH regulate the cycle, causes of irregularities, and clinical considerations around menstruation, contraception, fertility treatments, and disorders.
This document provides an overview of the menstrual cycle and factors that influence it. It discusses the roles of the hypothalamus, pituitary gland, ovaries, and other organs. Key points include how hormones like GnRH regulate the cycle, causes of irregularities, and clinical considerations around menstruation, contraception, fertility treatments, and disorders.
•Fifth year lecture •2020-2021 Menstruation with clinical considerations
Menstruation is defined as monthly
shedding of endometrial dead tissue which herald failure to achieve pregnancy. Menstrual blood is a mixture of dead endometrial tissue, blood components and pus cells. The normal limits of human cycle are 3- 7 days in duration, with frequency 21- 35 days with average 28 days The total blood loss should not exceed 70- 80 ml and usually above 30- 40 ml. Anatomical overview of the limbic system, hypothalamus and pituitary as related to menstruation • Pituitary composed of 2 parts • Anterior [art • Posterior part • Oxytocin and vasopressin are secreted from the posterior pituitar • LH and FSH are secreted from anterior pituitary gland after stimulation with GnRH hormone • The later is trensmitted to the pituitary via portal system The hypothalamus hormones inducing menstruation • GnRH is a deca peptide • Usually secreted in pulsatile manner every 30 munutes • They icrease in intensity and frequency throughout the cycle • And reduced at time of menstruation’ • GnRH analogue are synthesized by manpulating amino acids number 6 and 10 • Used in the treatment of endometriosis or IVF Hypothalamic specific causes which inhibits GnRH only
• There are specific causes
which inhibits LH and FSH or GnRH only from the thalamus • 1- athletes • Anorexia nervosa • Heavy job like light attendants, female pilot, ballet dancers Craniophapharyngioma • On the other hand all hormones secreted rom the pituitary may be depressed like in cranyopharyngioma • Inclusion cyst arise from Rathkes pouch • Usually increase is size with age and symptomes appear at early therties Pituitary gland • Anterior pituitary cells are stained either blue or red • Basophilic cells secrets FSH, LH, TSH, ACTH • While acidophil cells secretes growth hormones and prolactin during lactation Endometriosis • Endometriosis is a disease in which endometrial tissue present anywhere outside the endometrial cavity. • Inhibition of the menstruation for 6 months by GnRH analogues is used to induce amenorrhea. Contraceptive pills • Combined contraceptive pills are used for family control or contraception’s contains estrogen and synthetic progesterone. • They act by complete inhibition of FSH- LH secretion IVF • In vitro fertilization FSH and LH which can be mixed or FSH alone can be given in various protocols to induce maturation of the ovarian follicle • and then extracted under U/S guidance so the ova is fertilized under the microscope. • Usually 3-5 morula stage embryos are returned to the uterus. • Down regulation of the pituitary is essential to give exogenous gonadotrophins Enometrial carcinom • In endometrial carcinoma since the famous reports by Novak’s in USA that cannon balls in the lung have disappeared by progesterone; • progestational agents may be part of the treatment of advanced endometrial carcinoma Primary dysmenorrhea • Primary dysmenorrheal a disease associated with menstruation with severe colicky abdominal pain. • Contraceptive pills may be used as a second line. Anatomical overview of the ovary related to menstruation • The ovaries are suspended by peritoneal fold containing the suspensory ligament of the ovary • The fact that its blood supply is different from the uterus is a key stone in the development of endometrial gland and implantation of the zygot Ovary under microscop • Primordial ovarian follicle • Seconday ovarian follicle • Tertiary ovarian follicle • Immature and mature ovarian foliicle • Corpus luteum • Corpus albicans Mullerian inhibiting factor as predictor of menstrual age of woman
• Women from biological point of
view have 2 ages • The age of survival and has nothing to do with ovulation • The fertility age is the number of years spent while she can become pregnant • Menopause has no exact time to come and MIF have been used extensively to predict the age of meopause Mittelschmerz • Pain simulating acute abdomen which is usually coincide with ovulation • Caused by the few drops of blood which accompany rupture of the mature follicle • Frequently misdiagnosed as appendicitis and operated upon s Ovulation and fertilization Polycystic ovarian syndrome • PCO was described first by 2 scientist stein and levinthal as syndrome of obesity • Hirsutism • Hypo oligomenorrhea • Infertility • Nowadays it has been discovered to be one of the insulin resistance diseases • The increased testosterone among those women is to facilitate or sensitize insulin receptor to the high insulin levels • Androgens on the other hand impairs the process of follicle development and both ovaries contain large number of immature follicles after which its naming come Premature menopause • Menopause when occur at age less than 40 years. • Auto immune diseases are significantly associated with. • Family associated sometime seen. • Such women are those with highest risk of ischemic heart disease, CVA and osteoporosis. Hormone replacement therapy is the available treatment. Proliferative phase and luteal Anatomical overview of the fallopian tubes related to menstruation
Progesterone and ciliary movement of tte tube cilia
•Immediately after ovulation the level of progesterone secreted is start to increase in the blood •This affects the cilia push by the ciliated columnar epithelium in fallopian tbes •In case serum progesterone> 15 ug/ml the cilia push the zygote to the tube •Otherwise the cilia push the zygote to the fambiria causing ectopic pregnancy or infertility Simple test to confirm ovulation • Body temperature • Spinbarkeit test • Vaginal cells aspiration and staining with eosin and hematoxylin. • Aspiration of the endometrial lining for histopathology. • Serum progesterone at day 21 or mid luteal phase above 20 ug/ ml is highly associated with ovulation. • Ultrasounds scan at day 14 and 21 of the cycle • The modern widely used kits which stains according to the instructions coming with those kits may be used. Squamocolmnar junction and uterine cervix
•The juction between endervical canal with single columnar epithelium
and ecto cervix with stratified squamous epithelium is almost always the origi of vervical carcinoma. •Scarping of cells with special metal or wooden spatula may alert to premalignant possibility and this is called CIN cervical intra epithelia carcinoma