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absence of mentstrual flow when expected.
Primary; delay of menarche beyond age 18
Secondary; cessation of menses in a woman who has previously menstruated - absence for 3 months or more.
Normal- prepuberty, after menopause, and during pregnancy and lactation
start of the first menstrual cycle. Normally occurs btwn 9 & 17 yrs. of age. Average is 12.8 yoa
involving activity of the hypothalmus, pituitary, ovaries, uterus, fallopian tubes, vaagina, and mammary glands. varies btwn 24-29 days (28).
average blood loss is 35 ml. (range is 25-65)
scanty, infrequent menstrual flow.
common w/ polycystic ovary pts.
bleeding from the uterus at any time other than normal menstrual period.
not related to menstruation; considered pathologic; may be considered pathologic; may be caused by lesions of the cervix; its occurrence should lead to suspicion and serach for a malignancy in the genital tract, specifically cancer of the cervix.
GnRH; corticotropin-releasing factor (CRF); somatostatin; thyrotropin-releasing hormone (TRH); growth hormone-releasing factor (GHRF)
carried from the hypothalamus by the hypophyseal portal system to the pituitary gland.
consists of FSHRF & LHRF
increases papidly after ovulationa dn peaks about 7 days post ovulation. sevreted by the corpus luteum during teh second half of hte cycle. if ovum in not fertilized, corpus luteum regresses and less progesterone is secreted.
main function is to induce secretory activity in the endometrial glands that have been primed by estrogen and to prepare a site for the fecundated ovum.
desensitizes the myometrium to oxytocic activity, modifies the histological appearance of the vaginal epithelium, and inhibits the secretory activity of the cervical glands. increases the basal body temp., stimulates the development ofthe alveolar system, and inhibits hte secretion sof LH. (can inhibit and block the mid-cycle LH surge and ovulation.
inhibits contractability of the myometrium
begins at the onset of pubery.
first day of is counted as beginning of the menstrual cycle
appears sonogrpahically complex
early phase- Day 6-9; appears sonographically thin
late phase- Day 10-13; appears sonographically thicker w/ a spongiosa layer (trilaminar stripe) **if the menstrual cycle is irregular, this phase is either longer or shorter
appears sonographically thick and echogenic w/ possible enhancement
grossly apparent edema in the spongiosa layer; superficial layer becomes vascular and edematous and the serum progesterone levels rise and peak in syncronization w/ the develpment of hte corpus luteum.
if fertiliztion does not occur the secretory endometrium enters an Ischemic phase
during the latast day or 2 of the menstrual cycle. ;
localized deficiency of blood. give the endometrium a pale appearance
as spiral arteries become constricted and lead to bleeding indicated the new cycle
measured in sag. plane
Double layer thickness (DLT)
menstruation 2 mm
proliferative 4 - 8 mm
secretory 10- 12 mm (1 cm - 1.2 cm)
Single layer thickness
menstruation < 2mm
proliferative 2 -4 mm
secretory 5 - 6
**upper limits of normal is 7
1-3 mm DLT; 5mm poss. abnormal; > 8 def. abnormal
FSH promotes growht of 5 - 12 primary follicles. usually only one develops into a mature follicle and ruptures expelling the oocyte. each ovary contains approximately 200,000 primary follicles each consisting of an ovum surrounded by a layer of cells.
follicular (before ovulation)
luteal (after ovulation)
produciton and release of folliculin, (commonly known as estradoil), by developing follicles causing the uterine mucosa to repair
growth of egg bearing follicles occur w/ the ovary at this time
~ Day 14 - 28
development of corpus luteum and production of progesterone maintains the uterine mmucosa
fat yellow body
luteal phase lasts from day 15 - 28
ruptured graffian follicle is healed by acapillary bleeding and is eventually absorbed.
concurrently, follicular cells enlage and LH action causes ganulosa cells to be luteinzed into lipiod appearing substnaces whicch are transformed into the yellow, golden-colored body
grows for 7-8 days secresting estrogen and increases progesterone
a clear membrane, develops around the ova
~4-5 day the primary follicle develops into the secondary follicle
follicles begin migration @ ~ .5 cm (5mm)
~ 12 days follicle matures
Day 6 - 13
secondary follicle matures developing into a graffian follicle; other maturing follicle undergo atresia FSHRF secretin stimulates maximal FSH production early in the preovulartoyr phase. estrogen is increased by secondayr follicle increasing estrogen; hish estrogen levels inbibit FSHRF thus inhibiting FSH; LHFR is released and increases LH secretion; graafian follicle is concurrently secreting a small amount of progesterone and the ovum undergoes meiosis; LH w/ FSH= rupture
only follicle that will contain and egg.
reaches 1.5 - 2 cm.
the structure in the cortex of teh ovary that contains the immature ova
follicle supports the growth and maturation of the ovum
during reproductive years, one follicle a month usualy reaches maturation.
inrafollicular pressure forces egg out into the peritoneal cavity
in response to LH simulation follicle ruptures proelling the ovum
post ovulation the follicle collapses and fills w/ blood and serous fluid (corpus hemorrhagicum
if not fertilized - reaches maximym development ~7 days after ovulation and tehn degenerates into a mss ofibrous tissue; the corpus albicans
if fertilize - contiues to grow and to secrete hromones, reaching maximum development during the second month of pregnancy.; gradually regresses as the placenta matureas and takes over its endocirne function
fertlized ovum; implants after ~1 week following fertilzation
placenta secretes a hormone HCG which has the same functiona as LH and LTH
prevestns the involution of the corpus luteum and at the end of the menstrual cycle causing it to enlarge and secrete large amounts of progesterone and estrogen.
growth and differentiation of the primary oocyte
proliferation of follicular cells
development of a connective tissue capsule (theca follicle)
at day 1 productionof estrogen is low but FSH is max
FSH stimulstes production of estorgen to ropen the Graafian follicle
>estrogen = <LH
number of follicles respond w/ growth and increase estrogen occurs in 4-5 days @ this time menstrual phase has ended.
relatively even and slow for 10-12 days; granulosa layer thickens and antrum becomes distended; most new follicles have a relatively short life. their granulosa cells and ovum degenerate, leaving an atretic follicle.
a few continue to enlarge but in most cycles only one surges forward w/ a remarkable spurt toward teh mature graafian follicle which ruptures or ovulates on day 14.
follicle becomes oval and eccentric; the follicular cells proliferate more rapidly on one side.
fluid-filled spaces around teh follicular cells soom coalesce to form this cavity
when formed, ovarian follicle is called the secondary or vesicular follicle
oocyte is located at one side surrounded by a mound of follicular cells, the cumulus oophorus, that projects into the antrum
structure which is filled w/ a yelloish, oily secretion.
infolding as the walls of former follicle thickened and encroached more and more on the fibrin containing blood filled cavity lined w/ lutein
occurs w/in a few hours after ovulation
progesterone producion is quickly accelerated and its effect can be readily detecte by differentiation changes in the endometrial tissue w/in 48 hour of ovulation.
estrogen level drops and LH output is then decreased.
by day 20 estrogen level is high and progesterone reaches peak.- both pituitary gonadotropins are released or are produced in minimal quantities; the third, LTH supports morphologically and functionally the corpus luteum through last half of menstrual cycle
released by the corpus luteum; causes endometrial glands to secrete and prepare teh endometrium for implanation of a blastocyst. (previously blastomeres)
stimulation of the thermal center in the breain stem-rise in basal body temp. (sustained as long as corpus luteum functionas at max level; cerviacl mucous becomes scanty and viscid
if pregnancy occurs; corpus luteum contines and increases until the bright-yellow body makes up as much as half the total volue of teh ovary.
~2nd month of preg. slow process of regession begins and contiues throughout pregnancy
collapesd corpus luteum which is white in appearance and fille dw/ fibrous material
no pregnancy occurs; shrunke conulutions of hyalinized material
yellow margin of corpus luteum shrinkds rapidly and lutein cells degenerate into amorphous, hyaline masses heldt together by strands of connective tissue
degenerates ~ 10-12 days after ovulation
at this time- estrogen and progesterone prompts new output of pituitary gonadotropinsand new follicles
due to an inadequate release of FSH and LH- can not become pregant.
ovulation can be inducesd by administration of FSH and LH; multiple births frequently result;
follicle nears top size ~22 to 25 mm and estorgen levells increase. the endometrium changes during this time and a halo of hypoechoic tissue surrounds it.
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