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DIFFERENTIAL DIAGNOSIS OF COMMON GYNECOLOGICAL COMPLAINTS . . . CONT.

Notes

Non-Gynecological Causes thyroid disease (hyper-/hypo- thyroid) chronic liver disease von Willebrand disease leukemia idiopathic thrombocytopenic purpura hypersplenism rectal or urethral bleeding renal failure adrenal insufficiency and excess drugs: spironolactone, danazol, psychotropic agents metastatic cancer

REPRODUCTIVE ENDOCRINOLOGY

STAGES OF PUBERTY

1. accelerated growth 2. thelarche (breast budding) 3. pubarche and adrenarche (growth of pubic and axillary hair) 4. maximal growth (peak height velocity) 5. menarche

  • Tanner Staging (see Pediatrics Notes)

MENSTRUAL CYCLE

Characteristics menarche at age 11-14 entire cycle 28 +/– 7 days, with bleeding for 1 - 6 days polymenorrhea if < 21 days oligomenorrhea if > 35 days 25-60 mL of blood loss per cycle

MENSTRUAL CYCLE

LH

FSH

PROGESTERONE

FSH

LH

ESTROGEN

FSH

LH

Day 1

Day 4

Day 10

Day 12 Day 14 Ovulation

Day 20

Day 28 New Cycle Begins

MENSTRUAL

PROLIFERATIVE

SECRETORY

  • Day 1 to days 3-7: Menstruation, FSH and LH levels are rising.

  • Rising FSH stimulates growth of several ovarian follicles and maturation of an ovum.

  • FSH and rising LH stimulate the follicles to produce estrogen.

  • Estrogen causes proliferation of endometrium and further stimulates ripening of the ovum.

  • Estrogen triggers a LH surge which is responsible for ovulation.

  • After ovulation, progesterone produced by the corpus luteum stimulates secretory

changes in the endometrium.

  • Deterioration of the corpus luteum causes progesterone to decrease.

  • Decreasing progesterone and estrogen stimulate pituitary to produce FSH and LH.

Figure 2. Hormone Levels During Normal Menstrual Cycle

Proliferative/Follicular Phase first day of menses to ovulation variable in length low basal body temperature estrogenic endometrial priming ovarian follicular development

Gynecology 8

MCCQE 2000 Review Notes and Lecture Series

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