Human Repro: Health & Menstrual Cycle

Front 1

Average age at menarche

Average age of menopause

Back 1

12.3-12.5 yrs

51 yrs

Front 2

Amenorrhea

Back 2

- absence of menstruation
- primary amenorrhea = does not start to menstruate by age 16 or 17
- reversible or permanent
- secondary amenorrhea = stops menstruating
- reversible or non reversible
- excessive exercise, anorexia
- body fat min of 18-22%
- estrogen synthesized in adipose tissue
- low estrogen reduces LH surge, alters estrogen metabolites and reduces free estrogen
- excess exercise results in endorphins
- endorphins interfere with production of GnRH
- leads to low GnRH, less FSH, LH, no ovulation and no menstruation

Front 3

Dysmenorrhea

Back 3

- painful menstruation, cramps, also menorrhagia
- 30-50% of women
- most common in younger women
Causes:
- prostaglandins (uterus, corpus luteum) stimulate increased uterine contraction
- overactive myometrium
- low blood flow
Secondary Causes:
- IUD
- smoking
- fibroids, pelvic inflammatory disease, endometriosis
Treatments:
- aspirin, ibuprofen, anti-prostaglandins and analgesics
- increase blood flow through exercise, intercourse

Front 4

TSS
Toxic Shock Syndrome

Back 4

- staphylococcus aureus infection
- found in about 10% of women
- anaerobic conditions lead to rapid increase in bacteria
- tampon, contraceptive sponge
- bacteria produces toxin, triggers flu-like disease
- can be fatal

Front 5

PMS
Premenstrual Syndrome

Back 5

- 70-90% of women
- severe in about 5%
- physical and emotional symptoms
- begins one week prior to menstruation
- 1-2 days after start of menses

Front 6

Causes of PMS

Back 6

- rapid drop in progesterone/estrogen at end of luteal phase
- variations in neurological response to changes in steroids, decrease in endorphins

Front 7

Symptoms of PMS

Back 7

- palpitations, edema, migraines, breast tenderness, weight gain, acne, irritability, depression, fatigue

Front 8

Treatments of PMS

Back 8

- diuretics, anti-depressants (prozac), the pill, decrease salt, treatment for other symptoms, anti-GnRH (severe cases)

Front 9

Endometriosis

Back 9

- 10% of women (15-30 yrs)
- retrograde menstruation
- explants in fallopian tubes, uterus, ovaries, abdominal organs, lungs
- explants respond to hormonal cycles, bleed monthly
- results in dysmenorrhea, infertility (scarring, interference with ovulation)
Treatments:
- surgical or laser surgical removal, anti-GnRH
- often redevelop, sometimes not after pregnancy

Front 10

Cervical Cancer

Back 10

- 8th most common cancer (1/3rd die)
- develops slowly
- preceded by cervical dysplasia
- risk increases with more partners
- risk decreases with circumcision
- precancerous cervical dysplasia detected by pap test (every 1-3yrs)
Treatment:
- surgery, chemotherapy, radiation
- most caused by HPV

Front 11

Ovarian Cancer

Back 11

- most on surface epithelium
- common in young women
- 10% hereditary (same genes breast cancer)
- high fatality rate (>50%)
- no method for screening
- asymptomatic or vague symptoms
- usually advanced when diagnosed
Treatment:
- oophorectomy, chemotherapy (taxol - anti-estrogen, cisplatin), radiation
- CA125 protein increases in ovarian cancer patients, but not reliable
- best method is ultrasound, but expensive and time consuming

Front 12

Menopause

Back 12

- average age 51 years
- common symptoms: dizziness, numbness, palpitations, back aches, hot flashes, night sweats (75% women)

Front 13

Perimenopause

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- 4 years, starting at 47 yrs
- cycles shorten
- anovulatory
- irregular

Front 14

Longterm effects of Menopause

Back 14

- osteoporosis (25% women >50)
- increased serum cholesterol
- cardiovascular disease
- vaginal changes/decline of reproductive organs
- slight masculinization due to adrenal androgens

Front 15

Causes of Menopause

Back 15

- # of follicles decreasee
- decrease in inhibin secretion
- ovaries become insensitive to FSH and LH (decreased receptors and follicles)
- decrease in production of estrogen
- absence of stimulus for endometrial development
- no menstruation
- ovulation ceases
- hypersensitivity of sympathetic nervous system = hot flashes

Front 16

Decreased estrogen results in:

Back 16

- changes in cholesterol metabolism
- reduction in bone deposition relative to resorption
Low estrogen causes
- GnRH pulses decrease and also pituitary hormones
- no negative feedback to hypothalamus and pituitary
- secretion of GnRH increases and no long pulsatile
- increase in secretion of LH (4x) and FSH (10x)

Front 17

Human Menopausal Gonadotropin (HMG)

Back 17

- high in pituitary hormones (LH, FSH)
- extracted from urine of menopausal women
- treatment for certain kinds of infertility

Front 18

Treatment of Menopause
HRT

Back 18

- exogenous estrogen
- synthetic progesterone if uterus intact to reduce risk of endometrial cancer
- associated with risk of breast cancer (10% in 6 years, 70% after 9)
- no benefits for cardiovascular system
- other options for osteoporosis
- best for short term use

Front 19

Treatment of Menopause

Back 19

Phytoestrogens
- gaining popularity (soy products)

Non-steroidal (non-estrogenic) medications and exercise for prevention and treatment of osteoporosis