Follicular Phase

What’s Normal?

Normal starts with pre-puberty at which all hormones are relatively low. Hypothalamus decides when puberty starts. Gonad releasing hormone is released. Anterior pituitary sends signals to the ovary, and off we go.

Follicular phase

FSH is the first released – stimulates the follicles in the ovary. When a woman is born all eggs are already created and stored already but don’t get going until FSH is released. The follicle and egg grow together. The pituitary gets feedback from the follicle and stops with the FSH already. Follicle makes estrogen which preps everything for making a baby – makes everything rich and juicy – thickens cervical mucus, tissues swell, etc. Estrogen is sensed by the hypothalamus – at a certain level the LH is released and goes back to the ovary. Weakens the follicle so the egg can release, gives egg last push to maturity.

Ovulation phase

Fully matured ovum is released about ½ way thru the whole cycle. Follicle turns into the corpus luteum, which also makes hormones-progesterone. This sustains the pregnancy if implantation occurs. Also sends signals to anterior pit to turn of the LH/FSH. If a woman gets preggers the embryo makes HGC which feeds the corpus leuteum which then keeps making progesterone. Should the corpus luteum stop producing progesterone the cycle starts and so does the period eventually.

Exactly 28 day cycle is actually uncommon. More variation in the follicular stage. The luteal phase doesn’t vary much.

Can also have a cycle without having an egg release, but then it’s the estrogen that dies back and the period starts.

Count a cycle by counting the first day of the menstrual period to the first day of the next menstrual period.

Normal length is 3 – 7 days. Need more than slight coloration, spotting.

Now on to what’s not normal.

Abnormal Uterine Bleeding

AUB (abnormal uterine bleed) includes:

Menstruation more often than every 26 days.
There is room for anatomical variation – some ppl have shorter

Heavy periods
Especially if there are egg sized clots. There’s a measure, but it’s really hard to measure.

Any bleeding/spotting that occurs at the wrong time
There can be spotting at ovulation and that’s ok. Mittelschmertz pain is normal also.

Any bleeding more than 7 days

No bleeding at all.

AUB patterns

•Menorrhagia: aka hypermenorrhea, prolonged (> 7 days) or excessive bleeding at regular intervals

•Metrorrhagia: frequent menses at irregular intervals, the amount being variable
Metro means either womb or metro like the bus. Varies in amount and interval.

•Menometrorrhagia: prolonged bleeding at irregular intervals
Lots of blood and you don’t know when it’s going to happen

•Oligomenorrhea: infrequent bleeding, few periods.

•Polymenorrhea: regular, frequent

•Amenorrhea: no flow

•Dysmenorrhea: painful flow

AUB is “dysfunctional uterine bleeding” in ICD9 codes.

What causes it:

•Reproductive Tract

•Abortion (threatened, incomplete, or missed)

•Ectopic pregnancy

•Malignancies

•Endometrial hyperplasia

•Cervical lesions (erosions, polyps, cervicitis)

•Myomas (uterine fibroid)

•Foreign bodies (IUD)

•Traumatic vaginal lesions

•Systemic Disease

•Disorders of blood coagulation
von Willebrand’s disease, leukemia, sepsis, Idiopathic thrombocytopenic purpurea

•Hypothyroidism > hyperthyroidism

•Liver cirrhosis
Problems with the Liver = problems with the cycle. Problems with Liver can cause problems with blood production – liver blood deficiency?

•Iatrogenic causes:
Always ask about medications and supplements! All of them can affect the body and the cycle. Even herbs/supplements the woman’s partner is taking can sometimes affect her. (Best example: testosterone creams)

–Oral/ injectable hormones or other steroids (birth control pill, HRT)

–Tranquilizers/ psychotropic drugs(Always ask about medications)

See the slides

Braindroppings

Here’s a fun note: fat creates estrogen. Women after menopause tend to get a belly. This is an estrogen deal – the sex stuff stops, the fat takes up the slack because the body needs some.

Every egg/follicle comes along at birth. Follicle develop per the monthly cycle. Egg is released into the peritoneal cavity and it’s the fingers of the fallopian tubes that are tasked with grabbing them. There are instances of both ectopic preggers and of preggs implanting in the peritoneum, too. One side may be more prolific than the other. Sides tend to take turns. One egg from each side when both are fertilized = fraternal twins.

Mucus is very sticky stretchy going to the cervix and sperm can climb it like a ladder right before ovulation. You need to keep the tissues very juicy so that the fertilized egg can travel freely.

A cervical opening that has never passed a baby will be a small round hole. One that has passed a child will be line like opening like a little mouth. Like the one on the left.

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Random fact: if you want to get rid of old medications, take them to a pharmacy and get rid of them that way. They will burn it to cinder. That’s better than flushing or putting them in the trash.

Normal ovarian cycle

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Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun