Medical school Gynaecology notes
KNOWLEDGE FOR FINALS
, Gynaecology
Normal layout of any history with 7 sections then specifically:
Menstrual history
Age of menarche, age of menopause, last period, normal cycle for them,
details of bleeding (IM bleeding to distinguish pathological from normal heavy
periods), any post-coital bleeding?
Pain
Dysmenorrhoea, dyspareunia (vaginismus etc.), pelvic pain
Urodynamic
Questions about continence, new onset incontinence, stress incontinence,
frequency, Nocturia, dysuria and prolapse causing retention
Fertility
Pregnancies, conceptions, fertility treatments, frequency of intercourse,
contraception use, Sexual health.
Sexual history
A useful acronym for gynaecological histories: MOSCC
Menstruation
Obstetrics
Sexual history
Contraception
Cervical history (smears if over 25)
,Menstruation
1. Ovarian cycle (follicle development and release)
2. Uterine cycle (thickening and shedding of tissue)
The pre-ovulatory phase is 14 days long, also known as the follicular
phase/menstrual phase (this is the time when a woman is losing blood)
The Post-ovulatory phase is 14 days long, also known as the luteal/secretory
phase.
Weeks 1 and 2
GNRH (gonadotrophin releasing hormone) is released to cause FSH and LH
to be released from the anterior pituitary gland.
GNRH is released from the hypothalamus in pulses after puberty. This travels
to the pituitary gland and stimulates it.
Development of a follicle
Layers of the follicle: Primary Oocyte in the centre, granulosa cells
surrounding the Oocyte and theca cells on the most outer part
During the first 10 days theca cells develop LH receptors – in response to LH
they release Androstenedione
During the first 10 days Granulosa cells develop FSH receptors – in response
to FSH they release aromatase, which converts androstenedione to
oestrogen.
As the follicles grow more oestrogen is hence produced, which acts as a
negative feedback to the hypothalamus to produce less GTRH and hence less
, FSH: decreasing to a level so that there is only enough to stimulate one
follicle.
On Days 10-14 granulosa cells also develop LH receptors
At this point the oestrogen produced causes a positive feedback response
on the pituitary gland, causing the released of more GNRH, FSH and LH
This causes rupture of the follicle and the release of the primary oocyte.
A Spike in oestrogen optimises the chance of fertilization between days 11
and 15, because it makes the vaginal mucosa more hospitable to sperm.
Weeks 3 and 4
After ovulation while LH is still high, the remains of the follicle turn into the
corpus luteum (made up of theca and granulosa cells)
The theca cells respond to decreased levels of LH by producing
progesterone.
The granulosa cells respond by producing inhibin, which negatively
feedback to prevent the production of oestrogen in the menstrual cycle.
Progesterone causes spiral arteries to grow and uterine glands to secrete
more mucus. This encourages thickening of the endometrium.
After day 15 the cervical mucus thickens, decreasing hospitability.
The corpus luteum is subsequently replaced by the corpus albicans, and
no longer produces hormones.
Oestrogen and progesterone decrease
The spiral arteries collapse and the endometrium prepares to slough off.
Menstrual abnormalities (menorrhagia and PCOS)
KNOWLEDGE FOR FINALS
, Gynaecology
Normal layout of any history with 7 sections then specifically:
Menstrual history
Age of menarche, age of menopause, last period, normal cycle for them,
details of bleeding (IM bleeding to distinguish pathological from normal heavy
periods), any post-coital bleeding?
Pain
Dysmenorrhoea, dyspareunia (vaginismus etc.), pelvic pain
Urodynamic
Questions about continence, new onset incontinence, stress incontinence,
frequency, Nocturia, dysuria and prolapse causing retention
Fertility
Pregnancies, conceptions, fertility treatments, frequency of intercourse,
contraception use, Sexual health.
Sexual history
A useful acronym for gynaecological histories: MOSCC
Menstruation
Obstetrics
Sexual history
Contraception
Cervical history (smears if over 25)
,Menstruation
1. Ovarian cycle (follicle development and release)
2. Uterine cycle (thickening and shedding of tissue)
The pre-ovulatory phase is 14 days long, also known as the follicular
phase/menstrual phase (this is the time when a woman is losing blood)
The Post-ovulatory phase is 14 days long, also known as the luteal/secretory
phase.
Weeks 1 and 2
GNRH (gonadotrophin releasing hormone) is released to cause FSH and LH
to be released from the anterior pituitary gland.
GNRH is released from the hypothalamus in pulses after puberty. This travels
to the pituitary gland and stimulates it.
Development of a follicle
Layers of the follicle: Primary Oocyte in the centre, granulosa cells
surrounding the Oocyte and theca cells on the most outer part
During the first 10 days theca cells develop LH receptors – in response to LH
they release Androstenedione
During the first 10 days Granulosa cells develop FSH receptors – in response
to FSH they release aromatase, which converts androstenedione to
oestrogen.
As the follicles grow more oestrogen is hence produced, which acts as a
negative feedback to the hypothalamus to produce less GTRH and hence less
, FSH: decreasing to a level so that there is only enough to stimulate one
follicle.
On Days 10-14 granulosa cells also develop LH receptors
At this point the oestrogen produced causes a positive feedback response
on the pituitary gland, causing the released of more GNRH, FSH and LH
This causes rupture of the follicle and the release of the primary oocyte.
A Spike in oestrogen optimises the chance of fertilization between days 11
and 15, because it makes the vaginal mucosa more hospitable to sperm.
Weeks 3 and 4
After ovulation while LH is still high, the remains of the follicle turn into the
corpus luteum (made up of theca and granulosa cells)
The theca cells respond to decreased levels of LH by producing
progesterone.
The granulosa cells respond by producing inhibin, which negatively
feedback to prevent the production of oestrogen in the menstrual cycle.
Progesterone causes spiral arteries to grow and uterine glands to secrete
more mucus. This encourages thickening of the endometrium.
After day 15 the cervical mucus thickens, decreasing hospitability.
The corpus luteum is subsequently replaced by the corpus albicans, and
no longer produces hormones.
Oestrogen and progesterone decrease
The spiral arteries collapse and the endometrium prepares to slough off.
Menstrual abnormalities (menorrhagia and PCOS)
