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CBL Case Semester – I

6th Week
LEARNING OBJECTIVE
1. What is menstrual cycle.
2. What are the phases of menstrual cycle.
3. What are the hormones released during the cycle how they effect and
controlled.
4. Explain histological changes in ovary and endometrium.
13 year old girl has come to the doctor’s office with her mother. Her mother is
worried about irregularity in the menstrual cycle. She says that the cycles are
infrequent that is occurring every 5 to 6 weeks, she also complains that
sometimes the bleeding continues for 10-15 days. Her mother is very anxious
and seeks advice.

On history mother explains the doctor that:


Menarche was 6 months back
She is at present in the12th day of her current menstrual cycle
Secondary sexual characters are well developed
Her blood reports show:
FSH 10.5 IU/L N= (6.42 IU/L)
Estrogen100 IU/L N=(149.74 IU/L)
LH 1.00 IU/L N=(3.96 IU/L)
Progesterone 0.01 IU/L N=(0.64 IU/L)
QUESTIONS
Q1) Why are this girls period irregular?

Ans) It is irregular because there is some hormonal imbalance.

Q2) What do you expect to see in the endometrium and ovaries at this stage
of the cycle?
Ans) IN THE OVARIES: The phases are
1. Follicular phase: From (1-13) day of the cycle when FSH released
from the anterior pituitary acts on the follicles of the ovary 12- 15
follicles are stimulated but only one reaches maturity and becomes
graffian follicle.
2. Luteal Phase: After ovulation till the next menses (day 14-28)
IN THE ENDOMETRIUM:
1. Menstrual phase: shedding of the endometrium encluding the based
layer (day 1-5)
2. Proliferative phase: Preliferation of the endometrium for embedding
of the ovum. There are three layers in endometrium.
 Compact layer
 Spongy layer
 Based layer

3. Secretory phase: It begins 2-3 days after ovulation till the day 28 or
next cycle.
Q3) What is LH surge or leutinization?

Ans) The release of LH from the anterior pituitary in response to estrogen


release from the graffian follicle(G.F) LH surge causes rupture of G.F and
brings ovulation. This process is called leutinization.

Q4) How the cyclical changes in ovary are related to phasic changes in the
estrogen and progesterone?
Ans) Estrogen level peaks at 12 day of the cycle or 48 hours before
ovulation, this inhibits the FSH secretion on the anterior pituitary and
releases LH from the pituitary gland and ruptures G.F and convert it into
corpus luteum, this now secretes estrogen and progesterone another
hormone called INHIBIN also secreted from corpus luteum (C.L) inhibits
FSH release.
Q5) What can be done for this patient?

Ans) 1.Reassurcuvce to the mother by the girl

2. It is due to physiological immaturity of the hypothalamus and


pituitary gland and persist for 2 years after which it will become normal.

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