{"id":408,"date":"2020-08-13T20:26:30","date_gmt":"2020-08-13T20:26:30","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=408"},"modified":"2022-08-16T16:37:05","modified_gmt":"2022-08-16T16:37:05","slug":"the-menstrual-cycle","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/basic_obgyn\/advanced-training\/the-menstrual-cycle\/","title":{"rendered":"The Menstrual Cycle"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/je_3BC9v0yw\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><br \/>\nDuration 9:54<\/p>\n<input type='hidden' bg_collapse_expand='69e9c84f15f113005872772' value='69e9c84f15f113005872772'><input type='hidden' id='bg-show-more-text-69e9c84f15f113005872772' value='Show Teaching Script'><input type='hidden' id='bg-show-less-text-69e9c84f15f113005872772' value='Hide Teaching Script'><button id='bg-showmore-action-69e9c84f15f113005872772' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Teaching Script<\/button><div id='bg-showmore-hidden-69e9c84f15f113005872772' ><\/p>\n<p>hello and welcome to this aapko basic<br \/>\n00:02<br \/>\nscience objective video about the<br \/>\n00:04<br \/>\nphysiology of the menstrual cycle the<br \/>\n00:07<br \/>\nobjectives of this video are to<br \/>\n00:09<br \/>\nsummarize how the hypothalamic pituitary<br \/>\n00:11<br \/>\novarian axis regulates ovarian function<br \/>\n00:13<br \/>\nand the menstrual cycle to explain how<br \/>\n00:16<br \/>\nthe HPA axis defines the phases of the<br \/>\n00:19<br \/>\nmenstrual cycle and to differentiate<br \/>\n00:21<br \/>\nbetween how the hpo axis interacts to<br \/>\n00:23<br \/>\ndefine the stages of the reproductive<br \/>\n00:25<br \/>\ncycle puberty menstruation and menopause<br \/>\n00:29<br \/>\nhey mama dad I found these in the<br \/>\n00:31<br \/>\nbathroom what are they for<br \/>\n00:33<br \/>\nwell that might take a while but let&#8217;s<br \/>\n00:36<br \/>\nstart from the beginning the menstrual<br \/>\n00:38<br \/>\ncycle is divided into menses follicular<br \/>\n00:41<br \/>\nphase and the luteal phase the average<br \/>\n00:44<br \/>\ncycle is between 22 to 35 days only<br \/>\n00:47<br \/>\nabout 15% of women have a 28-day cycle<br \/>\n00:50<br \/>\nthe follicular phase is variable between<br \/>\n00:53<br \/>\n14 to 21 days while the luteal phase is<br \/>\n00:56<br \/>\nfixed at 14 days by convention the first<br \/>\n01:00<br \/>\nday of the cycle is the first day of<br \/>\n01:02<br \/>\nmenstruation remember the goal of the<br \/>\n01:05<br \/>\nmenstrual cycle is to release a mature<br \/>\n01:06<br \/>\noocyte through a tight coordination of<br \/>\n01:08<br \/>\nstimulatory and inhibitory factors<br \/>\n01:11<br \/>\nthat&#8217;s right and to understand this<br \/>\n01:14<br \/>\ntightly woven story we must understand<br \/>\n01:16<br \/>\nthe players and how they interact from<br \/>\n01:18<br \/>\nfetal development through puberty kanata<br \/>\n01:22<br \/>\ntrip and releasing hormone or GnRH<br \/>\n01:24<br \/>\nis secreted by neuro endocrine cells in<br \/>\n01:26<br \/>\nthe hypothalamus it is secreted in a<br \/>\n01:29<br \/>\npulsatile fashion and is regulated by<br \/>\n01:31<br \/>\nneurotransmitters follicle stimulating<br \/>\n01:33<br \/>\nhormone or FSH and luteinizing hormone<br \/>\n01:36<br \/>\nLH are both protein hormones from the<br \/>\n01:40<br \/>\nanterior pituitary gland they are<br \/>\n01:42<br \/>\ncomposed of two subunits the alpha<br \/>\n01:44<br \/>\nsubunit resembles the thyroid<br \/>\n01:46<br \/>\nstimulating hormone and human chorionic<br \/>\n01:48<br \/>\ngonadotropin LH is critical in<br \/>\n01:51<br \/>\ntriggering ovulation estrogen plays an<br \/>\n01:54<br \/>\nimportant regulatory role in the<br \/>\n01:56<br \/>\nmenstrual cycle and stimulates blood<br \/>\n01:58<br \/>\nflow to the uterus progesterone is<br \/>\n02:00<br \/>\ncritical for endometrial receptivity as<br \/>\n02:03<br \/>\nwell as functioning as a uterine<br \/>\n02:05<br \/>\nrelaxant inhibin a is from the corpus<br \/>\n02:08<br \/>\nluteum while inhibin b is from the<br \/>\n02:11<br \/>\ndeveloping follicles and<br \/>\n02:12<br \/>\nhave a role in keeping FSH levels low in<br \/>\n02:15<br \/>\nthe follicular phase now let&#8217;s pause<br \/>\n02:18<br \/>\nthink and apply disruption of the<br \/>\n02:21<br \/>\nhypothalamic pituitary ovarian access<br \/>\n02:23<br \/>\nmay alter hormone levels that support<br \/>\n02:26<br \/>\nand control what three functions of the<br \/>\n02:28<br \/>\nreproductive cycle ovulation<br \/>\n02:31<br \/>\nreproduction and menstruation is the<br \/>\n02:33<br \/>\nanswer okay but when are you going to<br \/>\n02:37<br \/>\ntell me what this is for we&#8217;re getting<br \/>\n02:40<br \/>\nthere this is a complex physiology and<br \/>\n02:42<br \/>\nyou must understand the scene first so<br \/>\n02:44<br \/>\nas we were saying in the early<br \/>\n02:47<br \/>\nfollicular phase FSH has three effects<br \/>\n02:49<br \/>\non the ovaries it recruits follicles<br \/>\n02:52<br \/>\nit increases LH receptors and it<br \/>\n02:54<br \/>\nincreases aroma taste enzymes in the<br \/>\n02:56<br \/>\novary LH increases androgens in the<br \/>\n02:59<br \/>\ntheca cells androgens then diffuse into<br \/>\n03:02<br \/>\nthe granulosa cells where it is<br \/>\n03:03<br \/>\nconverted to estrogen through aroma<br \/>\n03:05<br \/>\ntaste estrogen acts synergistically with<br \/>\n03:08<br \/>\nFSH to increase the number of FSH<br \/>\n03:10<br \/>\nreceptors on the cells and increase<br \/>\n03:12<br \/>\nmitotic activity of the granulosa cells<br \/>\n03:15<br \/>\nit is important to remember early in the<br \/>\n03:18<br \/>\nfollicular phase there are low levels of<br \/>\n03:20<br \/>\nestrogen and progesterone the negative<br \/>\n03:22<br \/>\nfeedback on the anterior pituitary and<br \/>\n03:24<br \/>\nhypothalamus lead to an increase in GnRH<br \/>\n03:27<br \/>\npulsatilla T which leads to an increase<br \/>\n03:30<br \/>\nin FSH during the mid follicular phase<br \/>\n03:33<br \/>\nFSH stimulates<br \/>\n03:34<br \/>\nfolliculogenesis and ultimately<br \/>\n03:36<br \/>\nrecruitment of the dominant follicle<br \/>\n03:39<br \/>\nrecall that the oocyte has been halted<br \/>\n03:41<br \/>\nin meiosis 1 prophase prior to the<br \/>\n03:44<br \/>\ninitiation of the menstrual cycle with<br \/>\n03:47<br \/>\nthe initiation of the menstrual cycle<br \/>\n03:48<br \/>\nand the stimulation of the OS 8 by FSH<br \/>\n03:51<br \/>\nthe primary oocyte becomes a secondary<br \/>\n03:54<br \/>\noocyte and is again halted this time in<br \/>\n03:57<br \/>\nmeiosis 2 metaphase until fertilization<br \/>\n04:01<br \/>\ngranulosa so hypertrophy leads to an<br \/>\n04:04<br \/>\nincrease in estrogen through FSH<br \/>\n04:06<br \/>\nstimulation of aromatase estrogen goes<br \/>\n04:09<br \/>\non to stimulate proliferation of the<br \/>\n04:11<br \/>\nendometrium and eventually negative<br \/>\n04:13<br \/>\nfeedback on the hypothalamus and<br \/>\n04:15<br \/>\npituitary to suppress FSH and LH during<br \/>\n04:19<br \/>\nthe late follicular phase the dominant<br \/>\n04:21<br \/>\nfollicle is selected and estrogen levels<br \/>\n04:24<br \/>\nincrease<br \/>\n04:25<br \/>\nbefore ovulation FSH induces LH<br \/>\n04:28<br \/>\nreceptors in the ovary and lead to an<br \/>\n04:31<br \/>\nincrease in ovary intrauterine growth<br \/>\n04:33<br \/>\nfactor 1 or igf-1 estrogen causes the<br \/>\n04:37<br \/>\nendometrium to thicken as well as change<br \/>\n04:39<br \/>\ncervical mucus consistency<br \/>\n04:41<br \/>\nduring this phase estrogen goes from<br \/>\n04:44<br \/>\nbeing a positive feedback on FSH to<br \/>\n04:46<br \/>\nultimately being a negative feedback as<br \/>\n04:48<br \/>\nestrogen begins to have a negative<br \/>\n04:50<br \/>\nfeedback on FSH non-dominant follicles<br \/>\n04:53<br \/>\nundergo atresia and disappear this<br \/>\n04:56<br \/>\nusually occurs between days 5 to 7<br \/>\n04:59<br \/>\novulation occurs 34 to 36 hours after<br \/>\n05:02<br \/>\nthe start of the LH surge estrogen<br \/>\n05:05<br \/>\nlevels must be above 200 pika grams per<br \/>\n05:08<br \/>\nmilliliter for 50 hours to stimulate<br \/>\n05:11<br \/>\nadequate LH surge low levels of<br \/>\n05:14<br \/>\nprogesterone promote the positive<br \/>\n05:16<br \/>\nfeedback on LH LH is responsible for the<br \/>\n05:20<br \/>\nresumption of meiosis 1 prophase lutein<br \/>\n05:23<br \/>\nization of granulosa cells and synthesis<br \/>\n05:25<br \/>\nof prostaglandin and progesterone both<br \/>\n05:29<br \/>\nof these mechanisms along with lysosomal<br \/>\n05:31<br \/>\nenzymes are essential for follicular<br \/>\n05:33<br \/>\nrupture with ovulation we move to the<br \/>\n05:37<br \/>\nluteal phase the corpus luteum which<br \/>\n05:39<br \/>\nforms from the luminous ation of the<br \/>\n05:41<br \/>\nbrain illusive cells produces<br \/>\n05:43<br \/>\nprogesterone and prostaglandin the<br \/>\n05:45<br \/>\nlevels of progesterone peak at day 21<br \/>\n05:48<br \/>\nprogesterone leads to further negative<br \/>\n05:50<br \/>\nfeedback and decreased estrogen<br \/>\n05:52<br \/>\nproduction gluteal phase can be broken<br \/>\n05:55<br \/>\ninto the early and late luteal phase in<br \/>\n05:58<br \/>\nthe early luteal phase estrogen Peaks<br \/>\n06:01<br \/>\none day prior to ovulation during this<br \/>\n06:03<br \/>\nphase the dominant follicle completes<br \/>\n06:06<br \/>\nthe first meiotic division just before<br \/>\n06:09<br \/>\novulation granulosa cells produced<br \/>\n06:11<br \/>\nprogesterone which leads to the<br \/>\n06:13<br \/>\ncessation of endometrial mitosis and<br \/>\n06:16<br \/>\norganization of glands in the late<br \/>\n06:19<br \/>\nluteal phase progesterone comes mainly<br \/>\n06:21<br \/>\nfrom the corpus luteum progesterone has<br \/>\n06:24<br \/>\na negative feedback on LH and eventually<br \/>\n06:26<br \/>\ndecreased LH levels decrease the<br \/>\n06:28<br \/>\nprogesterone and estrogen made by the<br \/>\n06:30<br \/>\ncorpus luteum<br \/>\n06:32<br \/>\nthe oocyte is fertilized the early<br \/>\n06:34<br \/>\nembryo makes chorionic gonadotropin<br \/>\n06:36<br \/>\nwhich maintains the corpus luteum and<br \/>\n06:38<br \/>\nprogesterone production<br \/>\n06:40<br \/>\nif there is no fertilization the drop in<br \/>\n06:44<br \/>\nestrogen and progesterone levels<br \/>\n06:45<br \/>\ndecrease the blood supply to the<br \/>\n06:47<br \/>\nendometrium and leads to slaughtering of<br \/>\n06:49<br \/>\nthe endometrial lining usually 14 days<br \/>\n06:53<br \/>\nafter LH surge only the functional layer<br \/>\n06:56<br \/>\nof the endometrium is lost as it is<br \/>\n06:58<br \/>\nresponsive to hormonal stimulation in<br \/>\n07:01<br \/>\ncontrast the basal layer is not hormonal<br \/>\n07:04<br \/>\nirresponsive with atresia of the corpus<br \/>\n07:07<br \/>\nluteum there is a decrease in steroid<br \/>\n07:09<br \/>\nproduction and the hypothalamic<br \/>\n07:11<br \/>\npituitary axis is released from negative<br \/>\n07:14<br \/>\nfeedback leading to the eventual rise of<br \/>\n07:16<br \/>\nFSH and resumption of the next cycle now<br \/>\n07:20<br \/>\nlet&#8217;s pause think and apply in primary<br \/>\n07:24<br \/>\nhyperkinetic trophic hypogonadism where<br \/>\n07:27<br \/>\nthere is impaired response of gonadal<br \/>\n07:29<br \/>\ntissue to LH and FSH how is ovulation<br \/>\n07:31<br \/>\nand menstruation affected you would see<br \/>\n07:35<br \/>\nan ovulation primary infertility in<br \/>\n07:38<br \/>\nprimary amenorrhea recall that LH<br \/>\n07:41<br \/>\nstimulates theca cells to produce<br \/>\n07:43<br \/>\nandrogens which diffuse to nearby<br \/>\n07:45<br \/>\ngranulosa cells granulosa cells<br \/>\n07:48<br \/>\nstimulated by FSH convert androgens into<br \/>\n07:51<br \/>\nestrogen therefore in these patients<br \/>\n07:54<br \/>\nthere would be an overall lack of<br \/>\n07:56<br \/>\nestrogen up until now we have only<br \/>\n07:58<br \/>\ndescribed the hpo axis at maturity<br \/>\n08:01<br \/>\nhowever many factors are in play to keep<br \/>\n08:04<br \/>\nthe HPA axis quiet prior to puberty and<br \/>\n08:07<br \/>\nthen begin the hormonal cascade which<br \/>\n08:09<br \/>\ncontinues until menopause yes in the<br \/>\n08:12<br \/>\nfetus kanata trip and release is<br \/>\n08:14<br \/>\nsuppressed by circulating estradiol from<br \/>\n08:16<br \/>\nthe mother and placenta the acute<br \/>\n08:19<br \/>\ndecrease in estradiol at birth removes<br \/>\n08:22<br \/>\nthe negative feedback on the pituitary<br \/>\n08:23<br \/>\ngland Peak gunatit riffin production<br \/>\n08:26<br \/>\noccurs by 3 months but by age 4 gunatit<br \/>\n08:29<br \/>\ndriven levels are undetectable it is<br \/>\n08:33<br \/>\nimportant to remember that the highest<br \/>\n08:34<br \/>\nnumber of oocytes 5 to 7 million exists<br \/>\n08:38<br \/>\nat 20 to 24 weeks in utero the numbers<br \/>\n08:41<br \/>\ndecrease until birth with only 300,000<br \/>\n08:44<br \/>\nremaining<br \/>\n08:45<br \/>\nand arrested in meiosis 1 prophase the<br \/>\n08:49<br \/>\nHPA axis remains suppressed from age 4<br \/>\n08:51<br \/>\nto 10 by an unknown mechanism in<br \/>\n08:54<br \/>\nadolescence the hypothalamus begins to<br \/>\n08:57<br \/>\nsecrete gnrh initially during sleep<br \/>\n08:59<br \/>\neventually there is an evening postal<br \/>\n09:02<br \/>\nrelease and finally a 24 hour pulse Atal<br \/>\n09:05<br \/>\nrelease this begins the Cascade of<br \/>\n09:07<br \/>\npuberty which occurs about two and a<br \/>\n09:09<br \/>\nhalf years prior to menarchy<br \/>\n09:11<br \/>\nperimenopause is defined by menstrual<br \/>\n09:14<br \/>\nirregularities as well as menopausal<br \/>\n09:17<br \/>\nsymptoms such as hot flashes and night<br \/>\n09:18<br \/>\nsweats menopause is defined by the<br \/>\n09:21<br \/>\nabsence of menses for 12 months hormonal<br \/>\n09:24<br \/>\nirregularities occur three to ten years<br \/>\n09:26<br \/>\nbefore menopause the average age of<br \/>\n09:29<br \/>\nmenopause is 51.4 in the United States<br \/>\n09:32<br \/>\nthere is an elevated level of FSH and LH<br \/>\n09:35<br \/>\nduring this time there is no laboratory<br \/>\n09:38<br \/>\ntesting that can confirm menopause<br \/>\n09:39<br \/>\nstatus during the transition as FSH<br \/>\n09:42<br \/>\nlevels do not stabilize for one to two<br \/>\n09:44<br \/>\nyears of note if amenorrhea comes before<br \/>\n09:48<br \/>\nthe age of 40 it is considered a<br \/>\n09:50<br \/>\npremature ovarian failure and may<br \/>\n09:52<br \/>\nwarrant further workup menopause is<br \/>\n09:55<br \/>\nexperienced differently by different<br \/>\n09:57<br \/>\nwomen it is often accompanied by hot<br \/>\n09:59<br \/>\nflashes mood lability vaginal dryness<br \/>\n10:02<br \/>\ndyspareunia and urinary symptoms so you<br \/>\n10:06<br \/>\nsee Sun this is just a normal part of a<br \/>\n10:08<br \/>\nwoman&#8217;s reproductive lifespan and really<br \/>\n10:10<br \/>\nonly a small portion<br \/>\n10:11<br \/>\noh and the tampon you asked about it&#8217;s<br \/>\n10:14<br \/>\njust a small roll of cotton used to soak<br \/>\n10:17<br \/>\nup the menstrual flow at the beginning<br \/>\n10:18<br \/>\nof the cycle you have any questions and<br \/>\n10:21<br \/>\nthanks I think that was plenty<br \/>\n10:27<br \/>\nthis concludes this aapko basic science<br \/>\n10:30<br \/>\nobjective video on the physiology of the<br \/>\n10:32<br \/>\nmenstrual cycle you should be able to<br \/>\n10:34<br \/>\nsummarize how the HPA axis regulates<br \/>\n10:36<br \/>\novarian function and the menstrual cycle<br \/>\n10:38<br \/>\nexplain how the HPA axis defines the<br \/>\n10:41<br \/>\nphases of the menstrual cycle and the<br \/>\n10:44<br \/>\nstages of the reproductive cycle thanks<br \/>\n10:47<br \/>\nfor watching<br \/>\n11:10<br \/>\nyou<br \/>\n<\/div>\n<hr \/>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/111767349\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration 4:30<\/p>\n<hr \/>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/332997817\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><a href=\"https:\/\/vimeo.com\/332997817\/ffefd3664f\">Uterine Contractions<\/a> from <a href=\"https:\/\/vimeo.com\/user34406030\">Michael Hughey, MD<\/a> on <a href=\"https:\/\/vimeo.com\">Vimeo<\/a>.<\/p>\n<p><span style=\"color: #000000;\"><input type='hidden' bg_collapse_expand='69e9c84f1692d6028970151' value='69e9c84f1692d6028970151'><input type='hidden' id='bg-show-more-text-69e9c84f1692d6028970151' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9c84f1692d6028970151' value='Hide Transcript'><button id='bg-showmore-action-69e9c84f1692d6028970151' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#fafafa;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9c84f1692d6028970151' ><strong>What does the Uterus do All Day Long?<\/strong><\/span><\/p>\n<p>There once was an OBGYN who had an ultrasound scanner in his office, some extra time, and an inventive curiosity. He wanted to know what uteri did all day long. He thought that being a smooth muscle organ, it probably would contract from time to time, but he wasn\u2019t sure.<\/p>\n<p>So he persuaded some of his patients to lie very still while he scanned them continuously, while he watched the monitor screen carefully for any signs of contractions. He didn\u2019t see anything.<\/p>\n<p>So he called on his friend, another OBGYN, to watch the videotapes of his scanning to confirm that nothing was happening on them. His friend agreed, but found that watching these tapes was very tedious, so he hit the fast forward button.\u00a0 To his surprise, the uterus that appeared to be at rest at normal speed, was visibly contracting when he sped up the tape.<\/p>\n<p>Not only was the uterus contracting constantly, it was contracting in a very consistent pattern. The contractions mostly started at the fundus and squeezed down and out the cervix, just like it would do if it were trying to deliver a baby.<\/p>\n<p>With further study, several additional things were discovered that I think provide insight into several of the many unanswered questions in OBGYN.<\/p>\n<p>First, this down and out contraction pattern was quite evident during menses and also leading up to ovulation. But with ovulation, the contraction pattern reversed, with most contractions starting near the cervix and squeezing up and out the fallopian tube.<\/p>\n<p>Well, this is very important in terms of sperm transport. You see, sperm are microscopic creatures who couldn\u2019t swim one centimeter in an entire sperm lifetime. So how is it that sperm deposited around the cervix will appear at the fimbriated end of the fallopian tube 10 minutes later? It\u2019s because they\u2019re not swimming that far\u2026they\u2019re being propelled by the uterine muscular squeeze that picks them up at the cervix and delivers them deep into the fallopian tube, where the villous membrane further propels them to their target, the ovum.<\/p>\n<p>This may also be important in some cases of infertility. You see, not everyone followed this pattern of up and out squeezes during ovulation. For some women, the contractions were not coordinated, or the uterine squeezes were from right to left or left to right, not a pattern that would be expected to contribute to sperm transport.<\/p>\n<p>This may also be important in the pathogenesis of endometriosis. If, during menses, instead of most of the contractions being in a down and out pattern, many are starting near the cervix and squeezing up and out, I would expect more than an average amount of menstrual products to be propelled through the fallopian tubes and into the abdomen, where some may successfully implant. It takes no great imagination to connect these dots and say that if uterine contraction patterns are abnormal, that may increase the likelihood both of endometriosis and of infertility.<\/p>\n<p>Following ovulation, the uterine contractions largely stop, and the uterus remains relatively relaxed until shortly before menstruation. This period of quiescence coincides with the ovaries production of progesterone. Progesterone is known to have smooth muscle relaxing properties. It\u2019s absence immediately after conception is an established cause of infertility, and abnormally low levels are known as a \u201cluteal phase defect\u201d and are believed by many to lead to loss of an early pregnancy. The mechanism by which lack of progesterone leads to these early losses is not known, but one contributing factor may be lack of progesterone-inspired uterine contractile quiescence that is normally seen during the luteal phase.<\/p>\n<p>The progesterone effect on uterine contractions may also play a role in hormone-based contraceptives. These contraceptives are thought to exert their effects in a number of overlapping ways, among them ovulation suppression, and a change in cervical mucous making it less permeable to sperm. An additional factor may be the impact of progestins on uterine contractility, interfering with the ovulatory surge in cervix to fallopian tube uterine contractions, thus interfering with sperm transport to the fallopian tube.<\/p>\n<p>So what does a uterus do all day long? It contracts in ways that are beneficial to preserving health and our species.<\/p>\n<p>Dr. Hughey<\/p>\n<p><\/div><\/p>\n<hr \/>\n<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/ABch4VYOJZ0\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n<p>Duration 6:43<\/p>\n<input type='hidden' bg_collapse_expand='69e9c84f16a247048366247' value='69e9c84f16a247048366247'><input type='hidden' id='bg-show-more-text-69e9c84f16a247048366247' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9c84f16a247048366247' value='Hide Transcript'><button id='bg-showmore-action-69e9c84f16a247048366247' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9c84f16a247048366247' ><\/p>\n<p>I think the hardest thing about being on<br \/>\n00:09<br \/>\nstreets is probably being a female if<br \/>\n00:21<br \/>\nyou&#8217;re a woman you like your face clean<br \/>\n00:23<br \/>\nyou know you like feeling good selling<br \/>\n00:25<br \/>\ngood<br \/>\n00:26<br \/>\nyeah period times are not good times for<br \/>\n00:29<br \/>\nus hi how are you and very uncomfortable<br \/>\n00:37<br \/>\n[Music]<br \/>\n00:41<br \/>\nand every day I wake up and I do my<br \/>\n00:44<br \/>\ndaily routine because nobody wants to<br \/>\n00:46<br \/>\nsmell you know and that&#8217;s that&#8217;s kind of<br \/>\n00:49<br \/>\na big deal out here I&#8217;ve been doing this<br \/>\n00:55<br \/>\nfor so long I&#8217;m 27 years old<br \/>\n00:58<br \/>\nthis will be my eighth winter out here<br \/>\n01:00<br \/>\nstraight we had a pretty rough childhood<br \/>\n01:03<br \/>\ngrowing up my mom was a victim of<br \/>\n01:05<br \/>\ndomestic violence and so she put us<br \/>\n01:08<br \/>\nthrough a lot I went into the system she<br \/>\n01:11<br \/>\ngot custody of me again and basically<br \/>\n01:14<br \/>\nshe was like you know what I don&#8217;t want<br \/>\n01:16<br \/>\nyou in the system anymore but you can&#8217;t<br \/>\n01:18<br \/>\nbe here I hadn&#8217;t lived on him since I<br \/>\n01:21<br \/>\nwas you know 10 years old you know and I<br \/>\n01:24<br \/>\ntook care of myself it was no keeping me<br \/>\n01:26<br \/>\nhome anyway you know whether she if she<br \/>\n01:29<br \/>\nwanted to or not there&#8217;s so many kids<br \/>\n01:31<br \/>\nthat it&#8217;s like they fall through the<br \/>\n01:33<br \/>\ncracks I guess and that&#8217;s kind of what<br \/>\n01:36<br \/>\nhappened with me<br \/>\n01:39<br \/>\n[Music]<br \/>\n01:44<br \/>\nif you got cramps good luck hunchback<br \/>\n01:47<br \/>\nfor now they get a water bottle and some<br \/>\n01:50<br \/>\nhot water from Starbucks or something<br \/>\n01:51<br \/>\nyou know you can do that maybe some<br \/>\n01:55<br \/>\nsteal some motrin it&#8217;s a little<br \/>\n01:57<br \/>\nstressful you know it&#8217;s hot stuff and<br \/>\n01:59<br \/>\nyou&#8217;re running around trying to get what<br \/>\n02:01<br \/>\nyou need<br \/>\n02:02<br \/>\nevery month they are placed in a crisis<br \/>\n02:05<br \/>\nsituation you shouldn&#8217;t have to decide<br \/>\n02:07<br \/>\nbetween a pad and having lunch a big box<br \/>\n02:10<br \/>\nof tampons probably runs around $10 so<br \/>\n02:13<br \/>\nthat could be half of what we made<br \/>\n02:15<br \/>\nduring the day<br \/>\n02:17<br \/>\ntampons that I need that&#8217;ll leave me<br \/>\n02:20<br \/>\nwith nothing then they have then I can&#8217;t<br \/>\n02:22<br \/>\neat<br \/>\n02:23<br \/>\ntampons and pots are so expensive here I<br \/>\n02:26<br \/>\nmean like the cheapest box of tampons in<br \/>\n02:30<br \/>\nthis Walgreens right here it&#8217;s like a<br \/>\n02:32<br \/>\nlittle over seven dollars it&#8217;s more<br \/>\n02:34<br \/>\nmoney than me and my boyfriend spent on<br \/>\n02:36<br \/>\na meal together I would rather be<br \/>\n02:42<br \/>\nbe full this is not a poor issue this is<br \/>\n02:46<br \/>\nnot just about getting products to those<br \/>\n02:48<br \/>\nwho need them which is obviously a<br \/>\n02:50<br \/>\npriority this is really about bringing<br \/>\n02:53<br \/>\ndignity to women<br \/>\n03:02<br \/>\nmy tend to flock to places like this<br \/>\n03:04<br \/>\nwhich is like public parks where they<br \/>\n03:07<br \/>\nhave public bathrooms<br \/>\n03:09<br \/>\nI come here to Thompson Square Park and<br \/>\n03:12<br \/>\nI do my mind cleaning up in the in the<br \/>\n03:15<br \/>\nsink and get a big cat like with like<br \/>\n03:17<br \/>\nthe big McDonald cup and I fill it up<br \/>\n03:20<br \/>\nwith water actually like I&#8217;ll straddle<br \/>\n03:23<br \/>\nit this way you&#8217;re able to you know pour<br \/>\n03:26<br \/>\nwater and use the soap and and basically<br \/>\n03:30<br \/>\nwatch over the toilet and get a really<br \/>\n03:33<br \/>\ngood cleansing that&#8217;s the best way to<br \/>\n03:36<br \/>\nactually get you know your feminine<br \/>\n03:38<br \/>\nhygiene I&#8217;m accomplished there&#8217;s a like<br \/>\n03:43<br \/>\nlittle tricks that I&#8217;ve picked up along<br \/>\n03:45<br \/>\nthe way and it&#8217;s only a few minutes like<br \/>\n03:48<br \/>\na couple of minutes I&#8217;ve always just<br \/>\n03:50<br \/>\nused like paper towels or toilet paper<br \/>\n03:53<br \/>\nthem like that it was like a napkin from<br \/>\n03:56<br \/>\nsome you know there&#8217;s like big white<br \/>\n03:59<br \/>\nnapkins I be taught a paper and plastic<br \/>\n04:02<br \/>\nbags<br \/>\n04:03<br \/>\nI&#8217;m mind Bosworth makeup head dude<br \/>\n04:09<br \/>\nsocks I had to ball up the socket when I<br \/>\n04:12<br \/>\nhad an old tank top that was bleach<br \/>\n04:15<br \/>\nI had to go and rinse it out squeeze it<br \/>\n04:18<br \/>\nout dry it put it back like four times<br \/>\n04:20<br \/>\nthat dish sometimes if we didn&#8217;t get<br \/>\n04:22<br \/>\nthings right away we just sit still<br \/>\n04:24<br \/>\nbut you know just as still until we came<br \/>\n04:27<br \/>\nup with something and I&#8217;ve learned how<br \/>\n04:34<br \/>\nto make my own tampons out of pads so<br \/>\n04:37<br \/>\nyou take the pad I try to use tampons as<br \/>\n04:40<br \/>\nmuch as I can but tampons are expensive<br \/>\n04:43<br \/>\nand of course ladies you want to wash<br \/>\n04:44<br \/>\nyour hands first<br \/>\n04:46<br \/>\npeople tend to when they do give care<br \/>\n04:49<br \/>\npackages it&#8217;s usually pads and then you<br \/>\n04:52<br \/>\ntie them like this and but usually<br \/>\n04:54<br \/>\nthey&#8217;re a little longer and then you can<br \/>\n04:56<br \/>\ntie a knot here and then you can still<br \/>\n04:58<br \/>\nhave like the string basically that&#8217;s it<br \/>\n05:01<br \/>\nit produces infections especially in<br \/>\n05:04<br \/>\nsome cases when women are wearing<br \/>\n05:06<br \/>\ntampons for longer than they should<br \/>\n05:07<br \/>\ntoxic shock syndrome it is a health<br \/>\n05:11<br \/>\nissue<br \/>\n05:12<br \/>\n[Music]<br \/>\n05:18<br \/>\nunfortunately there really wasn&#8217;t a<br \/>\n05:20<br \/>\nclear policy on where women can access<br \/>\n05:22<br \/>\nthe products there&#8217;s different levels of<br \/>\n05:25<br \/>\nhomelessness there&#8217;s women in shelters<br \/>\n05:27<br \/>\nthere&#8217;s women in Subway&#8217;s there&#8217;s women<br \/>\n05:30<br \/>\nyou know sleeping in parks I used to be<br \/>\n05:32<br \/>\nin a shelter but I haven&#8217;t been in one a<br \/>\n05:35<br \/>\nlot because I don&#8217;t drink and that was a<br \/>\n05:37<br \/>\nchoice and that&#8217;s where most of the<br \/>\n05:39<br \/>\nclinic crowd is in shelter I feel safer<br \/>\n05:42<br \/>\nout on the streets and I went in a<br \/>\n05:44<br \/>\nshelter won&#8217;t do it I can do it I choose<br \/>\n05:46<br \/>\nto be out on the streets<br \/>\n05:48<br \/>\nso why we needed to legislate this as<br \/>\n05:51<br \/>\nopposed to just changing a policy here<br \/>\n05:53<br \/>\nor there is that it is now the law of<br \/>\n05:55<br \/>\nthe land<br \/>\n05:57<br \/>\nyou want to feel clean like everybody<br \/>\n05:59<br \/>\nelse you know what I mean I like being<br \/>\n06:02<br \/>\nout here but everybody has a story<br \/>\n06:05<br \/>\nsee you never you don&#8217;t really know<br \/>\n06:07<br \/>\npeople and everybody has a reason for<br \/>\n06:09<br \/>\nthe things that they do they do you know<br \/>\n06:12<br \/>\nso that&#8217;s kind of my story<\/p>\n<p><\/div>\n<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/Hzb95Ip2CVA\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration 10:13<\/p>\n<input type='hidden' bg_collapse_expand='69e9c84f16fa18055019904' value='69e9c84f16fa18055019904'><input type='hidden' id='bg-show-more-text-69e9c84f16fa18055019904' value='Show Teaching Script'><input type='hidden' id='bg-show-less-text-69e9c84f16fa18055019904' value='Hide Teaching Script'><button id='bg-showmore-action-69e9c84f16fa18055019904' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Teaching Script<\/button><div id='bg-showmore-hidden-69e9c84f16fa18055019904' ><\/p>\n<p>00:00<br \/>\naapko basic science topic dysmenorrhea<br \/>\n00:02<br \/>\nand endometriosis dysmenorrhea is pain<br \/>\n00:05<br \/>\nassociated with menstruation is the most<br \/>\n00:08<br \/>\ncommonly reported menstrual disorder<br \/>\n00:10<br \/>\nwith more than half of menstruating<br \/>\n00:11<br \/>\nwomen experiencing some pain each month<br \/>\n00:14<br \/>\nthe objectives of this video are<br \/>\n00:16<br \/>\nunderstand the histology of normal<br \/>\n00:19<br \/>\nendometrium and myometrium to understand<br \/>\n00:22<br \/>\nthe pathophysiology behind dysmenorrhea<br \/>\n00:24<br \/>\nand endometriosis and to understand the<br \/>\n00:26<br \/>\npharmacological treatment of<br \/>\n00:28<br \/>\ndysmenorrhea to review the clinical<br \/>\n00:30<br \/>\nmanagement of dysmenorrhea and<br \/>\n00:32<br \/>\nendometriosis please view the Affco<br \/>\n00:34<br \/>\nclinical educational videos topic number<br \/>\n00:36<br \/>\n46 and 38 let&#8217;s meet our patient &#8211;<br \/>\n00:40<br \/>\namenorrhea is a 19 year old female who<br \/>\n00:42<br \/>\npresents to your clinic for dysmenorrhea<br \/>\n00:44<br \/>\nmitakuye was age 12 and menstruation has<br \/>\n00:47<br \/>\nbeen painful for as long as she<br \/>\n00:48<br \/>\nremembers she is regular monthly cycles<br \/>\n00:51<br \/>\nthat lasts five days pain begins on day<br \/>\n00:54<br \/>\none gradually decreases and is gone by<br \/>\n00:56<br \/>\nday three she asks you why are my period<br \/>\n01:00<br \/>\nso painful to answer her question let&#8217;s<br \/>\n01:04<br \/>\ntake a closer look at the uterus and<br \/>\n01:05<br \/>\nendometrium the uterus is a muscular and<br \/>\n01:08<br \/>\nglandular organ the myometrium is a<br \/>\n01:10<br \/>\nhighly vascular muscular layer composed<br \/>\n01:13<br \/>\nof bundles of smooth muscle and<br \/>\n01:14<br \/>\ninterwoven layers responsible for<br \/>\n01:16<br \/>\nuterine contractions it surrounds the<br \/>\n01:19<br \/>\nendometrium the inner glandular layer<br \/>\n01:21<br \/>\nVanda metrium is composed of simple<br \/>\n01:24<br \/>\ncolumnar epithelium with some both<br \/>\n01:26<br \/>\ntubular glands as we zoom out it has two<br \/>\n01:29<br \/>\nlayers the stratum function nail in the<br \/>\n01:31<br \/>\nstratum basale also known as the stratum<br \/>\n01:33<br \/>\nfunction Ellis and basalis<br \/>\n01:35<br \/>\nthe stratum function nail is the luminal<br \/>\n01:38<br \/>\nlayer and contains the tubular glands<br \/>\n01:40<br \/>\nsurrounded by endometrial stroma as well<br \/>\n01:42<br \/>\nas the distal portions of the spiral<br \/>\n01:44<br \/>\narteries and it&#8217;s arterioles the stratum<br \/>\n01:46<br \/>\nfunction nail is hormonal irresponsive<br \/>\n01:48<br \/>\nin proliferates and degenerates with the<br \/>\n01:50<br \/>\nmenstrual cycle is the temporary layer<br \/>\n01:53<br \/>\nof the endometrium as lost during menses<br \/>\n01:55<br \/>\nthe stratum basale is deep to the<br \/>\n01:58<br \/>\nstratum functional and contains the<br \/>\n02:00<br \/>\nbasal portion of the endometrial glands<br \/>\n02:02<br \/>\nand the proximal portion of the spiral<br \/>\n02:04<br \/>\narteries<br \/>\n02:04<br \/>\nunlike the stratum function nail the<br \/>\n02:06<br \/>\nstratum basale<br \/>\n02:07<br \/>\nis retained during menses and does not<br \/>\n02:09<br \/>\nchange with the menstrual cycle<br \/>\n02:11<br \/>\nnow that we&#8217;ve reviewed the tissues<br \/>\n02:13<br \/>\nlet&#8217;s answer our patients question what<br \/>\n02:15<br \/>\nis going on to cause the pain primary<br \/>\n02:18<br \/>\ndysmenorrhea is painful menstruation<br \/>\n02:20<br \/>\nwithout a clinically identifiable<br \/>\n02:22<br \/>\nideology while secondary dysmenorrhea is<br \/>\n02:25<br \/>\npainful menstruation caused by an<br \/>\n02:27<br \/>\nidentifiable underlying condition such<br \/>\n02:29<br \/>\nas endometriosis primary dysmenorrhea is<br \/>\n02:33<br \/>\nmediated by prostaglandins let&#8217;s discuss<br \/>\n02:36<br \/>\nprostaglandins in more detail<br \/>\n02:38<br \/>\nprostaglandins contribute to painful<br \/>\n02:40<br \/>\nmenses in two ways prostaglandins<br \/>\n02:43<br \/>\nresulting contractions in ischemia as<br \/>\n02:45<br \/>\nwell as overall increased pain<br \/>\n02:46<br \/>\nsensitivity by increasing the resting<br \/>\n02:48<br \/>\nmembrane potential of pain neurons<br \/>\n02:50<br \/>\nresulting in painful menses<br \/>\n02:52<br \/>\nprostaglandins e 2 and F 2 alpha are<br \/>\n02:55<br \/>\nproduced by the endometrium in response<br \/>\n02:57<br \/>\nto progesterone levels which increased<br \/>\n02:59<br \/>\nduring the menstrual cycle and peak at<br \/>\n03:00<br \/>\nthe mid luteal phase<br \/>\n03:02<br \/>\nmost of the prostaglandins present<br \/>\n03:04<br \/>\nduring the endometrial Slough are<br \/>\n03:06<br \/>\ncreated at that moment secondary to a<br \/>\n03:08<br \/>\nshort half-life the prostaglandins are<br \/>\n03:10<br \/>\nliberated by cell wall break down from<br \/>\n03:12<br \/>\nthe shedding endometrium prostaglandins<br \/>\n03:14<br \/>\nmediate smooth muscle contraction and<br \/>\n03:16<br \/>\nact on the myometrium to cause<br \/>\n03:18<br \/>\ncontractions which lead to high entry<br \/>\n03:20<br \/>\nand pressures the increased intrauterine<br \/>\n03:22<br \/>\npressure exceeds arterial pressure the<br \/>\n03:25<br \/>\narteries serving the uterine tissues are<br \/>\n03:27<br \/>\ncompressed and caused mudra ischemia in<br \/>\n03:30<br \/>\nischemia anaerobic metabolites<br \/>\n03:33<br \/>\naccumulate and stimulate type C pain<br \/>\n03:35<br \/>\nneurons other causes of dysmenorrhea are<br \/>\n03:38<br \/>\nmediated by stretch receptors and other<br \/>\n03:40<br \/>\nmechanisms<br \/>\n03:41<br \/>\nlet&#8217;s pause read and apply when does<br \/>\n03:45<br \/>\npain with primary despond area typically<br \/>\n03:47<br \/>\noccur with each menstrual cycle pain<br \/>\n03:50<br \/>\ntypically begins right before<br \/>\n03:52<br \/>\nmenstruation as the level of<br \/>\n03:53<br \/>\nprostaglandins are high with endometrial<br \/>\n03:55<br \/>\nsloughing as menstruation continues and<br \/>\n03:59<br \/>\nthe endometrium is shed prostaglandins<br \/>\n04:01<br \/>\nand pain levels decrease the onset of<br \/>\n04:04<br \/>\nprimary dysmenorrhea in a woman&#8217;s life<br \/>\n04:06<br \/>\noften coincides with the onset of<br \/>\n04:08<br \/>\nmenarche consistent with their patient&#8217;s<br \/>\n04:10<br \/>\nhistory<br \/>\n04:11<br \/>\nconversely secondary dysmenorrhea is<br \/>\n04:13<br \/>\npainful menstruation caused by an<br \/>\n04:15<br \/>\nidentifiable underlying condition of the<br \/>\n04:17<br \/>\nreproductive system pain onset maybe<br \/>\n04:20<br \/>\nlater in life with the onset of the<br \/>\n04:22<br \/>\nunderlying condition<br \/>\n04:23<br \/>\nalso pain is often not historically<br \/>\n04:26<br \/>\nassociated timing with menses as in<br \/>\n04:28<br \/>\nprimary dysmenorrhea pay may begin a few<br \/>\n04:31<br \/>\ndays before menses may worsen is menses<br \/>\n04:33<br \/>\ncontinues and may not cease after it<br \/>\n04:35<br \/>\nends common causes of secondary<br \/>\n04:38<br \/>\ndysmenorrhea include endometriosis and<br \/>\n04:41<br \/>\nno meiosis public inflammatory disease<br \/>\n04:43<br \/>\nand uterine fibroids let&#8217;s go back to<br \/>\n04:47<br \/>\nour patient dish&#8217; has heard of<br \/>\n04:49<br \/>\nendometriosis before and wants to know<br \/>\n04:51<br \/>\nmore about it she asks you what is<br \/>\n04:53<br \/>\nendometriosis you discussed with her<br \/>\n04:56<br \/>\nthat endometriosis is the presence of<br \/>\n04:58<br \/>\nendometrial tissue outside of the uterus<br \/>\n05:01<br \/>\ncommon areas for these endometrial<br \/>\n05:03<br \/>\ndeposits include the ovaries fallopian<br \/>\n05:05<br \/>\ntubes called the sac Brad ligaments<br \/>\n05:08<br \/>\nuterus sacral ligaments and peritoneum<br \/>\n05:10<br \/>\ndeposits can be superficial or deeply<br \/>\n05:13<br \/>\ninfiltrating and are responsive to<br \/>\n05:15<br \/>\nhormonal stimulation like normal<br \/>\n05:17<br \/>\nendometrial tissue these extra uterine<br \/>\n05:20<br \/>\nlesions trigger inflammation leading to<br \/>\n05:22<br \/>\ndysmenorrhea the etiology of<br \/>\n05:25<br \/>\nendometriosis is thought to be<br \/>\n05:27<br \/>\nmultifactorial and there are multiple<br \/>\n05:29<br \/>\nhypotheses about its pathophysiology<br \/>\n05:31<br \/>\nincluding the retrograde menstruation<br \/>\n05:34<br \/>\ntheory aberrant lymphatic or vascular<br \/>\n05:36<br \/>\nspread of endometrial tissue and the<br \/>\n05:39<br \/>\nsalome achmed aphasia theory in<br \/>\n05:42<br \/>\nretrograde menstruation endometrial<br \/>\n05:44<br \/>\ndebris travels backwards through the<br \/>\n05:46<br \/>\nfallopian tube during menses into the<br \/>\n05:47<br \/>\nperitoneal cavity tissue implants on<br \/>\n05:50<br \/>\nvarious structures women without flow<br \/>\n05:53<br \/>\ntract anomalies have been shown to have<br \/>\n05:55<br \/>\nhigh incidence of endometriosis which<br \/>\n05:57<br \/>\nsupports this theory however most women<br \/>\n06:00<br \/>\nhave retrograde menstruation but only a<br \/>\n06:02<br \/>\nfew have endometriosis other factors<br \/>\n06:05<br \/>\nmust play a role and a material tissue<br \/>\n06:08<br \/>\nmay also spread through the lymphatic<br \/>\n06:09<br \/>\nand Vascular systems for instance<br \/>\n06:12<br \/>\nendometriosis has been found in public<br \/>\n06:14<br \/>\nlymph nodes of women with endometriosis<br \/>\n06:16<br \/>\nin addition endometriosis can be found<br \/>\n06:20<br \/>\nin unusual and distant locations like<br \/>\n06:22<br \/>\nthe lungs one way to remember the celiac<br \/>\n06:25<br \/>\nmetaplasia theory is to remember that<br \/>\n06:26<br \/>\nsilom means body cavity this theory<br \/>\n06:29<br \/>\nsuggests that cells in the peritoneum<br \/>\n06:31<br \/>\nare pluripotent and can undergo<br \/>\n06:33<br \/>\ntransformation to tissue identical to<br \/>\n06:35<br \/>\nmetrium this may explain endometrium<br \/>\n06:38<br \/>\nless of the ovary since both the ovary<br \/>\n06:39<br \/>\nand mullerian ducts which give rise to<br \/>\n06:41<br \/>\nthe endometrium are derived from the<br \/>\n06:43<br \/>\nsame epithelium this also helps explain<br \/>\n06:45<br \/>\nhow some girls have endometriosis prior<br \/>\n06:48<br \/>\nto menarche our patient wonders could I<br \/>\n06:51<br \/>\nhave endometriosis how would we know you<br \/>\n06:54<br \/>\nexplain how an ohmmeter iosys is often<br \/>\n06:56<br \/>\nsuspected clinically based on history<br \/>\n06:58<br \/>\nand physical exam and treated<br \/>\n06:59<br \/>\nempirically however the gold standard of<br \/>\n07:02<br \/>\ndiagnosis is laparoscopy in these<br \/>\n07:05<br \/>\nlaparoscopic images the top image is the<br \/>\n07:08<br \/>\ntypical lesion while the bottom is a<br \/>\n07:10<br \/>\nendometrium oh where there is<br \/>\n07:11<br \/>\nendometriosis within an ovary<br \/>\n07:14<br \/>\nendometrium us are also called chocolate<br \/>\n07:16<br \/>\ncysts<br \/>\n07:16<br \/>\nsince their contents can have a brown<br \/>\n07:18<br \/>\ntar-like appearance inflammatory cells<br \/>\n07:21<br \/>\nbreak down the red blood cells in the<br \/>\n07:22<br \/>\ntissue deposits resulting in pigmented<br \/>\n07:24<br \/>\nlesions as shown here lesions may be red<br \/>\n07:27<br \/>\nwhite or black<br \/>\n07:28<br \/>\nalso known as powder burn lesions and<br \/>\n07:30<br \/>\nthe older the lesion is the more likely<br \/>\n07:33<br \/>\nit is to be pigmented lesions can be<br \/>\n07:36<br \/>\nbiopsied and sent to pathology zooming<br \/>\n07:39<br \/>\nin this is a typical on Demetri attak<br \/>\n07:41<br \/>\nlesion with endometrial glands and blood<br \/>\n07:43<br \/>\nin the background of endometrial stroma<br \/>\n07:46<br \/>\nimaging and biomarkers can also be used<br \/>\n07:48<br \/>\nto aid diagnosis transvaginal ultrasound<br \/>\n07:51<br \/>\nAG Rafik an detect endometrium as if<br \/>\n07:53<br \/>\nthey are present and helps exclude other<br \/>\n07:55<br \/>\npotential causes of pelvic pain with<br \/>\n07:58<br \/>\nultra sonography and the metrio m&#8217;as can<br \/>\n08:00<br \/>\nrange in appearance from a hemorrhagic<br \/>\n08:02<br \/>\nfunctional assist to similar to<br \/>\n08:04<br \/>\nmalignancy on the left is a hemorrhagic<br \/>\n08:06<br \/>\ncyst basis have a reticular pattern with<br \/>\n08:10<br \/>\na fishnet or lacy appearance on the<br \/>\n08:12<br \/>\nright is a classic appearance of a<br \/>\n08:14<br \/>\nendometrium ah with a diffuse<br \/>\n08:15<br \/>\nground-glass<br \/>\n08:16<br \/>\nappearance ca-125 can be a biomarker<br \/>\n08:20<br \/>\nbut it&#8217;s not often clinically used in<br \/>\n08:22<br \/>\ngeneral levels correlate with disease<br \/>\n08:24<br \/>\nseverity though ca-125 has poor<br \/>\n08:26<br \/>\nsensitivity to detect mild disease as<br \/>\n08:30<br \/>\ndysmenorrhea is mediated by<br \/>\n08:32<br \/>\nprostaglandins release from endometrial<br \/>\n08:34<br \/>\ntissue<br \/>\n08:34<br \/>\nfirst-line treatment is targeted at<br \/>\n08:36<br \/>\ndecreasing prostaglandins as well as by<br \/>\n08:38<br \/>\nreducing a new material tissue for our<br \/>\n08:42<br \/>\npatient you recommend taking a<br \/>\n08:44<br \/>\nnon-steroidal anti-inflammatory drug<br \/>\n08:45<br \/>\nsuch as ibuprofen<br \/>\n08:47<br \/>\nin addition you recommend hormonal<br \/>\n08:49<br \/>\nsuppression such as with an oral<br \/>\n08:51<br \/>\ncontraceptive pill which will help<br \/>\n08:53<br \/>\ndecrease pain and service birth control<br \/>\n08:55<br \/>\nof needed<br \/>\n08:56<br \/>\nlet&#8217;s pause read and apply wire NSAIDs<br \/>\n09:00<br \/>\ncommonly used in the treatment of<br \/>\n09:01<br \/>\ndysmenorrhea NSAIDs inhibit cox-1 and<br \/>\n09:05<br \/>\ncox-2 in the Cascade leading to<br \/>\n09:07<br \/>\nprostaglandin production cox-1 and cox-2<br \/>\n09:10<br \/>\nare involved in the production of<br \/>\n09:12<br \/>\nprostaglandins from arachidonic acid<br \/>\n09:14<br \/>\ninhibiting cox-1 and cox-2 with NSAIDs<br \/>\n09:17<br \/>\nthus decreased prostaglandin \/ formation<br \/>\n09:20<br \/>\nhormone suppression another 1st line for<br \/>\n09:22<br \/>\ndysmenorrhea also decreases<br \/>\n09:24<br \/>\nprostaglandin production at the level of<br \/>\n09:26<br \/>\narachidonic acid hormonal suppression<br \/>\n09:29<br \/>\nsuch as with oral contraceptive pills<br \/>\n09:31<br \/>\ninhibits gonadotropin release which<br \/>\n09:33<br \/>\nsuppresses hormonal stimulation and<br \/>\n09:35<br \/>\nproliferation of the endometrium<br \/>\n09:36<br \/>\nresulting in endometrial atrophy but<br \/>\n09:40<br \/>\nthen and the metrium contains relatively<br \/>\n09:42<br \/>\nsmall amounts of arachidonic acid<br \/>\n09:44<br \/>\ndecreasing the amount of prostaglandins<br \/>\n09:46<br \/>\nthis concludes the Affco basic science<br \/>\n09:48<br \/>\nvideo and dysmenorrhea we&#8217;ve discussed<br \/>\n09:50<br \/>\nthe histology of normal and metrium in<br \/>\n09:52<br \/>\nmyometrium the pathophysiology behind<br \/>\n09:55<br \/>\ndysmenorrhea and endometriosis and the<br \/>\n09:57<br \/>\npharmacological treatment of<br \/>\n09:59<br \/>\ndysmenorrhea<br \/>\n10:00<br \/>\n[Music]<br \/>\n10:11<br \/>\nyou<\/p>\n<p><\/div>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\ufeff Duration 9:54 Duration 4:30 Uterine Contractions from Michael Hughey, MD on Vimeo. \ufeff Duration 6:43 Duration 10:13 &nbsp;<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":160,"menu_order":11,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-408","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/408","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/comments?post=408"}],"version-history":[{"count":4,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/408\/revisions"}],"predecessor-version":[{"id":1202,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/408\/revisions\/1202"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/160"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/media?parent=408"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}