1 - Puberty and Menstruation

Question 1

What are the 4 stages of puberty?

Answer 1

1) Thelarche (breast)
2) Adrenarche (axilla) and Pubarche (pubic)
3) Growth Spurt
4) Menarche (1st menses)

Question 2

What is the average age you’d expect to see each of the 4 stages of development to begin?

Answer 2

Thelarche = 8-9
Adrenarche/Pubarche = 9-10
Growth spurt = 10-12
Menarche = 12-13

Question 3

What are the 4 main factors that determine the onset of development?

Answer 3

1) age
2) wt
3) FHx
4) body fat

Question 4

You have a patient who is 15 years old. She has experienced breast development and has pubic hair and underarm hair; however she has not yet experienced her menarche. Does this patient have amenorrhea? If so, is it primary or secondary?

Answer 4

No. If she has not had menarche by her 16th year, then she can be diagnosed with primary amenorrhea

Question 5

You have a 19 year old female who is sexually developed and had her menarche at age 14. She comes to see you today concerned that she has not had a period for the last 4 months. She has not been sexually active. What is your diagnosis?

Answer 5

Secondary amenorrhea

Question 6

A 14 yof comes to your office concerned that she has not noticed any breast development. When you question her, she denies having had a menses and on exam you do not detect any sexual hair growth. What is your diagnosis?

Answer 6

Primary amenorrhea.

Question 7

What is the role of the pituitary gland in menstruation?

Answer 7

It releases the gonadotropins FSH and LH

Question 8

What is the role of the hypothalamus in menstruation?

Answer 8

It releases GnRH (gonadotropin releasing hormone) which signals the pituitary to secrete gonadotripins

Question 9

How do you know when the CNS is mature and ready to begin coordination of menses?

Answer 9

The release of GnRH from the hypothalamus becomes pulsatile

Question 10

What 2 types of cells are involved in the “two cell hypothesis?”

Answer 10

granulosa cells and theca cells

Question 11

LH acts predominantly on _________ cells, while FSH acts predominantly on ___________ cells

Answer 11

LH–theca

FSH–granulosa

Question 12

What type of cells directly surround the follicle?

What type of cells are part of the connective tissue?

Answer 12

The follicle is directly surrounded by the granulosa cells (protective granny) and connective tissue is the theca cells

Question 13

What is the term for the dominant egg during ovulation?

Answer 13

corpus luteum

Question 14

What do the granulosa cells produce? (FSH dependent)

Answer 14

estradiol and progesterone

Question 15

What is produced by the theca cells? (LH dependent)

Answer 15

testosterone, which can be converted to estrogen

Question 16

Explain the two cell hypothesis

Answer 16

1) FSH acts on the granulosa cells to produce estradiol and progesterone.
2) LH acts on the theca cells to produce testosterone
3) testosterone moves locally from the theca cells into the granulosa cells and is converted to estrogen via FSH-induced aromatase activity.

(LH-dependent theca cells need FSH-dependent granulosa cells to convert testosterone to estrogen)

(Thank you google)

Question 17

What triggers ovulation?

Answer 17

LH surge

Question 18

What triggers the LH surge?

Answer 18

Rising estradiol levels in mid-cycle

Question 19

On day zero of the menstrual cycle, what does a woman experience

Answer 19

First day of bleeding

Question 20

At what point in the cycle does a woman ovulate?

Answer 20

14 days before the first day of period

Question 21

A woman menstruates every 54 days. What day did she ovulate?

Answer 21

Day 40

Question 22

How many days is an average menstrual cycle?

What is the range of “normal” frequency?

Answer 22

Average cycle is 28 days. Range is between 21 and 35 days

Question 23

What is the average duration of a cycle?

Answer 23

3-5 days

Question 24

What is ovarian estradiol responsible for?

Answer 24

Proliferative endometrium

Question 25

What is ovarian progesterone responsible for?

Answer 25

Secretory endometrium (ready to receive egg)