1 - Puberty and Menstruation Flashcards
What are the 4 stages of puberty?
1) Thelarche (breast)
2) Adrenarche (axilla) and Pubarche (pubic)
3) Growth Spurt
4) Menarche (1st menses)
What is the average age you’d expect to see each of the 4 stages of development to begin?
Thelarche = 8-9
Adrenarche/Pubarche = 9-10
Growth spurt = 10-12
Menarche = 12-13
What are the 4 main factors that determine the onset of development?
1) age
2) wt
3) FHx
4) body fat
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?
No. If she has not had menarche by her 16th year, then she can be diagnosed with primary amenorrhea
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?
Secondary amenorrhea
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?
Primary amenorrhea.
What is the role of the pituitary gland in menstruation?
It releases the gonadotropins FSH and LH
What is the role of the hypothalamus in menstruation?
It releases GnRH (gonadotropin releasing hormone) which signals the pituitary to secrete gonadotripins
How do you know when the CNS is mature and ready to begin coordination of menses?
The release of GnRH from the hypothalamus becomes pulsatile
What 2 types of cells are involved in the “two cell hypothesis?”
granulosa cells and theca cells
LH acts predominantly on _________ cells, while FSH acts predominantly on ___________ cells
LH–theca
FSH–granulosa
What type of cells directly surround the follicle?
What type of cells are part of the connective tissue?
The follicle is directly surrounded by the granulosa cells (protective granny) and connective tissue is the theca cells
What is the term for the dominant egg during ovulation?
corpus luteum
What do the granulosa cells produce? (FSH dependent)
estradiol and progesterone
What is produced by the theca cells? (LH dependent)
testosterone, which can be converted to estrogen
Explain the two cell hypothesis
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)
What triggers ovulation?
LH surge
What triggers the LH surge?
Rising estradiol levels in mid-cycle
On day zero of the menstrual cycle, what does a woman experience
First day of bleeding
At what point in the cycle does a woman ovulate?
14 days before the first day of period
A woman menstruates every 54 days. What day did she ovulate?
Day 40
How many days is an average menstrual cycle?
What is the range of “normal” frequency?
Average cycle is 28 days. Range is between 21 and 35 days
What is the average duration of a cycle?
3-5 days
What is ovarian estradiol responsible for?
Proliferative endometrium
