14: Menarche, Puberty, Menstrual Disorders

Question 1

5 peptide amines from hypothalamus

Answer 1

GnRH, TRH, CRH, PIF, somatostatin

Question 2

What part of hypothalamus produces GnRH?

Answer 2

Arcuate nucleus

Question 3

Estradiol effect on GnRH

Answer 3

Increases release of GnRH

Question 4

Six hormones from anterior pituitary

Answer 4

FSH, LH, TSH, prolactin, GH, ACTH

Question 5

Two hormones from posterior pituitary

Answer 5

Vasopressin, oxytocin

Question 6

Initial health visit for females: when it should occur

Answer 6

Between ages 13-15

Question 7

Median age of menarche

Answer 7

12.43 years old

Question 8

By age 15, what % of females will have had menarche?

Answer 8

98%

Question 9

Trelarche

Answer 9

Breast budding, occurs 2-3 years before puberty

Question 10

Median length of first menstrual cycle

Answer 10

34 days

Question 11

When is a workup indicated if a female isn’t having her period?

Answer 11

No period for 3 months

Question 12

Endocrine causes of irregular cycles

Answer 12

DM, PCOS, Cushings, thyroid dysfunction, ovarian failure

Question 13

Acquired conditions that cause irregular cycles

Answer 13

Stress-related hypothalamic dysfunction, meds, stress-induced amenorrhea, eating disorders, tumors

Question 14

What amount of blood loss is associated with anemia?

Answer 14

80+ ml

Question 15

Dysfunctional uterine bleeding

Answer 15

Abnormal uterine bleeding that cant be attributed to meds, blood dyscrasias, systemic disease, trauma, or an organic condition like pregnancy or cancer; usually caused by aberrations in HPO axis

Question 16

Primary amenorrhea

Answer 16

absence of menarche by age 13 without secondary sexual development OR by age of 15 with secondary sexual development

Question 17

Secondary amenorrhea

Answer 17

Absence of menstruation for 6 months

Question 18

Polymenorrhea

Answer 18

Frequent menses at intervals less than 21 days

Question 19

Menorrhagia

Answer 19

Excess/prolonged menses at 80+ ml or greater than 7 days at regular intervals

Question 20

Metrorrhagia

Answer 20

Irregular episodes of uterine bleeding

Question 21

Menometrorrhagia

Answer 21

Heavy and irregular uterine bleeding

Question 22

Intermesntrual bleeding

Answer 22

Scant bleeding at ovulation for 1-2 days

Question 23

Oligomenorrhea

Answer 23

Menstrual cycle at >35 days

Question 24

Lab tests to diagnose AUB

Answer 24

Pregnancy test, CBC, targeted screen for bleeding disorders, TSH, chlamydia

Question 25

Three populations that indicate an endometrial biopsy (EMBX)

Answer 25

1. Post-menopausal women with spotting or bleeding
2. 45-menopause with any AUB
3. <45 y/o with bleeding in the setting of unopposed estrogen or prolonged amenorrhea

Question 26

Some surgical treatment options for AUB

Answer 26

Polypectomy, myomectomy, D&C, uterine endometrial ablation, hysterectomy

Question 27

Diagnostic D&C

Answer 27

For irregular menstrual bleeding or post-menopausal bleeding to rule out endometrial hyperplasia or cancer

Question 28

Therapeutic D&C

Answer 28

For endometrial structural abnormalities

Question 29

Endometrial ablation

Answer 29

Radiofrequency in a bipolar mesh electrode + suctioning

Question 30

Types of hysterectomy routes

Answer 30

1. Total abdominal hysterectomy
2. Vaginal hysterectomy
3. Laparoscopic assisted vaginal hysterectomy
4. Da Vinci assisted hysterectomy

Question 31

What hormones increase between ages 8-11?

Answer 31

DHEA and androstenedione

Question 32

Cause of onset of puberty

Answer 32

Gradual loss of sensitivity of hypothalamus to negative feedback of sex steroids + loss of CNS inhibition of GnRH release

Question 33

Thelarche

Answer 33

Breast development - unilateral development and slight tenderness in first six months is not uncommon

Question 34

Pubarche / andrenarche

Answer 34

Pubic and axillary hair development

Question 35

What hormone is required for thelarche and pubarche?

Answer 35

Thelarche: estrogen
Pubarche: androgens