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Reproduction > 3) Puberty & Abnormalities of Menstruation > Flashcards

3) Puberty & Abnormalities of Menstruation Flashcards

1
Q

At what age does puberty take place in girls?

A

8-13 years

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2
Q

At what age does puberty take place in boys?

A

9-14 years

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3
Q

What changes take place in a boy at puberty?

A

Genital development begins
Adrenarche (pubic hair growth)
Spermatogenesis begins
Growth spurt (10cm/year)

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4
Q

What changes take place in a girl during puberty?

A

Thelarche - breast bud development, 1st sign of puberty
Adrenarche - pubic hair growth
Growth spurt (9cm/year)
Menarche - onset of menstrual cycles

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5
Q

Puberty is under hormonal control. Which hormones are involved?

A

Onset of puberty:
Rise in FSH & LH (brain initiates)
due to Pulsatile GnRH secretion

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6
Q

What is the significance of body weight and puberty?

A

Body weight most important factor in timing of puberty

47kg critical weight for menarche

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7
Q

What happens to the reproductive cycle if body weight falls significantly below 47kg?

A

Reproductive cycle ceases

May be signalled to brain by leptins

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8
Q

At what weight does the growth spurt start in boys & girls?

A

30kg girls

55kg boys

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9
Q

What is adrenarche and how does it occur?

A

Pubic and axillary hair growth
Depends on androgens in both sexes
From adrenal glands in girls

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10
Q

What causes the growth spurt in girls & boys during puberty?

A

Growth hormone & Steroids
Ended by epiphyseal fusion
Oestrogen closes epiphyses earlier in girls
Growth spurt earlier & shorter in girls

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11
Q

What is thelarche?

A

Breast development

dependant on oestrogen

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12
Q

What is male genital development dependant on?

A

Testosterone

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13
Q

What is precocious puberty?

A

Development of signs of puberty before 8yrs in girls or 9yrs in boys

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14
Q

What causes precocious puberty?

A

Unknown
Can be due to:
Neurological causes, inappropriate GnRH secretion
- Pineal tumours, meningitis
Uncontrolled gonadotrophin or steroid secretion
- Hormone secreting tumours

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15
Q

What happens during pre-menopause and what age does it occur?

A 
>40 years
Changes in menstrual cycle
Follicular phase shortens, ovulation early or absent
Less oestrogen secreted
Less -ve feedback - FSH & LH rise
FSH rises more - loss of inhibin too
Reduced fertility
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16
Q

What changes occur during menopause?

A 
Cessation of menstrual cycles
Average age 49-50
Female has run out of follicles
Oestrogen falls dramatically
Less -ve feedback - FSH & LH rise
FSH rise dramatically - loss of inhibin
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17
Q

What are the vascular effects of menopause?

A

Hot flushes (80%)
Transient rises in skin temp
Relieved by oestrogen treatment

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18
Q

What are the effects of menopause on oestrogen sensitive tissues?

A

Uterus: regression of endometrium, shrinkage of myometrium
Thinning of cervix
Vaginal rugae lost (thinner, less distensible)
Involution of some breast tissue
Changes in skin
Reduction in bladder tone

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19
Q

What are the effects of menopause on bone?

A

Bone mass reduces by 2.5% per year for several years
Increased reabsorption relative to production
Osteoporosis (limited by oestrogen therapy)

20
Q

What are positives and negatives about Hormone Replacement Therapy (HRT)?

A

Relieves symptoms of menopause
Orally/topically by patch/gel
Can limit osteoporosis
Not advised for cardio-protection

21
Q

What is amenorrhoea?

A

Absence of periods for at least 6 months

22
Q

What is primary amenorrhoea?

A

Never had a period
Absence of menses by 14 with abscence of secondary sexual characteristics e.g. thelarche
or Absence by age 16 with normal SSC

23
Q

What is secondary amenorrhoea?

A

Established menstruation has ceased for 3 months in woman with history of regular cyclical bleeding
9 months in a woman with a history of irregular periods
Normally aged 40-55

24
Q

What is oligomenorrhoea?

A

Infrequent periods occurring at intervals of 35days - 6months

25
Q

What is dysmenorrhoea?

A

Painful periods

26
Q

What is menorrhagia?

A 
Heavy vaginal bleeding that is not DUB
Heavy periods
Excessive >80ml
Prolonged >7 day uterine bleeding
Usually ovulatory
27
Q

What is cryptomenorrhoea?

A

Periods occur but not visible due to obstruction in outflow tract

28
Q

What is dysfunctional uterine bleeding(dub)?

A

Abnormal bleeding, no obvious organic cause

29
Q

What are anovulatory cycles?

A

No ovulation/luteal phase

Oligo/Amenorrhoea +/- Mennorhagia

30
Q

What are ovulatory cycles?

A

Normal menstrual cycles + dysmenorrhoea/mastalgia (sore breasts)

31
Q

What causes amenorrhoea?

A

Origin is Hypothalamic/Pituitary, Ovarian or Outflow tract (uterus, vagina, cervix)

32
Q

How do problems with the hypothalamus/pituitary cause amenorrhoea?

A

Inadequate levels of FSH
Inadequately stimulated ovaries
Ovaries fail to produce enough oestrogen to stimulate the endometrium of uterus
Hypo/hyperthyroidism may cause secondary

33
Q

Name a cause of primary hypothalamic amenorrhoea

A

Kallmann syndrome - Inability to produce GnRH (& FSH subsequently)

34
Q

Name some causes of secondary hypothalamic amenorrhoea

A

Exercise amenorrhoea
Stress amenorrhoea
Eating disorders & weight loss (obesity, anorexia, bulimia)
Fall below critical weight 47kg & menses ceases

35
Q

Name some causes of secondary pituitary amenorrhoea

A

Sheehan syndrome - hypopituitarism
Hyperprolactinaemia
Haemochromatosis - ‘Iron overload’

36
Q

What is hypergonadotrophic amenorrhoea?

A

Ovarian amenorrhoea, ovary doesn’t respond to pituitary stimulation - low oestrogen levels
Lack of -ve feedback - elevated FSH levels in the menopausal range

37
Q

Name some causes of primary gonadal/end-organ amenorrhoea

A

Gonadal dysgenesis - e.g. Turner’s syndrome (45,X)
Androgen Insensitivity Syndrome
Receptor abnormalities for FSH & LH
Specific forms of congenital adrenal hyperplasia

38
Q

Name some causes of secondary gonadal/end-organ amenorrhoea

A 
Pregnancy
Anovulation
Menopause (or premature menopause)
Polycystic Ovarian Syndrome
Drug-induced
39
Q

What is outflow tract amenorrhoea?

A

Hypothalamic-Pituitary-Ovarian Axis is functional
FSH level normal
Problem with uterus/vagina/cervix

40
Q

Name some causes of primary outflow tract obstruction (amenorrhoea)

A

Uterine - Mullerian agenesis (15% primary)

Vaginal - Vaginal atresia, cryptomenorrhoea, imperforate hymen

41
Q

Name a cause of secondary outflow tract obstruction (amenorrhoea)

A

Intrauterine Adhesions (Asherman’s syndrome)

42
Q

How is amenorrhoea managed?

A

Depends on cause:
Hormone replacement
Modification of lifestyle factors (exercise, weight loss)

43
Q

Explain what happens when dysfunctional uterine bleeding (DUB) occurs when ovulation is not occurring

A

90%
CL does not form to release progesterone
Oestrogen is produce continuously - overgrowth of uterine endometrium & subsequent bleeding

44
Q

Explain what happens when dysfunctional uterine bleeding (DUB) occurs when ovulation is occurring

A

10%?
Progesterone secretion prolonged as oestrogen levels are low
Irregular shedding of uterine lining & erratic bleeding

45
Q

How is dysfunctional uterine bleeding (DUB) diagnosed?

A 
Exclusion of other causes:
hCG, TSH - Exclude pregnancy, thyroid
Coagulation workup
Smear if appropriate - Exclude cancer
Sample endometrium
46
Q

Name some causes of menorrhagia

A

Usually secondary to distortion of uterine cavity
Uterus unable to contract down on open venous sinuses in zona basalis
Or organic, endocrine, haemostatic, iatrogenic (fibroids, hypothyroidism)

47
Q

How is menorrhagia managed?

A

Progesterone

Reproduction (13 decks)

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