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15. Reproductive > 3. Puberty and Abnormalities of Menstruation > Flashcards

3. Puberty and Abnormalities of Menstruation Flashcards

1
Q

What is the difference between primary and secondary sexual characteristics?

A

Primary are established before birth, secondary only come when the reproductive system is activated in puberty.

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2
Q

What are the ranges of ages for the beginning of puberty in males and females?

A

Males: 9-14 years
Females: 8-13 years

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3
Q

What are the changes in the male at puberty?

A

Genital development begins, pubic hair growth (adrenarche), spermatogenesis begins, growth spurt.

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4
Q

How much do males grow per year during their growth spurt?

A

10cm

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5
Q

What are the changes in the female at puberty?

A

Breast bud (thelarche), pubic hair growth (adrenarche), menstrual cycle (menarche), growth spurt.

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6
Q

How much do females grow per year during their growth spurt?

A

9cm

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7
Q

What initiates puberty?

A

The brain.

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8
Q

What hormonal changes are associated with the start of puberty?

A

Steady rise in FSH and LH caused by pulsatile GnRH.

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9
Q

What is the most important factor in the timing of puberty?

A

Body weight.

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10
Q

What is the critical weight for menarche?

A

47kg

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11
Q

What is the growth spurt starting weight for males and females?

A

Males: 55kg
Females: 30kg

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12
Q

What does adrenarche (pubic and axillary hair) depend on?

A

Androgens in both sexes.

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13
Q

How do growth spurts differ between males and females?

A

Girls have earlier and shorter growth spurts so men are generally larger due to their longer and faster growth spurt.

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14
Q

What do growth spurts depend on?

A

Growth hormone and steroids in both sexes.

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15
Q

What ends growth spurts and how does this differ between males and females?

A

Ends in epiphyseal fusion. In girls, oestrogen closes the epiphyses earlier.

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16
Q

What is thelarche (breast development) dependent on?

A

Oestrogen.

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17
Q

What is male genital development dependent on?

A

Testosterone.

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18
Q

What is precocious puberty?

A

The signs of puberty before the age of 8 in girls or 9 in boys.

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19
Q

What can precocious puberty be due to?

A

Neurological causes (early stimulation of central maturation giving early, inappropriate GnRH secretion - pineal tumours or meningitis), or uncontrolled gonadotrophin or steroid secretion (hormone secreting tumour).

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20
Q

When is pre-menopause?

A

> 40 years.

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21
Q

What are the changes in the menstrual cycle during pre-menopause?

A

Follicle phase shortens so ovulation is early or absent, less oestrogen secreted so less negative feedback and LH and FSH rise (FSH rises more-so as loss of inhibin), reduced fertility but still possible to get pregnant.

22
Q

What is the menopause?

A

Cessation of the menstrual cycle as the female has run out of follicles.

23
Q

What is the average age of menopause?

A

49-50 years.

24
Q

What are the hormonal changes in menopause?

A

Oestrogen levels fall dramatically so less negative feedback and LH and FSH rise (FSH rises dramatically due to loss of inhibition from inhibin).

25
Q

What are the vascular effects of the menopause?

A

Hot flushes in 80% of women, transient rises in skin temperature and flushes.

26
Q

How are hot flushes relieved?

A

By oestrogen treatment.

27
Q

What are the effects of the menopause on oestrogen sensitive tissues?
(Uterus, cervix, vagina, breasts, skin, bladder)

A

Uterus - regression of endometrium, shrinkage of myometrium, shrinks away into a very small organ.
Thinning of cervix.
Vaginal rugae lost - thinner, less distensible.
Involution of some breast tissue.
Changes in skin.
Reduction in bladder tone.

28
Q

What are the effects of the menopause on bone?

A

Bone mass reduces by 2.5% per year from increased reabsorption relative to production. Causes osteoporosis.

29
Q

What can limit the effects of the menopause on bone?

A

Oestrogen therapy.

30
Q

What are the goals of hormone replacement therapy?

A

Relieves symptoms of the menopause and can limit osteoporosis.

31
Q

What is amenorrhoea?

A

Absence of periods for at least 6 months.

32
Q

What is primary amenorrhoea?

A

Never had a period, absence of menses by 14 with absence of secondary sexual characteristics or absence by 16 with normal secondary sexual characteristics.

33
Q

What is secondary amenorrhoea?

A

Established menstruation has ceased for three months in a woman with a history of regular cyclic bleeding or nine months in a woman with a history of irregular periods.

34
Q

What is oligomenorrhoea?

A

Infrequent periods occurring at intervals of 35 days to 6 months.

35
Q

What is dysmenorrhoea?

A

Painful periods.

36
Q

What is menorrhagia?

A

Heaving periods. Excessive >80ml and prolonged >7 days uterine bleeding.

37
Q

What is cryptomenorrheoa?

A

Periods occur but aren’t visible due to obstruction in the outflow tract.

38
Q

What is dysfunctional uterine bleeding (DUB)?

A

Abnormal bleeding, no obvious organic cause.

39
Q

What are anovulatory cycles?

A

No ovulation/luteal phase, oligo/amenorrhoea +/- menorrhagia.

40
Q

What are ovulatory cycles?

A

Normal menstrual cycles with dysmenorrhea/mastalgia (sore breasts).

41
Q

What are the possible origins of amenorrhea?

A

Hypothalamic/pituitary, ovarian tract, or outflow tract (uterus, vagina, cervix).

42
Q

What is hypothalamic/pituitary amenorrhoea?

A

Inadequate levels of FSH lead to inadequately stimulated ovaries, which then fail to produce enough oestrogen to stimulate the endometrium of the uterus -> amenorrhoea.

43
Q

What can cause primary and secondary hypothalamic amenorrhoea and secondary pituitary amenorrhoea?

A

Primary - Kallmann syndrome = inability to produce GnRH => can’t produce FSH.
Secondary - exercise amenorrhoea = from exercise, stress amenorrhoea = from eating disorders and weight loss below 47kg critical weight.
Secondary pituitary - Sheehan syndrome = hypopituitarism, hyperprolactinaemia, haemochromastosis = iron overload.

44
Q

What is gonadal/end-organ amenorrhoea?

A

The ovary doesn’t respond to pituitary stimulation so there are low oestrogen levels. Lack of negative feedback from oestrogen means FSH is elevated to levels in the menopausal range.

45
Q

What are the causes of primary and secondary amenorrhoea?

A

Primary: gonadal dysgenesis, androgen insensitivity syndrome, receptor abnormalities for FSH and LH, congenital adrenal hyperplasia.
Secondary: pregnancy, anovulation, menopause, polycystic ovarian syndrome, drug-induced.

46
Q

What is outflow tract amenorrhoea?

A

Hypothalamic-pituitary-ovarian axis is functional so FSH is normal.

47
Q

What are the causes of primary and secondary outflow tract obstruction?

A

Primary: uterina - Mullarian agenesis in 15%; vaginal - vaginal atresia, cryptomenorrhoea, imperforate hymen.
Secondary: intrauterine adhesions in Asherman’s syndrome.

48
Q

How is amenorrhoea managed?

A

Depends on the cause. If insufficiency in hormone, hormone replacement. If lifestyle, modify factors.

49
Q

What are the causes of dysfunctinoal uterine bleeding?

A

90% from when ovulation isn’t occurring so the corpus luteum doesn’t form to release progesterone meaning oestrogen is produced continuously -> overgrowth of uterine bleeding and subsequent bleeding.
10% with ovulation but progesterone secretion is prolonged due to low oestrogen -> irregular shedding of uterine lining and erratic bleeding.

50
Q

What causes of bleeding must be ruled out in diagnosing DUB?

A

HCG, TSH to exclude pregnancy/thyroid problem, coagulation workup, smear to exclude cancer, sample endometrium.

51
Q

What is menorrhagia from?

A

Secondary to distortion of the uterine cavity, leading to the uterus being unable to contract down on open venous sinuses in zona basalis.

52
Q

How is menorrhagia managed?

A

With progesterone.

15. Reproductive (12 decks)

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