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*GIGU I > 40. Menarche, Pubarche, and Mentrual Disorders > Flashcards

40. Menarche, Pubarche, and Mentrual Disorders Flashcards

1
Q

4 cycles associated with female reproduction (i.e., sources of control)

A

Hypothalamic
Pituitary
Ovarian
Endometrial

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2
Q

The ideal menstrual cycle is ____ days, with ovulation occurring day _____

The first day of bleeding is cycle day _____

The average length of bleeding is _____

Average blood loss is _____

A

28; 14

1

3-7

30cc

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3
Q

Mean age of menarch = _____

Mean age of menopause = ____

A

13; 52

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4
Q

Normal menstrual cycles in young females in terms of menarche, mean cycle interval, menstrual cycle interval, menstrual flow length, and menstrual product use

A

Menarch = 12.43 yrs

Mean cycle interval = 32.2 days first year

Menstrual cycle interval = 21-45 days

Menstrual flow length = 7 days or less

Menstrual product use = 3-6 pads or tampons/day

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5
Q

During the luteal phase, the follicle is transformed into the corpus luteum. This phase is 12-14 days long, and the corpus luteum lasts _____ days

A

9-10

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6
Q

Menses occurs due to withdrawal of _____ and _____. Spiral arteries ______, resulting in necrosis/ischemia of endometrium

A

Progesterone (P4), estrogen (E2); constrict

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7
Q

During proliferative phase of endometrium, endometrial glands are deep within ____ layer

This phase is responsive to ______, which causes growth and thickening, elongation of spiral arteries, and glands appear straight

A

Basalis; estrogen

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8
Q

The secretory phase of the endometrium involves _____ stimulation from corpus luteum; secretions increase from glandular cells and they have sawtooth appearance

A

Progesterone

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9
Q

_____ is characterized by development of secondary sexual characteristics and reproductive ability

A

Puberty

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10
Q

What factors affect onset of puberty?

A 
Genetics
Geographic location
Nutritional status
Excessive exercise - Frisch theory
Psychologic factors
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11
Q

T/F: age of menarch has increased through history

A

False, has decreased from age 17 in 1840, age 13 in 1979, and today age 12.4

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12
Q

During the fetal/newborn period, there is complex integration of negative feedback mechanisms. At 20 weeks gestation, there is _____ rise, as well as _______ rise to encourage organ dev’t

A

FSH/LH; glucocorticoid

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13
Q

Placental and maternal estrogen provide negative feedback for _______, this negative feedback is lost after delivery of the placenta

A

Gonadotropins

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14
Q

The fetal adrenal gland produces _____, which regresses after delivery. This precursor is used by the placenta and other pathways

A

DHEA-S

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15
Q

What axis is suppressed between the ages of 4-10 years old?

A

Hypothalamic-pituitary-ovarian axis

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16
Q

The hypothalamic-pituitary system regulating gonadotropin release is termed the ______

A

Gonadostat

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17
Q

Low levels of gonadotropins and sex steroids during this prepubertal period are the function of what 2 mechanisms?

A

Gonadostat - sensitive to the negative feedback of low circulating estradiol

Intrinsic CNS - inhibition of the hypothalamic gonadotropin-releasing hormone (GnRH) secretion

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18
Q

Between the ages of 8-11, there is an increase in ______, _____, and ______

Adrenal androgen production increases, and there is differentiation by the ____ ____ of the adrenal cortex

A

DHEA; DHEA-S, and androstenedione

Zona reticularis

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19
Q

The rise in adrenal androgens in late childhood leads to growth of _____ and _____

A

Axillary and pubic hair

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20
Q

Around 11 years of age, there is gradual loss of sensitivity by the _______ to negative feedback of sex steroids. Intrinsic loss of CNS inhibition of hypothalamic ____release

A

Gonadostat; GnRH

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21
Q

Sleep-associated increses in ____ secretion occur and gradually shift into adult type secretory patterns

A

GnRH

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22
Q

GnRH increases at onset of puberty lead to what changes?

A

Promotion of ovarian follicular maturation and sex steroid production

Secondary sexual characteristics

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23
Q

By mid to late puberty, the positive-feedback mechanism of _____ on LH release from AP gland is complete and ovulatory cycles are established

A

Estradiol

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24
Q

Physiology of puberty summary

A

HPA axis suppressed ages 4-10

Age 8-11 — androgens increase, adrenal cortex differentiation occurs, adrenarche starts (DHEA, DHEA-S)

Age 11-12 — negative feedback intrinsic control lessens, GnRH increases, role of leptin, gonadotropins increase, ovarian follicular maturation

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25
Q

______ is the first physical sign of puberty in females, which requires ______

A

Thelarche (breast development); estrogen

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26
Q

Pubarche/adrenarche (pubic hair/axillary hair development) requires ______

A

Androgens

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27
Q

Maximal growth or peak height velocity occurs 2 years earlier in _____; occurs about 1 year _____ onset of menses

A

Girls; before

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28
Q

Menarche requires ______ GnRH from the hypothalamus, FSH and LH from the _____, estrogen and progesterone from the ______, and a normal outflow tract

A

Pulsatile; AP; ovaries

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29
Q

Tanner staging based on breast tissue

A

Stage 1: preadolescent; elevation of papilla only

Stage 2: breast bud stage; elevation of breast and papilla as small mound with enlargement of areolar region

Stage 3: further enlargement of breast and areola without separation of their contours

Stage 4: projection of areola and papilla to form a secondary mound above the level of the breast

Stage 5: mature stage; projection of papilla only, resulting from recession of the areola to the general contour of the breast

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30
Q

Tanner staging based on pubic hair

A

Stage 1: preadolescent; absence of pubic hair

Stage 2: sparse hair along labia, hair downy with slight pigment

Stage 3: hair spreads sparsely over junction of pubis; dark and coarse

Stage 4: adult type hair; no spread to medial thigh

Stage 5: adult type hair with spread to medial thighs assuming inverted triangle pattern

31
Q

Average duration of pubarche

A

4.5 years

32
Q

The growth spurt that occurs with pubarche is mediated by what 3 hormones?

A

GH
Insulin
ILGF

33
Q

Fusion of the long bones during pubarche is mediated by ____ production

A

Steroid

34
Q

What is the difference in bone mass in males vs. females prior to vs. after puberty?

A

Prior to puberty: bone mass same in males/females

After pubterty: females have more body fat and less skeletal bone mass

35
Q

Menarche occurs 2-3 years after ________, roughly tanner stage _____

Menarche is rare before tanner stage ____

A

Thelarche; IV

III

36
Q

98% of females will have had menarche by age 15, if they do not, it is called ______

A

Primary amenorrhea

37
Q

What is the purpose of the initial health visit to OB/GYN in females age 13-15?

A

PMH, PSH and FH

Review of normal dev’t

Educate on safe sex and STIs

Screen for at-risk behavior

Exam may be indicated

Vaccinations and HPV info

38
Q

What is the purpose of regular preventative health visit for OBGYN?

A 
Annual exam
Cervical cancer screening
Mammography
Contraceptives
Reproductive choices
Vaccines
Review of health history
39
Q

What are the 4 most common causes of menstrual irregularity?

A

Pregnancy
Endocrine causes
Acquired conditions
Tumors

40
Q

What are endocrine causes of menstrual irregularity?

A 
Poorly controlled DM
PCOS
Cushing’s
Thyroid dysfunction
Premature ovarian failure
Late onset congenital adrenal hyperplasia
41
Q

Acquired conditions that cause menstrual irregularity

A

Stress-related hypothalamic dysfunction
Medications
Exercise-induced amenorrhea
Eating disorders

42
Q

Tumors that cause menstrual irregularity

A

Ovarian tumors
Adrenal tumors
Prolactinomas

43
Q

What are important considerations when evaluating abnormal uterine bleeding?

A

Good menstrual hx (frequency, irregularity, duration, blood loss)

Pelvic exam

Rule out pregnancy!!!

44
Q

No menstruation has occurred by the age of 13 without secondary sexual development or by age of 15 with secondary sexual development

A

Primary amenorrhea

45
Q

Absence of menses for 6+ months

A

Secondary amenorrhea

46
Q

Abnormally frequent menses at intervals <21 days

A

Polymenorrhea

47
Q

Excessive and/or prolonged menses (>80mL and >7days) occurring at regular intervals

A

Menorrhagia

48
Q

Irregular episodes of uterine bleeding

A

Metrorrhagia

49
Q

Heavy and irregular uterine bleeding

A

Menometrorrhagia

50
Q

Scant bleeding at ovulation for 1-2 days

A

Intermenstrual bleeding

51
Q

Menstrual cycles at >35 day cycles

A

Oligomenorrhea

52
Q

Mnemonic for the causes of dysfunctional uterine bleeding

A

PALM (structural) COEIN (functional)

P = polyp
A = adenomyosis
L = leiomyoma
M = malignancy and hyperplasia
C = coagulopathy
O = ovulatory dysfunction
E = endometrial
I = iatrogenic
N = not yet classified
53
Q

Soft friable protrusion of endometrium into the endometrial cavity associated with menorrhagia, spontaneous, or post-menopausal bleeding

A

Endometrial polyps

54
Q

What are ultrasound findings associated with endometrial polyps

A

Focal thickening of endometrial stripe

Saline hysterosonography and hysteroscopy allows for better detection

55
Q

T/F: endometrial polyps are usually benign

A

True; more concerning if symptomatic or postmenopausal

56
Q

Extension of endometrial glands and stroma into uterine musculature (>2.5 mm beneath basalis layer), sometimes associated with endometriosis, and the associated islands of cells do not participate in secretory cycles

A

Adenomyosis

57
Q

Symptoms of adenomyosis

A

May be asymptomatic

Severe secondary dysmenorrhea and menorrhagia

Associated with dyspareunia with deep penetration

58
Q

What is leiomyoma?

A

Uterine fibroids — benign tumors derived from smooth muscle of myometrium

59
Q

Most common neoplasm of the uterus

A

Leiomyoma

60
Q

Symptoms of leiomyoma

A

Excessive uterine bleeding, pelvic pressure, pelvic pain, infertility

Most are asymptomatic

61
Q

What is the most common indication for a hysterectomy?

A

Leiomyoma

62
Q

What are risk factors for developing uterine fibroids?

A

Increasing age during reproductive years

African american women have 2-3x risk

Nulliparity

Family hx

63
Q

______means precursor to malignancy, can be simple or complex with or without atypia

A

Hyperplasia

64
Q

Type 1 vs. type 2 malignancy in OB cancers, which one is most common?

A

Type 1 = endometrial adenocarcinoma — MOST COMMON

Type 2 = clear cell and papillary serous

65
Q

Risk factors for malignancy

A

Obesity
Smoking (risk for type 2)
Unopposed estrogen
Genetic factors

66
Q

What is the most common presentation of endometrial malignancy?

A

Postmenopausal bleeding

[or irregular bleeding with perimenopause]

67
Q

Coagulopathies (AUB-C) are associated with heavy flow and ______ disease

A

Von willebrand

68
Q

Ovulatory dysfunction (AUB-O) is associated with what changes in menses? What condition?

A

Unpredictable menses with variable flow

associated with PCOS

69
Q

Endometrial causes (AUB-E)

A

Infection (endometritis)

70
Q

Iatrogenic causes (AUB-I)

A

IUD, IUS, exogenous hormones

71
Q

Evaluation of DUB

A

H and P
UPT
Labs: CBC, TSH, prolactin, coagulation studies
Imaging: TVUS, sonohystogram, MRI
Biopsy: endometrial, D and C, hysteroscopy

72
Q

Indications for in-office endometrial biopsy

A

AUB (in postmenopausal women with spotting/bleeding, in age45-menopause with intermenstrual bleeding or menorrhagia, in less than 45 yrs with unopposed estrogen exposure like obesity or PCOS or prolonged amenorrhea

Cervical cytology results + glandular cells

73
Q

Medications for AUB

A

NSAIDs to normalize prostaglandins

Antifibrinolytic therapy like tranexamic acid during menses

Coordinate endometrial sloughing with OCPs like MPA or COC

Endometrial suppression with progestin daily, extended cycling with COC, LNG-IUS

74
Q

Surgical therapy for AUB

A 
Polypectomy
Myomectomy
Uterine ablation
D and C
Hysterectomy

*GIGU I (67 decks)

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