5: Menstruation, Puberty, Development

Question 1

H’s from anterior vs posterior pituityar

Answer 1

1. anterior: FSH, LH, TSH, prolactin, GH, ACTH

2. posterior: oxytocin, ADH

Question 2

five hormones from the hypothalamus that affect the reproductive cycle

Answer 2

GNRH, Thyrotropin-releasing H, somatostatin, CRF, PIF

Question 3

where does the majority of progesterone come from during follicular development

Answer 3

peripheral conversion of adrenal pregnenolone

Question 4

two zones of the endometrium + what their arteries are called

Answer 4

1. functional: spiral arteries

2. basalis: basal arteries

Question 5

median age of menarche

Answer 5

12.43 years

Question 6

when does thelarche occur compared to menarche

Answer 6

thelarche -> 2 or 3 yrs -> menarche

Question 7

primary amenorrhea

Answer 7

no menstruation by 13 years without secondary sex characteristics OR by 15 with secondary sex characteristics

Question 8

mean blood loss per menstrual period

Answer 8

30ccs

Question 9

what amount of blood loss during menses is associated with anemia?

Answer 9

80cc+

Question 10

invariant weight necessary to start menarche

Answer 10

106 lbs

Question 11

what years is the HPO axis suppressed in females?

Answer 11

btween 4-10yrs of age

Question 12

two things that keep low levels of gonadotropins and sex steroids during prepubertal phase

Answer 12

1. gonadostat sensitivity to negative feedback of low esradiol
2. CNS inhibition of GNRH secretion

Question 13

what is the initial endocrine change associated with puberty?

Answer 13

adrenal androgen production

Question 14

four stages of normal pubertal development

Answer 14

1. thelarche (breast devel)
2. pubarche & andrenarche (pubic and axillary hair)
3. maximal growth / peak height velocity
4. menarche

Question 15

unilateral breast development

Answer 15

not uncommon for first 6 months of puberty

Question 16

four things that qualify as delayed puberty

Answer 16

1. no secondary sex characteristics by 13
2. no thelarche by 14
3. no menarche by 15
4. no menses 5 years after onset of thelarche

Question 17

OPC function in PCOS

Answer 17

suppresses LH an FSH, allowing regression of overproduction of T

Question 18

what does clomiphene citrate do?

Answer 18

induce ovulation

Question 19

what does spironolactone do in PCOS?

Answer 19

competes for T-binding sites -> anti-andogen effects at target organ

Question 20

why does hirsutism occur?

Answer 20

hair follicles exposed to an excess of androgen

Question 21

virilization

Answer 21

masculinization of a female due to marked increase in T -> clitoromegaly, temporal balding, deep voice, decreased breast size, hirsutism

Question 22

scoring system for hirsutism

Answer 22

Ferimma-Galloway

Question 23

polymenorrhea

Answer 23

abnormally frequent menses, cycle less than 21 days

Question 24

metrorrhagia

Answer 24

irreg bleeding episodes

Question 25

menometrorrhagia

Answer 25

heavy and irregular uterine bleeding

Question 26

oligomenorrhea

Answer 26

menstrual cycles more than 35 days long, but less than 6 months

Question 27

DUB: dysfunctional uterine bleeding

Answer 27

AUB that cant be attributed to meds, blood dyscrasias, systemic disease, trauma, or organic conditions (pregnancy, fibroids, CA) - usually due to changes in HPO axis

Question 28

massive AUB: treatment

Answer 28

hospitalizations, transfusions, IV conjugated estrogens then OCPs/Mirena

Question 29

moderate AUB treatment

Answer 29

OPCs or mirena

Question 30

AUB unresponsive to meds - Tx

Answer 30

d&c, polypectomy, myomectomy, endometrial ablation, hysterectomy