Chapter 20 puberty and the menstrual cycle and menopause Flashcards
Breast bud development to menstruation how many yrs?
2.5
Pubertal sequence
- Accelerated growth
- Breast development (thelarche)
- Development of pubic and axillary hair (pubarche)
- Onset of menstruation (menarche)
Menstrual cycle divided into 2 14 day phases
Follicular and luteal which describes the changes in ovary and
Proliferative and secretory phase which describes endometrium over the same period of time
The – causes release of fsh from the pituitary gland resulting in development of primary ovarian follicle. The ovarian follicle produces —
Follicular phase, ovarian follicle produces estrogen which causes uterine lining to proliferate
At day 14 there is an – spike in response to preceding estrogen surge which stimulates ovulation, the release of ovum from the follicle
Lh
After ovulation, luteal phase begins. Remnants of the follicle left behind in the ovary develop into corpus luteum. Corpus luteum is responsible for secretion of
Progesterone
Progesterone
Maintains endometrial lining in preparation to receive a fertilized ovum. If fertilization doesn’t occur, corpus luteum degenerates and progesterone levels fall. Without progesterone endometrial lining is sloughed off
withdrawal of estrogen and progesterone during luteal phase of prior cycle causes gradual increase in FSH. FSH stimulates growth of approx
5-15 PRIMORDIAL ovarian follicles, initiating follicular phase again.
during the follicular phase, the endometrium is in the __ phase
proliferative phase, growing in response to estrogen.
during the luteal phase, the endometrium is in the __ phase
secretory phase., as it matures and is prepared to support the implantation.
if ovum is not fertilized, corpus luteum degenerates after approximately 14 days leading to a fall in __ and __ levels
estrogen and progesterone levels.
withdrawal of __ causes endometrium to slough, initiating menstrual phase
progesterone
estradiol is preserved until late perimenopause when FSH and estradiol both fluctuate
true
define menopause
12 months of amenorrhea after final menstrual period in the absence of any other pathological or physiological causes.
early menopause is more common in women with hx of
- cigarette smoking
- short menstrual cycles
- nulliparity
- type 1 diabetes
- family hx of early menopause.
premature ovarian failure is
onset of spontaneous menoapuse before age of 40
menopause heralded by menstrual irregularity as # of oocytes capable of responding to FSH and LH decreases and anovulation becomes more frequent. during this period, FSH and LH rise because of diminished estrogen production. the fall in __ levels leads to hot flashes, mood changes, insomnia, depression, osteoporosis and vaginal atrophy
estradiol.
no gonadal estrogen affects
bone (oesteoporosis)
cardiovascular system (atherosclerosis)
uterus/vagina (atrophy)
breast (atrophy)
cardiovascular consequence of estrogen decrease:
protective benefits of estrogen on lipid profile HDL and decreased LDL and on vascular endothelium
(prevents atherogenesis, increases vasodilation, and inhibits platelet adherence, are lost). women are at increased risk for coronary artery disease.
bone resorption accelerates with menopause because
estrogen plays important role in regulating osteoclast activity. increased bone resorption can lead to osteopenia and potentially osteoporosis. pts are at increased risk of hip and vertebral fractures, pain, loss of height, and immobility
HRT: use of combination of estrogen and progesterone to treat menopausal related sx in women who still have uterus in situ. menopausal sx are due to decrease in ___.
estrogen levels.
unopposed estrogen exposure whether endogenous or exogenous can result in endometrial hyperplasia and/or endometrial cancer.
true
when estrogens are being used, with uterus, __ must be used to decrease risk of endometrial hyperplasia and cancer.
progestin
benefits of HRT and ERT
control of menopausal symptoms including reduction of vasomotor flushing , improvement in mood and sleep dysfunction, prevention of urogenital and vaginal atrophy, and improvementin skin and muscle tone. HRT also resulted in decreased risk of colorectal cancer, and both HRT and ERT provided protection from oesteoporotic fractures in hip and vertebra. cardioprotective? no clear data
RISKs:
increased coronary artery events, increased DVT and PEs, and increased risk of invasive breast cancer who used HRT for prolonged period of time >5 years.
contraindications to HRT
chronic liver impairment, pregnancy, known estrogen dependent neoplasm (breast, ovary uterus). hx of thromboembolic disease(DVT, PE, CVA). and undiagnosed vaginal bleeding.
NON hormonal treatment of menopausal symptoms:
should be targed towards individual’s symptoms and treatment goals:
vasomotor symptoms - clonidine (Catapres), SSRI inhibiros such as paroxetine (Paxil) and serotonin and norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor).
complementary and alternative therapies - soy, blackcohosh, phytoestrogens, dong quai, evening primrose oil. have not been found to be more effective than placebos.
Vaginal and urogenital atrophy can be managed
low dose vaginal estrogen. minimal systemic absorption. when used at low vaginal dosing, these estrogen sources do not require opposing progestin use in women with an intact uterus.
prevention and treatment for osteoporosis:
calcium and vitamin d supplementation; reduction in smoking and caffeine; and alcohol.
