Chapter 20 puberty and the menstrual cycle and menopause

Question 0

Breast bud development to menstruation how many yrs?

Answer 0

2.5

Question 1

Pubertal sequence

Answer 1

1. Accelerated growth
2. Breast development (thelarche)
3. Development of pubic and axillary hair (pubarche)
4. Onset of menstruation (menarche)

Question 2

Menstrual cycle divided into 2 14 day phases

Answer 2

Follicular and luteal which describes the changes in ovary and

Proliferative and secretory phase which describes endometrium over the same period of time

Question 3

The – causes release of fsh from the pituitary gland resulting in development of primary ovarian follicle. The ovarian follicle produces —

Answer 3

Follicular phase, ovarian follicle produces estrogen which causes uterine lining to proliferate

Question 4

At day 14 there is an – spike in response to preceding estrogen surge which stimulates ovulation, the release of ovum from the follicle

Answer 4

Lh

Question 5

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

Answer 5

Progesterone

Question 7

Progesterone

Answer 7

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

Question 8

withdrawal of estrogen and progesterone during luteal phase of prior cycle causes gradual increase in FSH. FSH stimulates growth of approx

Answer 8

5-15 PRIMORDIAL ovarian follicles, initiating follicular phase again.

Question 9

during the follicular phase, the endometrium is in the __ phase

Answer 9

proliferative phase, growing in response to estrogen.

Question 10

during the luteal phase, the endometrium is in the __ phase

Answer 10

secretory phase., as it matures and is prepared to support the implantation.

Question 11

if ovum is not fertilized, corpus luteum degenerates after approximately 14 days leading to a fall in __ and __ levels

Answer 11

estrogen and progesterone levels.

Question 12

withdrawal of __ causes endometrium to slough, initiating menstrual phase

Answer 12

progesterone

Question 13

estradiol is preserved until late perimenopause when FSH and estradiol both fluctuate

Answer 13

true

Question 14

define menopause

Answer 14

12 months of amenorrhea after final menstrual period in the absence of any other pathological or physiological causes.

Question 15

early menopause is more common in women with hx of

Answer 15

1. cigarette smoking
2. short menstrual cycles
3. nulliparity
4. type 1 diabetes
5. family hx of early menopause.

Question 16

premature ovarian failure is

Answer 16

onset of spontaneous menoapuse before age of 40

Question 17

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

Answer 17

estradiol.

Question 18

no gonadal estrogen affects

Answer 18

bone (oesteoporosis)
cardiovascular system (atherosclerosis)
uterus/vagina (atrophy)
breast (atrophy)

Question 19

cardiovascular consequence of estrogen decrease:

Answer 19

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.

Question 20

bone resorption accelerates with menopause because

Answer 20

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

Question 21

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 ___.

Answer 21

estrogen levels.

Question 22

unopposed estrogen exposure whether endogenous or exogenous can result in endometrial hyperplasia and/or endometrial cancer.

Answer 22

true

Question 23

when estrogens are being used, with uterus, __ must be used to decrease risk of endometrial hyperplasia and cancer.

Answer 23

progestin

Question 24

benefits of HRT and ERT

Answer 24

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

Question 25

RISKs:

Answer 25

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.

Question 26

contraindications to HRT

Answer 26

chronic liver impairment, pregnancy, known estrogen dependent neoplasm (breast, ovary uterus). hx of thromboembolic disease(DVT, PE, CVA). and undiagnosed vaginal bleeding.

Question 27

NON hormonal treatment of menopausal symptoms:

Answer 27

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.

Question 28

Vaginal and urogenital atrophy can be managed

Answer 28

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.

Question 29

prevention and treatment for osteoporosis:

Answer 29

calcium and vitamin d supplementation; reduction in smoking and caffeine; and alcohol.