Development/Menopause/Contraception Flashcards
Between what ages should females begin puberty?
8 - 13
What is the order of puberty for females?
Thelarche
Pubarche
Growth spurt
Menarche
Between what ages should females begin menses?
10 - 16
Stage 1 puberty
Pre-puberty adolescence
Stage 2 puberty
Breast buds + pubic hair
Stage 3 puberty
Breast mounds + coarsening of pubic hair
Stage 4 puberty
Breast enlarges with raised areola
Stage 5 puberty
Adult breast contour with flat areola + pubic hair on the medial thighs
What occurs in the Follicular phase of the menstrual cycle?
Increased GnRH –> Increased FSH –> Estrogen production and growth of follicles
Day 14 is Ovulation. What occurs?
Estradiol reaches its peak –> LH surge –> rupture of a follicle which releases an ovum and then becomes the corpus luteum
After Ovulation, what is the next stage of the menstrual cycle?
Luteal phase
During the follicular phase, estradiol dominates. During the luteal phase, progesterone dominates. Why?
Corpus luteum produces progesterone to prepare endometrium for implantation
If pregnancy does occur, how long will the corpus luteum produce progesterone? What takes over?
8 weeks
–> Placenta takes over
If pregnancy does not occur, the corpus lutuem dies and what happens to the hormone levels?
DROP –> sloughing of the endometrial lining (menses) and the cycle starts over again
What defines Precocious Puberty?
Onset of secondary sex characteristics BEFORE 8 years of age
What should be done to evaluate Precocious Puberty?
Wrist X-ray to assess bone age
If bone age is > 2 years ahead of chronological age, what diagnostics should be pursued?
FSH
LH
Estrogen
Brain/Ovarian studies
If DHEAS is high, the etiology is likely where?
Adrenal glands
What medication class can be used to treat Precocious Puberty that is not due to another cause?
GnRH Analogs
What defines Menopause? When is it considered Premature?
No menses for 12 monthes
– Premature if this occurs before age 40
List symptoms of Menopause
- Hot flashes
- Insomnia
- Mood changes and poor concentration
- Vaginal atrophy and dryness
- Low libido
What will the levels of FSH and LH be with Menopause?
HIGH
When is Hormone Replacement Therapy likely indicated for Menopause?
Vasomotor symptoms
With HRT, what is important to know about your patient?
Do they have a Uterus?
With HRT, if your patient DOES have a uterus, what should be given?
Estrogen + Progestin
With HRT, if your patient does NOT have a uterus, what should be given?
Estrogen only
HRT increases risk for what complications? (4)
- Breast cancer
- Endometrial cancer
- DVT
- Cardiovascular mortality
List 3 drug/classes that can be used for Menopause?
- SSRIs/SNRIs
- Clonidine
- Gabapentin
What can be used for vaginal atrophy, dryness or dyspareunia with Menopause?
Estrogen cream
With Menopause, women are at an increased risk for _____ due to low estrogen. What supplements should they be given?
Osteoporosis
– Calcium + Vitamin D
If you start Bisphosphonates for Osteoporosis, what are 2 possible complications?
Esophagitis
Jaw osteonecrosis
When should women be screened with a DEXA scan?
65
Nexplanon is a progestin implant in the upper arm. How long does it last? Side effects?
3 years – irregular periods
Progestin IUDs last for how long?
5 years
What is the benefit of Progestin only contraceptive methods?
Safe with breastfeeding
How long does a Copper IUD last? Side effect?
10 years
– HEAVY bleeding
Medroxyprogesterone injections are given how often? What is a complication that is reversible?
q3 months
– Decreases bone mineral density but this is reversible
OCPs protect against what cancers?
Endometrial and Ovarian
What are contraindications for beginning OCPs?
- Age > 35 + smoker
- History of DVT
- Migraines with aura
- Hypertension
- GERD
What are contraindications for beginning OCPs?
- Age > 35 + smoker
- History of DVT
- Migraines with aura
- Hypertension
- GERD
