Lec 21 Reproductive III Flashcards
What is role of leptin in puberty?
increased fat tissue –> increased leptin –> triggers puberty
What is role of kisspeptin in puberty?
agonist for GPR54 receptor in brain; may initiate pulsatile GnRH secretion
What is effect of FSH in puberty?
FSH increases E2 levels
What happens in female puberty?
- growth spurt [androgens and E2] before menarche
- breast budding stimulated by ovarian E2
- pubic hair stimulated by adrenal and ovarian androgens
- uterus elongates and ovaries enlarge
When is normal menarche?
age 12-16 yrs (avg 12.5)
When is first day of bleeding in menstrual cycle?
day 1
What is follicular phase? How long?
period from onset of menses to ovulation
variable duration avg 14 days
What is luteal phase? duration?
period from ovulation to onset of bleeding
constant length of 14 days
When is estradiol highest in menstrual cycle?
at time of ovulation
When is progesterone highest in menstrual cycle?
after ovulation in luteal phase
What happens in follicular phase?
LH stimulates theca cells to produce androgens
androgens diffuse to granulosa cells and serve as substrate for E2 production
What is effect of LH surge in ovulation?
- stimulates completion of meiosis
- stimulates luteinization of granulosa cells
- stimulates progesterone production by corpus luteum
What is effect of progesterone rise in ovulation?
- causes synthesis of prostglandins in follicel necessary for ovulation
- enhances production of proteolytic enzymes for digestion and rupture of follicular wall
What is effect of FSH mid cycle surge prior to ovulation?
- induces production of plasmin
- frees oocytes from the follicle wall
- increases expression of LH receptors
What are clinical signs of ovulation?
- mittelschmerz [main from follicle rupture]
- ferning of cervical mucus
- increased spinnbarekit
- rise in basal body temp
- increased libido
What is most fertile time period?
the 1 or 2 days before ovulation
What is role of progesterone in luteal phase?
secreted by corpus luteum
corpus luteum is maintained by LH (hCG in pregnancy)
promotes secretory endometrium, edema, angiogenesis
What is luteolysis?
apoptosis of corpus luteum in luteal phase –> leads to progresterone decrease
What happens to E2 and P in luteal phase?
abrupt decrease in E2/P
local secretion of prostaglandins –> vasospasm and ischemic necrosis –> menstrual bleeding
prostaglandins induce uterine contractions
What is PMS?
complex of symptoms at end of luteal phase only in ovulating women; remission within 3 days after onset of menses
What is primary amenorrhea?
absence of menses by age 16 or no menses and no development of secondary sex characteristics by age 14
What is secondary amenorrhea?
no menstrual period for > 6 mos
What is oligomenorrhea?
infrequent periods; cycle > 35 days
What is the main etiology of primary amenorrhea?
pregnancy
What is long term treatment for untreated amenorrhea?
osteoporosis from hypoestrogenism
What is treatment for hypothalamic amenorrhea?
treat cause; oral contraceptives
What is treatment for primary ovarian failure?
oral contraceptives
What are the source of androgen in normal female?
- ovary produces small amount of T –> converted to DHT
- ovary/adrenals secrete larger amount of weaker androgens DHEA/androstenedione
What is control of ovarian androgens?
LH control –> produced by theca cells as pre-hormone for estrogens
What is control of adrenal androgens?
under ACTH control
What happens if increased SHBG?
increase free E2:T ratio
seen in liver disease, thyrotoxicosis
What happens if decreased SHBG?
increase free T:E2 ratio
seen in obesit, hypothyroidism
What are clinical manifestations of hyperandrogenism in women?
- amenorrhea/oligomenorrhea
- mild –> hirsuitism
- severe –> virilization
What is hirsuitism?
excess hair growth in females in area where not normally found
What is virilization?
hirsuitism + masculinization
usually associated wtih testosterone > 150 ng/dl
have temporal balding, increased muscle mass, deepening of voice, clitoromegaly
What are 2 ovarian causes of hyperandrogenism?
- polycystic ovary syndrome
- androgen producing ovarian tumor
What are 3 adrenal causes of hyperandrogenism?
- congenital adrenal hyperplasia
- androgen producing adrenal tumors
- cushings syndrome
When do you need to rule out tumor as cause of hyperandrogenism?
serum T > 200 or virilization present
What are the signs of polycystic ovarian syndrome?
oligomenorrhea/amenorrhea
signs of hyperandrogenism
multiple cysts on ovary ultrasound
LH:FSH ratio > 2
What are complications associated with polycystic ovarian syndrome?
- obesity
- insulin resistance
- hyperlipidemia
What are treatments for polycystic ovarian syndrome?
- oral contraceptive agents and anti-androgens [aldactone]
- if pregnancy desired: ovulation induction via clomiphene citrate
- if insulin resistance: metformin
WHat is menopause?
last episode of menstrual bleeding induced by cyclic endogenous secretion of ovarian hormones
What is perimenopause?
period immediately before and 1st year after menopause
What is etiology of menopause?
follicular depletion
What is average age of menopause?
51 yo in USA
What happens in perimenopause?
anovulatory cycles –> decreased progesterone –> unopposed estrogen –> endometrial hyperplasia and breakthrough bleeding
estrogen levels fluctuate leading to intermittent hypoestrogenic symptoms [hot flashes, mood changes, vaginal dryness]
What happens ot gonadotropin levels in menopause?
- increase in FSH > LH reflecting lack of inhibin and E2 feedback
- low estrogens
- low androgens
What are signs/symptoms of menopause?
- vasomotor symptoms = hot flashes
- atrophic GU tract
- skin and hair changes = thinning and wrinkling
- loss of REM sleep
- mood changes
What are longterm complications of menopause?
osteoporosis
CV disease –> increased total cholesterol and LDL; HDL unchanged
What are benefits of HRT therapy?
- symptom relief
- decrease bone loss
- better lipids (higher HDL, lower LDL)
What are risks of HRT therapy?
endometrial hyperplasia/cancer [can be prevented if combined with progestins
