Lecture 35: Menarche/Puberty/Menstrual Disorders

Question 1

How does the hypothalamus and pituitary effect menstruation?

Answer 1

GnRH from hypothalamus stimulates anterior pituitary to release FSH and LH which stimulates estrogen and protegesterone release from ovarian follicle

Question 2

LH stimulates theca cells to produce what?

FSH stimulates granulosa cells to convert androgens into what?

Answer 2

androgens (androsenedione and testosterone)

estrogens

Question 3

What should happen during the first GYN visit?

Answer 3

Gather history, HPV vaccine, educate patient and parents about puberty normals

Question 4

What is the average age of menarche?

Answer 4

12.43 years old

occuts 2-3 years after thelarche at tanner stage IV

Question 5

What is primary amenorrhea?

Answer 5

absense of menarche by age 13 without secondary sexual development

Or

absence of menarche by age 15 with secondary sexual developement

Question 6

What is secondary amenorrhea?

Answer 6

absence of menstriation for 6 months

if greater than 90 days at time of presentation, get pregnancy test

may be associated with other conditions

Question 7

Within the first year of menstrual cycles, what is the typical cycle length?

Answer 7

21-45 days

by third year after menarche, most menstural cycles are 21-35 days long

Question 8

What are the causes of menstrual irregularity?

Answer 8

Pregnancy, Endocrine causes, acquired (from lifestyle) conditions, tumors

Question 9

Define these terms:

1. Polymenorrhea
2. Menorrhagia
3. Metorrhagia
4. Menometorrhagia
5. Intermenstrual bleeding
6. Oligomenorrhea

Answer 9

1. abnormally frequent menses at intervals at <21 days
2. excessive or prolonged menses
3. irregular episodes of uterine bleeding
4. heavy and irregular uterine bleeding
5. scant bleeding at ovulation for 1-2 days
6. menstrual cycles >35 days

Question 10

What defines excessive menstrual flow?

Answer 10

changing pads every 1-2 hours especially if more than 7 days

Question 11

What are structural causes for abnormal uterine bleeding?

Answer 11

PALM

polyp

adenomyosis (glands in uterine muscle)

leimyoma (fibroids)

malignancy and hyperplasia

Question 12

What are nonstructural causes of abnormal uterine bleeding?

Answer 12

COEIN

coagulopathy (Von Willebran dz heavy flow)

ovulatory dysfunction (PCOS)

endometrial (infection)

iatrogenic (IUD, exogeneous hormones)

not classified

Question 13

What are endometrial polyps?

Answer 13

• protrusions in the endometrial wall, can cause menorrhagia, spontaneous or post menopausal bleeding
• most are benign

Question 14

What are the average ages of the following in white populations

Thelarche

Adrenarche

Menarche

Answer 14

10. 3yrs
11. 5yrs
12. 5 yrs

earlier in african american and hispanic populations

Question 15

What are treatment options for AUB if the causes are…

polyp/fibroid

Nonstructural

Answer 15

• Polyp/fibroid removal, hysterectomy, endometrium removal, meds that stop cyclic bleeding (Mirena, NSAIDs, provera)
• treat underlying condition

Question 16

When does puberty typically occur?

Answer 16

10 -16 yo (12.4 is mean)

Question 17

Stagess of Normal Pubertal Development

Answer 17

Thelarche (breast) - 1st sign

Pubarche/adrenarche - pubic/axillary hair development

Maximal growth/peak height - 2 years earlier in girls

Menarche - onset of menses

Question 18

Tanner stages of breast development:

Answer 18

Stage 1: preadolescent, papilla elevation only

Stage 2: Breast bud, small elevation of breast and papilla, areaola also grows

Stage 3: further enlargement, no countour separation

Stage 4: areola and papilla form second mound

Stage 5: papilla projection only, areola recession to breast contour

Question 19

Tanner stages of Pubic hair development

Answer 19

Stage 1: no pubic hair

Stage 2: sparse along labia

Stage 3: sparsely spraid over pubes, darker and coarser

Stage 4: adult type hair but don’t spread to medial thighs

Stage 5: spread to medial thighs