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GIGU Final > Menarch puberty and menstrual disorders > Flashcards

Menarch puberty and menstrual disorders Flashcards

1
Q

What is primary amenorrhea

A
  • absence of menarche by 13 without secondary sex development or by age of 15 with secondary sesx development
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2
Q

What is secondary amenorrhea

A
  • absence of menstruation for 6 months
    • rare for girls and adolescents to be amenorrhea for more than three months
      • if greater than 90 days workup is indicated
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3
Q

What is polymenorrhea

A
  • abnormally frequent mensses with intervals of less than 21 days
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4
Q

what is oiligomenorrhea?

A

Menstrual cycless at greater than 35 days

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5
Q

what is menorrhagia

A
  • excessive and prolongned menses occuring at regular intervals
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6
Q

what is metorrhagia

A
  • irregular episodes of uterine bleeding
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7
Q

what is menometrorrhagia

A
  • heavy and irregular uterine bleeding
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8
Q

What is intermenstrual bleeding

A
  • bleeding at ovulation for 1-2 days
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9
Q

What does the follicular phase of ovary cycle begin with and end in?

A
  • onset of menstruation
  • ends with preovulatory surge of LH
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10
Q

What does the luteal phase of ovulatory cycle begin and end with?

A
  • Begins onset of preovulatory LH surge
  • Ends with first day of menses
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11
Q

What initiates an increase in FSH by NFB mechanism resulting in stimulation of follicle growth and estradiol secretion?

A

Decreasing levels of estradiol and progesterone from the regressing corpus luteum of the preceding cycle

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12
Q

What is the two cell theory of ovarian follicular development and estrogen production?

A
  • Cells in the ovarian follicle hae separate cellular functions
    • theca cell stimulated by LH produces Androstenedione and testosterone
    • Granulosa cell stimulated by FSH will convert Androsetnedione into estrone and testosterone into estradiol via aromatization
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13
Q

When does the luteal phase occur, what do the hormones look like?

A

After ovulation occurs and FSH and LH are suppressed due to elevated progesterone estradiol levels

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14
Q

Durinng the luteal phase if fertilization doesen’t occur what happens to progesterone and estradiol levels?

A
  • Declinne near the end of the phase as the CL is regressing
  • FSH rises initiating the new follicular growth for the next cycle
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15
Q

What hormone is high when proliferative phase growth occurs?

A

When Estradiol is the dominant hormone

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16
Q

How is GnRH secreted throughout menstrual cycle, in luteal phase and in follicular?

A
  • Secreted pulsatile fashion throughout menstrual cycle
  • within the foilliclular phase pulses are more frequent with low amplitude
  • In luteal phase pulses are high amplitude low frequency
  • Estradiol enhances hypo release of GnRH
    • FSH and LH inhibit it
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17
Q

When do estradiol levels rise?

A
  • During early follicular development the levels are low but ~1 week begore ovulation the levels of E2 begin to rise
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18
Q

When do estrogen levels reach a maximum?

A
  • 1 day before the midcycle LH surge
  • After the peak and before oulation there is a significant fall, but durinng luteal phase it rises to maximum again 5-7 days after oulation and returns to baseline before menstruationn occurs
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19
Q

Describe progesterone secretionn durinng follicular development.

A
  • ovary is only secreting small amounts
    • most of progesteroe comes from peripheral conversion of adrenal pregnenolone and pregnenolone sulfate
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20
Q

When is progesterone secretion at its max and when does it fall?

A
  • Max levels secreted by CL 5-7 days after ovulation
  • Retuns to baselie before menstruation occurs
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21
Q

What is the cumulus oophorus?

A

Innermost 3-4 layers of granulosa cells that are cuboidal and adherent to ovum

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22
Q

What makes up the corona radiata?

A

Innermost layer of granulosa cells of he cumulus become elongated forming this, CR gets released with oocyte at ovulation

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23
Q

After ovuvlation what happens to the granulosa cells?

A
  • Undergo lutenization, granulosa cells, theca cells capillaries and CT form the Corpus Luteum
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24
Q
A
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25
Q

How do you diagnose menopause?

A

elevated FSH

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26
Q

What are the two zones of endometrium?

A
  1. Outer functionalis layer: sloughed off during menstruation contains spiral arteries
  2. Inner basalis portion: unchanged during each cycle proides stem cells for renewal of fxnl layer after menstruation, contains basal arteries
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27
Q

What are the phases of the uterine cycle?

A
  1. Menstrual phase
  2. Proliferative (estrogenic phase)
  3. Secretory (progestational phase)
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28
Q

Describe menstrual phase

A
  • Only portion of cycle that is visualized
  • First day of menstruation is day 1
  • Disruption anddisintergration of endometrial glands and stroma and leukocyte infiltation and RBC extravasation
  • Slouging off functionalis layer and compression of the basalis layer
29
Q

Proliferative phase?

A
  • Endometrial growoth and proliferation secondary to estrogenic stimulation
  • Increase in the length of the spiral arteries andn numerous mitoses can be seen
30
Q

Secretory phase?

A
  • Follows ovulation, progesterone secretion by CL stimulates the glandular cells to serete mucus & glycogen
  • Glands become tortuous and lumens are dilated
  • Stroma becomews edamatous
  • Spiral arteris extend into superficial layer of endometrium and become convoluted
  • endometrium reaches max thickness 8-14 mm
31
Q

What happens if coonception doesn’t occur by 23 days

A
  • CL regresses secretion of progesteronne and estradiol decreases and endometrium undergoes involution
32
Q

What happens one day prior to menstruation?

A
  • Constriction of the spiral arteries occurs resulting in ischemia of endometrium, leukocytes infiltrate, and RBC extravasation occurs
33
Q

what is the median age of menarche?

A

12

34
Q

What is thelarche? What is significant about this?

A
  • Breast budding, menarche occurs 2-3 years after this
  • unilateral devvelopment and tenderness are commonn
  • Requires estrogen
35
Q

In the first gynecologic year how can a cycle length range?

A

21 to 45 days

36
Q

How much blood is lost per menstrual period?

A

30 cc

37
Q

What is dysfunctional uterine bleeding (DUB)

A
  • abnormal uterine bleedig not attributed to:
    • Medications
    • blood dyscrasias
    • Systemic disesases
    • trauma
    • organic conditions
  • Usually caused by aberrations in HPO axis resulting in anovulation
  • Occurs around menarche or perimenopause
  • now PALM COEIN
38
Q

What is PALM COIEN?

A
  • The new classification system for abnormal uterie bleeding
  • Structural causes:
    • Polyp
    • Adenomyosis
    • Leiomyoma
    • Malignancy & hyperplasia
  • Non structural:
    • Coagulopathy
    • Ovulatory dysfxn
    • Endometrial
    • Iatrogenic
    • Not yet classified
39
Q

Describe endometrial polyps. What does US show?

A
  • Form from endometrium to create soft friable protrusion innto endometrial cavity, most polyps are benign, need to remove with hysteroscopy since cancers can also present as polyps
  • US:
    • shows focal thickening of endomeetrial stripe
    • Saline hysterosonography and hysteroscopy allows better dissection
40
Q

What is adenomyosis? (AUB-A)

A
  • Extension of endometrial glands and stroma into the musculature
  • 15% of pts with this have endometriosis also
  • Sx:
    • severe secondary dysmenorrhea and menorrhagia
    • Can be assoc. with dyspareuni and deep penetration
    • May also be asymptomatic
41
Q

What is leiomyomas (AUB-L)?

A
  • AKA Fibroids
  • Benign tumors derived from sm mm of myometrium
  • Most common neoplasm of the uterus
  • Rarely malignant
  • Most are asymptomatic, 45% women have them by 50
  • symptomatic ones are excessive bleeding, pelvic pressure pain and infertility
  • Most common indication for hysterectomy is symptomatic fibroids
42
Q

What are the characteristics of uterinen leiomyomas?

A
  • Usually spherical well circumscribed, white firm lesions with whorled appearance upon cutting
  • May degenerate and caues pain
  • May calcify in postmenopausal pts
43
Q

What are sx of leiomyomas?

A
  • Pelvic or lower back pain
  • Severe pain not common unless undergoing acute infarction
  • Frequent urination
  • Prolonged heavy bleeding
    • assoc with submucosal or intramural fibroids
  • Increased inertility
    • more common with submucosal
44
Q

Endometrial hyperplasia? (AUB-M)

A
  • Over growth of endometrial lining as result of persisten unopposed estrogen
    • PCOS
    • Granulosa thecal cell rumors producing estrogen
    • Obesity secondadry to androgens to estrogegns in adipose cells
    • Exogenous estrogens
    • Tamoxifen
  • Precursor to endometrial cancer
45
Q

What types of hyperplasia are precursors to cancer?

A
  • Simple without atypia
  • Complex without atypia
  • Simple with atypia
  • Complex with atypia
46
Q

What is the most comon type of endometrial cancer?

A

Type 1 Endometrial adenocarcinoma

47
Q

What are risk factors for endometrial cancers and presentation?

A
  • obesity
  • unapposed estrogen
  • Postmenopausal bleeding- most common sx
  • Irreguar uterine bleeding-perimenopause
48
Q
A
49
Q

What are Coagulopathies ?

A

Von willebrand disease, assoc with heavy flow

50
Q

What is ovulatory dysfxn?

A

Assoc wit hunpredictable menses with variable flow such as PCOS

51
Q

what are endometrial causes of AUB?

A

Infections

52
Q

Wrhat are iatrogenic AUB causes?

A

IUD, IUS, exogenous hormones

53
Q

What are indications for in office endometrial biopsy?

A
  • AUB
    • postmenopausal women with any spotting or bleedinng or endo lining greater than 4 mm
  • 45 to menopause
    • any AUB including intermenstrual bleeding, menorrhagia
  • Less than 45
    • any bleeding in setting of unopposed estrogen exposure, such as obesity, PCOS, or prolonged amenorrhea
  • Cerevical cytology results
    • positive glandular cells on cervical cytology
54
Q

What is EMBX? Side effects and contraindications?

A

In office endometrial biopsy

  • Blind bipsy but adequate for 90% of patients
  • Better when pathology is global rather than focal
  • Side effects:
    • cramping and uterine perforation
  • Contraindications:
    • pregnancy and relative bleeding diathesis
55
Q

How do you treat AUB with medications?

A
  • Normalize prostaglandins with NSAIDS
  • Antifibriolytic therapy
  • Coordinate endometrial sloughing
  • Endometrial suppression
    • progesterone daily
    • continuous BC
    • Intrauterine system
56
Q

Surgical AUB treatemetns?

A
  • polypectomy
  • Myomectomy
  • Dilation and currettage
  • Uterinne endometrial ablation
  • hysterectomy
57
Q

What are two types of D&C?

A
  • Diagnostic Dilate and Curette:
    • performed for irregular menstrual bleeding or postmenopauseal bleeding to rule out endometrial hyperplasia or cancers
  • Theraputic D&C:
    • performed for endometrial structureal abnormalities
58
Q

What is endomoetrial ablation?

A
  • Uses radiofrequency in a bipolar mesh electrode while at same time applying suction
  • Ablation time is 90 seconds
59
Q

What is route for total abdominal hysterectomy?

A

Incision on abdomen

60
Q

What is route for vaginal hysterectomy?

A

vaginal incision

61
Q

What is laparoscopic assisted vaginnal hysterectomy?

A

small ab inisions and vaginal incisions

62
Q

What is da vini assisted hysterectomy?

A

Small abdominal incisions and vaginal inisions with a robot

usually home by the end of the day

63
Q

When does an infant acquire lifetime peak number of oocytes?

A

Mid gestation 16-20 weeks with 6-7 million

64
Q

When is the HPO axis suppressed?

A

between ages 4 and 10

65
Q

What are the two mechanisms for low levels of gonadotropins and sex steriods during prepubertal period?

A
  1. gonadostat sensitivity to the NFB of low estradiol
  2. Intrinsic CNS inhibition of hypothalamic GnRH
66
Q

Between 8-11 theres an increase in sesrum concentrations of ___ and ___.

A

DHEA and DHEA-S

67
Q

What are the stages of normal pubertal development?

A

TAGME:

  • Thelarche
  • Pubarche/Adrenarche
  • Max growth spurt
  • Menarche
68
Q

What is tanner staging in regards to breast development?

A
  • Stage one: preadolescent breast
  • Stage 2: dev breast bug
  • Stage 3: further enlargement of breast and areola without eparation of contorus
  • Stage 4: projection of areola and papilla to orm secondary mount above breast
  • Stage 5: mature breast projection of papilla only resulting from recession of areola to general contour of breast
69
Q

What is tanner staging in regards to pubic hair?

A
  • 1: no hair
  • 2: sparse hair along labia
  • 3: sparslly over pubic bone darker coarser
  • 4: adult type hair no spread to thigh
  • 5: adult type hair with spread to medial thigh, inverted triangle

GIGU Final (12 decks)

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