Menarche Flashcards
What is the time frame of the follicular phase of the ovulatory cycle?
it begins with the onset of menstruation and culminates in the preovulatory surge of LH
what is the time frame of the luteal phase of the ovulatory cycle?
it begins with the onset of the preovulatory LH surge and ends with the first day of menses
what is the effect of the decreasing levels of estradiol and progesterone from the regressing corpus luteum of the preceding cycle?
it is going to initiate an increase in FSH by a negative feedback mechanism, which stimulates follicular growth and estradiol secretion
What does LH stimulate in the ovarian follicle?
the theca cells to produce andorgens
what does FSH stimulate in the ovarian follicle?
the granulosa cells to convert the androgens made in the theca cells into estrogens
what happens to the LH and FSH levels during the luteal phase?
they are significantly suppressed through the negative feedback effect of the elevated circulating estradiol and progesterone
what happens to the levels of progesterone and estrogen near the end of the luteal phase if conception does not occur?
they will decline
what type of hormone is GnRH?
a decapeptide synthesized in the arcuate nucleus
what effect does estradiol have on the hypothalamus?
it appears to enhance the hypothalamic release of GnRH and induce the midcycle LH surge
what effect do the gonadotropins have on GnRH release?
an inhibitory effect
when do estrogen levels generally reach a maximum peak?
1 day before the midcycle LH surge
during the follicular development, the ovary secretes only a very small amount of progesterone. Where does the bulk of the progesterone come from?
the peripheral conversion of the adrenal pregnenolone and pregnenolone sulfate
prior to ovulation the unruptured luteinizing graafian follicle begins to produce what?
increasing amounts of progesterone
at about 8-10 weeks of fetal development, what do the oocytes become surrounded by?
the precursor granulosa cells- this complex is called the primordial follicle
what do the inner most layer of the granulosa cells of the cumulus oophorus become?
the corona radiata
what does the corpus luteum produce?
copious amounts of progesterone and some estradiol
what is the endometrium responsive to?
circulating progestins, androgens, and estrogens
what kind of arteries does the functional layer of the endometrium contain?
spiral arteries
what kind of arteries does the inner/ basalis layer of the endometrium contain?
straight/ basal arteries
the cyclic changes in the histophysiology of the endometrium can be divided into 3 stages. What are these stages?
the menstrual phase, the proliferative (estrogenic) phase, and the secretory (progestational) phase
what is the proliferative phase characterized by?
endometrial growth/proliferation secondary to estrogenic stimulation/ increase in the length of the spiral arteries and numerous mitoses can be seen in these tissues
when does the secretory phase occur?
following ovulation
what stimulates the secretory phase?
progesterone secretion by the corpus luteum stimulates the glandular cells to secrete mucus, glycogen, and other substances
does mitosis occur during the secretory phase?
it is rare
what happens if conception does not occur by day 23?
the corpus luteum begins to regress, secretion of progesterone and estradiol declines, and the endometrium undergoes involution
what typically happens one day prior to the onset of menstruation?
there is marked constriction of the spiral arteries ( results in ischemia of the endometrium) leukocytes infiltrate and there is RBC extravasation
restoration of blood vessels require successful interaction of platelets and clotting factors; what medications can impair this coagulation system and be associated with heavy bleeding?
warfarin, aspirin, and clopidogrel
what is the purpose of the human papillomavirus vaccine?
it offers protection against cervical cancer, cervical dysplasia, vulvar or vaginal dysplasia, and genital warts associated with the gardasil HPV genotypes
when is the median age of menarche?
12 years
what is primary amenorrhea?
the absence of menarche by age 13 without secondary sexual development OR by the age of 15 with secondary sexual development
what is the median length of the first cycle after menarche?
34 days
what is secondary amenorrhea defined as?
the absence of menstruation for 6 months
what are the general causes of menstrual irregularity?
pregnancy, endocrine causes, acquired conditions, or tumors
what is greater than 80 cc blood loss associated with?
anemia
what is dysfunctional uterine bleeding (DUB) (also known as abnormal uterine bleeding now)?
abnormal uterine bleeding that cannot be attributed to medications, blood dyscrasias, systemic disease, trauma, or organic conditions
what is dysfunctional uterine bleeding usually caused by?
aberrations in the H-P-O axis resulting in anovulation
what is polymenorrhea?
abnormally frequent menses at intervals less than 21 days
what is menorrhagia (hypermenorrhea)?
excessive and/or prolonged menses occurring at regular intervals
what is metrorrhagia?
irregular episodes of uterine bleeding
what is menometrorrhagia?
heavy and irregular uterine bleeding
what is intermenstrual bleeding?
scant bleeding at ovulation for 1-2 days
what is oligomenorrhea?
menstrual cycles at >35 day cycles
what is the classification system used for abnormal bleeding in reproductive-aged women?
PALM-COEIN
what are the causes of the PALM abnormal bleeding in reproductive-aged women?
structural causes
what does the P stand for in PALM?
polyp
what does the A stand for in PALM?
adenomyosis
what does the L stand for in PALM?
leiomyoma
what does the M stand for in PALM?
malignancy and hyperplasia
what are the causes of the COEIN abnormal bleeding in reproductive-aged women?
non-structural causes
what does the C stand for in COEIN?
coagulopathy
what does the O stand for in COEIN?
ovulatory dysfunction
what does the E stand for in COEIN?
endometrial
what does the I stand for in COEIN?
iatrogenic (relating to illness caused by medical examination or treatment- like an IUD)
what does the N stand for COEIN?
not yet classified
what can polyps cause?
menorrhagia or spontaneous or post menopausal bleeding
what would the ultrasound findings of a patient with endometrial polyps suggest?
focal thickening of the endometrial stripe
how would you detect a poly?
saline hysterosonography and hysteroscopy
what is an adenomyosis?
the extension of the endometrial glands and stroma into the uterine musculature
what are the symptoms of adenomyosis?
they may be asymptomatic; severe secondary dysmenorrhea (pain with menstrual cycles) and menorrhagia(heavy vaginal bleeding); dyspareunia (pain with intercourse) with deep penetration
how is adenomyosis diagnosed?
histopathology
what is a leiomyoma?
a fibroid- a benign tumor derived from smooth muscle cells of the myometrium
what is the most common indication of hysterectomy?
symptomatic fibroids
what are the risk factors for developing fibroids?
increasing age during reproductive years, african american women, nulliparity (never been pregnant), and a family history
what stimulates the proliferation of smooth muscle cells?
estrogen
what happens to fibroids during pregnancy?
they can dramatically enlarge
what is a subserosal fibroid?
if a fibroid occurs on the outside of the uterus
what is an interstitial fibroid?
if a fibroid occurs in the muscle of the uterus
what is a submucosal fibroid?
if a fibroid occurs on the inside of the uterus with a protrusion into the endometrium
if a fibroid does produce symptoms, what would they be?
pelvic or lower back pain, frequency of urination, prolonged or heavy bleeding, increased incidence of infertility
which fibroids are associated with prolonged or heavy bleeding?
submucosal or intramural (interstitial) fibroids
what fibroids are more associated with infertility?
submucosal fibroids
what is endometrial malignancy/ hyperplasia?
it represents an overabundant growth of the endometrial lining usually as a result of persistent unopposed estrogen
what is endometrial hyperplasia a precursor to?
endometrial cancer
what is type 1 hyperplasia?
endometrial adnenocarcinoma- the most common type
what is type 2 hyperplasia?
clear cell and papillary serous
what is the presentation of endometrial hyperplasia?
postmenopause bleeding or irregular uterine bleeding( after the age of 35)
what would indicate an in office endometrial biopsy?
abnormal uterine bleeding in post menopausal women or if there are positive glandular cells on a cervical cytology
what is an in office endometrial biopsy and when is it best used?
it’s a blind biopsy and it is better if used when the pathology is global (like hyperplasia) rather than focal (polyp)
what are the contraindications of an in office endometrial biopsy?
pregnancy (absolute) and bleeding diathesis (relative)
what is the removal of fibroids called?
myomectomy
what are three surgical options to treat AUB?
D&C, uterine endometrial ablation, and hysterectomy
what is a therapeutic D&C used for?
performed for endometrial structural abnormalities (polyps, small submucosal fibroids)
what is a diagnostic D&C used for?
performed for irregular menstrual bleeding or postmenopausal bleeding to rule out endometrial hyperplasia or cancer
what is endometrial ablation?
it uses radio frequency to the bipolar mesh electrode while at the same time applying suction to the endometrium
what is the average duration of puberty?
4-5 years
between the ages of 8-11, there is an increase in serum concentrations of what?
DHES, DHEA-S, and androstenedione
what are the initial endocrine changes associated with puberty?
adrenal androgen production and differentiation by the zona reticularis of the adrenal cortex
what does rise in adrenal androgens cause?
growth of axillary and pubic hair (adrenarche or pubarche)
what happens around 11 years of age when talking about the onset of puberty?
there is a gradual loss of sensitivity by the gonadostat to the negative feedback of sex steroids; in combination with the intrinsic loss of CNS inhibition of hypothalamic GnRH release
what does an increase in GnRH promote?
ovarian follicular maturation and sex steroid production, which leads to the development of secondary sexual characteristics
what are the stages of normal pubertal development?
TAG ME- thelarche, adrenarche, growth spurt, menses
what does thelarche require?
estrogen
what does pubarche/adrenarche require?
androgens
when does maximal growth or peak height occur?
about 1 year before onset of menses
how many stages are there in the tanner staging?
5
