Menarche, Pubarche, Thelarche

Question 1

Avg age of menarche

Answer 1

12.4 yrs

Question 2

Which hormones rise at 20 wks gestation?

Answer 2

FSH/LH and glucocorticoids

Question 3

What is gonadostat?

Answer 3

The hypothalamic-pituitary system regulating gonadotropin release

Question 4

How are low levels of gonadotropins and sex steroids maintained in prepuberty? (2)

Answer 4

1. Gonadostat is sensitive to negative feedback of low estradiol.
2. Intrinsic CNS inhibition of GnRH secretion.

Question 5

What steroids increase from ages 8-11? (3)

Answer 5

DHEA
DHEA-s
Androstenedione

Question 6

When does onset of puberty occur?

Answer 6

Approx 11 y/o

Question 7

What is the feedback of estradiol on LH during mid to late puberty?

Answer 7

The positive feedback of estradiol on LH creating ovulation is complete and ovulatory cycles are established

Question 8

Summary of puberty

Answer 8

HPA is suppressed from 4-10 (2 ways)
From 8-11 androgens increase
Age 11-12 GnRH increases and ovarian follicular development occurs.

Question 9

In what order are somatic changes?

Answer 9

Thelarche (breast development)
Adrenarche/Pubarche (pubic hair and androgen development)
Increased growth
Menarch

TAPup-ME

Question 10

Tanner staging of breasts

Answer 10

1 -flat
2 - breast bud
3 - enlargement of bud w/o contour
4 - projection of areola
5 - recession of areola and contour established

Question 11

Menses occurs how long after puberty?

How long after thelarche?

Answer 11

1 yr

2-3 yrs

Question 12

Primary amenorrhea

Answer 12

Absence of menarche by 13 y/o w/o secondary sex development OR by 15 w/ secondary sex development.

Question 13

Secondary amenorrhea

Answer 13

No period for 6 mo

Question 14

Polymenorrhea

Answer 14

Frequent periods at <21 days

Question 15

Menorrhagia

Answer 15

Excessive/prolonged BUT regular periods

Question 16

Metorrhagia

Answer 16

Irregular episodes of uterine bleeding

Question 17

menometrorrhagia

Answer 17

Heavy and irregular uterine bleeding

Question 18

Endometrial polyps

Answer 18

Protrusion of endometrium into endometrial cavity.
Signs: Menorrhagia, spontaneous or post menopausal bleeding.
Usually benign.

Question 19

Adenomyosis is:

Sx

Answer 19

Extension of endometrial glands into uterine musculature.
Might be asymptomatic.
Severe secondary dysmenorrhea and menorrhagia.
Painful sex

Question 20

Uterine fibroids

Answer 20

Benign tumors from SM cells of myo.
Rarely malignant.
Mostly asymptomatic, but can have excessive bleeding, pressure, pain, etc
Fixed w/ hysterectomy.

Question 21

Risks for fibroids

Answer 21

Increasing age in reproductive yrs.

AAs w/ 2-3x increase.

Question 22

Type 1 malignancy

Type 2 malignancy

Answer 22

Type 1 - endometrial adenocarcinoma (most common)

Type 2 - clear cell and papillary serous

Question 23

Presentation of uterine malignancy

Answer 23

Postmenopausal bleeding

Irregular bleeding

Question 24

Risk factors for malignancy

Answer 24

Obesity, smoking, unopposed estrogen.

Question 25

Indications for in office bx

Answer 25

Abn uterine bleeding in postmenopausal women
Intramenstrual bleeding in women 45 to menopause.
<45 y/o w/ unopposed estrogen

Question 26

TTM of nonstructural causes of AUB

Answer 26

Normalize PGs w/ NSAIDs
Antifibrinolytic therapy (tranexamic acid)
Coordinate endometrial sloughing (MPA and COC)
Endometrial suppression (progestin, COC)

Question 27

Diagnostic D and C

Answer 27

Performed for irregular menstruual bleeding of postmenopausal women to r/o cancers

Question 28

Therapeauic D and C

Answer 28

Performed for endometrial structural abnormalities (polyps, fibroids, etc)