Menarche: Puberty and Menstrual Disorders Flashcards
What is the name of the dura mater that is covering the Sella Turcica?
Diaphragma Sella
List the Hormones that are produced by the Anterior and Posterior Pituitary.
Anterior: FLAT PeG
Posterior: ADH (vaspressin) and Oxytocin
LH is going to stimulate the ___________ cells to produce ___________ . While FSH is going to stimulate the ____________ cells to produce ____________ .
- Theca Cells (produce androstenedione and testosterone)
- Granulosa Cells (produce Estradiol)
What is the structure of GnRH?
Decapeptide
When is the best time to have intercourse if you would like to make a baby?
- Day 14 of the menstrual cycle (Ovulation) and a couple days after that!
- Male should not ejaculate for about a week before in order to increase the semen count
When is a female going to have the maximum number of Oocytes?
20 weeks Gestation
Which cells are going to make up the Corpus Luteum?
Lutenized Granulosa Cells, Theca Cells, Capillaries and Connective Tissue
List the 9 steps that will describe the hormone changes in the Menstrual Cycle.
- Corpus Luteum dies, Estrogen and Progesterone levels FALL
- Pituitary responds to Fallin E and P by INCREASING FSH secretion
- FSH recruits large antral (Follicles secrete LOW amounts of ESTROGEN and INHIBIN B)
- E and INHIBIN B negatively feed back on FSH
- Declining FSH will cause Follicular Atresia except for DOMINANT follicle (Produces HIGH levels of ESTROGEN)
- High E has positive feedback on the gonadotropes LH (and some FSH) SURGES
- LH surge induces meiosis maturation, ovulation, and luteinization. The Corpus Luteum Produces HIGH P, E, and INHIBIN A
- HIGH P, E, and INHIBIN will NEGATIVELY feed back on LH and FSH, returning them to basal levels
- Corpus Luteum progressively becomes less sensitive to basal LH and will DIE if levels of LH-LIKE activity (hCG) does not increase!
What happens when a female keeps having miscarriages around the 10th week?
LOW Progesterone! Normally the placenta is going to take over the production of Progesterone but there may be a problem there.
Which type of arteries are going to be present in the Functionalis and Basalis layers of the endometrium?
Functionalis: SPIRAL arteries
Basalis: BASAL arteries
What happens to the endometrium when you are in the Proliferative Phase?
- Epithelium is highly organized
- Increase in length of the Spiral Arteries
- Endometrial Growth
List the changes that occur when you are in the Secretory Phase within the endometrium.
- Progesterone secretion stimulates the GLANDULAR cells to secrete MUCUS, GLYCOGEN, and other substances
- Epithelium is not as organized as before
- Endometrial LINING reaches it’s MAXIMAL thickness!
What should you do EVERYTIME you see a post-menopausal women spot?
ULTRASOUND!
When should you first see a female patient?
13-15 years
Which vaccine should you give a woman before she is sexually active?
HPV Vaccine
When should a female have their first Pap Test?
21 years
Define the characteristics of Primary Amenorrhea.
- ABSENCE of Menarche by age 13 years WITHOUT Secondary Sexual development
- ABSENCE of Menarche by age 15 years WITH Secondary Sexual development
How long is a normal menstrual cycle?
28 +/- 7 days (21-35 Days)
How long is the menstrual cycle interval in young females in their FIRST year?
Typically 21-45 Days
Define the characteristics of Secondary Amenorrhea.
- ABSENCE of menstruation for 6 Months
What is the mean blood loss during Menses?
30 cc
A Menstrual flow that is greater than 80 cc is going to be associated with what?
Anemia
Define Polymenorrhea.
- TOO many cycles
- < 21 days per cycle
Define Oligomenorrhea.
- NOT ENOUGH cycles
- > 35 day cycles
Define Menorrhagia.
Excessive and/or prolonged menses (> 80 cc and > 7 days) occuring at REGULAR intervals
Define Metrorrhagia.
IRREGULAR episodes of Uterine Bleeding
Define Menometrorrhagia.
HEAVY and IRREGULAR Uterine Bleeding
Define Intermenstrual Bleeding.
SCANT bleeding at OVULATION
Define Dysfunctional Uterine Bleeding (DUB). What is the usual cause? When is this usually going to occur?
- Abnormal Uterine bleeding that cannot be attributed to: Medications, Systemic Disease, Trauma, etc.
- Cause is changes in the H-P-O Axis
- Most DUB occurs around the years of menarche (11-14 years) or perimenopause (45-50 years)
Explain the PALM-COEIN pneumonic for Abnormal Uterine Bleeding (AUB).
Structural Causes: Polyp, Adenomyosis, Leiomyoma, Malignanacy & Hyperplasia
Non Structural Causes: Coagulatory, Ovulatory Dysfunction, Endometrial, Iatrogenic, and Not yet classified
Which tool would you use to visualize a Polyp in the Uterus?
Hysteroscope
Define Adenomyosis.
Enlargement of the Uterus due to HYPERPLASTIC nodule in the myometrium
What are the three most common places for Leiomyoma in the myometrium of the Uterus?
- Subserosal Fibroid
- Interstitial Fibroid
- Submucosal Fibroid
What are examples of the Nonstructural causes of AUB? (5)
- Coagulopathies: Van Willebrand Disease
- Ovulatory Dysfunction: Polycystic Ovarian Syndrome
- Endometrial Causes: Infection
- Iatrogenic: Exogenous Hormones
- Not yet classified: Arteriovenous malformation
What are some laboratory tests that you can order if you suspect Abnormal Uterine Bleeding?
- Pregnancy Test
- CBC
- PT and PTT (Bleeding Disorders)
- TSH
- Chlamydia test
What are the imaging tests that you can use when an Abnormal Uterine Bleed is suspected?
- Transvaginal Ultrasonography
- Saline infusion sonohysterography
- MRI
- Hysteroscopy
When does Puberty Typically occur in Females?
10-16 years old
What are some factors that can influence the onset of Puberty in females?
- Genetic and Race: African Americans and Hispanic girls usually begin puberty earlier
- Geographic Location: EARLIER if you live in Metropolitan Areas or at altitudes that are near Sea LEVEL
- Nutritional Status: Obese Children (EARLY), Malnourished (LATE), weight of 106 lbs is ESSENTIAL to start menarche
Which peptide is associated with Menarche?
Leptin! Heavier females will go through Puberty EARLIER!
Name the 2 ways to suppress the H-P-O axis during the Childhood Period.
- GnRH sensitivity is LOW due to low circulating estradiol
2. Intrinsic CNS inhibition of the GnRH secretion from the Hypothalamus
In general, what are some changes that are associated with the onset of Puberty?
- Androgen Production (causes Adrenarche or Pubarche)
- Differentiation of the Zona Reticularis of the Adrenal Cortex
- Initial Endocrine Changes
What is the Gonadostat? Explain the levels of the Gonadostat.
- Gonadostat: changes in set point of the H-P-O axis which typically induces negative feedback
- You are going to have less sensitivity to the Gonadostat when you reach puberty!
List the Stages, in order, of Normal Pubertal Development.
- Thelarche (Breast Development): REQUIRES ESTROGENS
- Pubarche / Adrenarche (Pubic / Axillary Hair Development)
- Growth Spurt
- Menarche
(TAG Me)
Explain the different stages of Normal Breast development (Tanner Staging).
Stage 1: Preadolescent (elevation of papilla only)
Stage 2: Breast Bud Stage (Elevation of BREAST and PAPILLA as a small mound with enlargement of the areolar Region)
Stage 3: Further enlargement of the Breast and Areola without separation of their contours
Stage 4: Projection of AREOLA and PAPILLA to form a secondary mound above the level of the breast
Stage 5: Mature Stage (projection of PAPILLA only)
Explain the different stages in Pubic Hair Development (Tanner Staging).
Stage 1: Preadolescent (ABSENCE of pubic Hair)
Stage 2: Sparse hair along Labia
Stage 3: Sparse hair spreads to Pubis
Stage 4: Adult-type Hair but NO spread to medial Thigh
Stage 5: Adult-type hair and SPREAD to Medial Thight
