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ENRE > Menarche Puberty and Menstrual Disorders > Flashcards

Menarche Puberty and Menstrual Disorders Flashcards

1
Q

What is the basic hypothalamic-pituitary-ovarian axis?

A

GnRH –> FSH and LH –> estrogen and progesterone from ovarian follicle

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2
Q

What separate the pituitary gland from the cranial cavity?

A

condensation of dura matter

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3
Q

What denotes the follicular phase?

A

begins w/ onset of menstruation –> ends w/ preovulatory surge of LH

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4
Q

What denotes the luteal phase?

A

begins w/ onset of preovulatory LH surge –> ends w/ first day of menses

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5
Q

what stimulates follicular growth?

A

general cycle:

decreasing levels of E and P from regressing corpus luteum of the preceding cycle –> increase in FSH –> follicular growth –> E secretion

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6
Q

What does LH stimulate?

What about FSH?

A

LH –> theca cells to produce androgens

FSH –> granula cells convert androgens into estrogens (E1 and E2)

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7
Q

What occurs hormonally in the luteal phase?

A

Both LH and FSH are depressed as E2 and P increase

if conception doesn’t occur –> no HcG –> corpus luteum regresses –> E and P will decrease –> FSH will then rise to initiate next cycle

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8
Q

How does estradiol affect the hypothalamus?

A

enhances the release of GnRH and induce midcycle LH surge

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9
Q

What are estrogen levels like in the ovarian cycle?

A

early = low

approx 1 week before ovulation –> E2 increases –> peaks 1 day before midcycle LH peak –> then drops again

reaches max in luteal phase 5-7 days after ovulation and returns to baseline before menstruation

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10
Q

Where does progesterone come from during follicular development?

A

ovary only secretes a small amount

bulk from peripheral conversion of pregnenolone to progesterone

corpus luteum secretes a lot and reaches peak 5-7 days afer ovulation –> returns to baseline before menstruation

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11
Q

When do oocytes become surrounded by precursor granulosa cells?

A

8-10 weeks of fetal dev

primordial follicle

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12
Q

What is the cumulus oophorus?

A

innermost 3-4 layers of granulosa cells surrounding the oocyte

become cuboidal

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13
Q

What is the corona radiata?

A

innermost layer of granulosa cells of the cumulus oophorus

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14
Q

What occurs during pre-ovulatory LH surge?

A

cells on follicular wall surface degenerate –> stigma forms –> follicular basement membrane bulges through stigma

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15
Q

How long is the normal functional life span of the corpus luteum?

A

9-10 days

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16
Q

What do you see in hormone levels during menopause?

A

lower E –> no neg feedback on FSH and LH

so you see increased FSH and LH

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17
Q

What are the 2 layers of the endometrium?

A

functionalis = where sprial arteries are, sloughed off during menstruation

basalis = unchanged during cycle, provides stem cells for functionalis renewal, contains basal As

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18
Q

What is the only part of the uterine/ovarian cycle that is visible externally?

A

menstrual phase

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19
Q

What occurs in the proliferative phase of ovarian cycle?

A

estrogen –> endometrial growth/proliferation

spiral As increase and length, can see numerus mitoses

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20
Q

What occurs in the secretory phase of ovarian cycle?

A

P from corpus luteum –> glandular cells secrete mucus, glycogen, etc.

glands become tortuous = sawtoothed pattern

stroma becomes edematous

mitosis rare

endometrial lining max thickness

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21
Q

When will the corpus luteum begin to regress?

A

if conception doesn’t occur by day 23

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22
Q

When does necrosis of endometrium occur?

A

1 day prior to onset of menstruation

caused by constriction of spiral arteries

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23
Q

What is required to restore the blood vessels in the endometrium?

A

successful interaction of platelets and clotting factors

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24
Q

When should an initial repro health visit for a female occur?

what happens at this visit?

A

13-15 yrs

build trust, just talk to pt

pelvic exam usually not indicated unless problem

talk about repro health-related topics for prevention

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25
Q

When should a pap smear first be performed?

A

age 21

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26
Q

What did the first gardasil vaccine protect against?

what about gardasil 9?

A

1 series age 9-45

gardasil: HPV 6, 11, 16, 18

G 9: 6, 11, 16, 18, 31, 33, 45, 52, 58

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27
Q

What is the median age of menarche?

A

12.43 yrs

10% at 11.11 yrs

90% menstruating by 13.75 yrs

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28
Q

What is thelarche?

A

breast budding

29
Q

What defines primary amenorrhea?

A

absence of menarch by age 13 w/out 2ndary dev

OR

by 15 w/ secondary dev

30
Q

When do cycles start to become regular?

A

by 3rd year after menarche: 80% 21-35 days long, as is typical in adults

31
Q

What is mean cycle interval in 1st gyno year?

menstrual flow length?

Menstrual product use?

A

32.2 days

7 days or less

3-6 pads or tampons per day

32
Q

what defines secondary amenorrhea?

A

absence of menstruation x 6 months

rare for girls and adolescents to remain amenorrheic for more than 3 mos –> workup if > 90 days

33
Q

What are endocrine causes of menstrual irregularity?

A

poorly condrolled DM

PCOS

cushing’s

thyroid dysfunction

premature ovarian failure

late-onset CAH

34
Q

What is mean blood loss per menstrual period?

What is associated w/ anemia?

A

avg = 30 cc = 3-6 pad changes per day

> 80 cc = assoc w/ anemia = changing pad q 1-2 hrs

35
Q

What is polymenorrhea?

A

abnormally frequent menses at <21 days

36
Q

Menorrhagia

A

excessive/prolonged menses occuring at regular intervals

37
Q

metrorrhagia?

A

irregular episodes of uterine bleeding

38
Q

menometrorrhagia

A

heave and irregular uterine bleeding

39
Q

intermenstrual bleeding

A

scant bleeding at ovulation for 1-2 days

40
Q

oligomenorrhea

A

menstrual cycles at > 35 day cycles

41
Q

What are the structural causes for abnormal bleeding in repro-age women?

A

PALM

Polyp

Adenomyosis

Leiomyoma (submucosal or other)

Malignancy and hyperplasia

42
Q

What are the nonstructural causes for AUB?

A

COEIN

Coagulopathy

Ovulatory Dysfunction

Endometrial

Iatrogenic

Not yet classified

43
Q

What is an endometrial polyp and how are they detected?

A

form from endometrium –> soft friable protrusion into endometrial cavity

can cause menorrhagia, spontaneous, or post menopausal bleeding

see on ultrasound = focal thickening of endometrial stripe

saline hysterosonography and hysteroscopy allows form better detection

44
Q

What is Adenomyosis?

A

extension of endometrial glands and stroma into uterine musculature (>2.5 mm beneath basalis layer)

15% of ppl with it have endometriosis

see homogenous enlargement of the uterus

45
Q

What are uterine leiomyomas?

A

“fibroids”

benign tumors derived from sm m cells of myometrium

most common neoplasm of uterus, rarely malignant

common in older women

most asymptomatic

subserosal, interstitial, or submucosal

46
Q

What can cause leiomyomas to enlarge?

A

pregnancy causes dramatic enlargement

47
Q

What are common symptoms of leiomyomas?

A

most asymptomatic

pelvic/low back pain

seve pain not common

freq of urination

prolonged/heavy bleeding (submucosal or intramural)

increased incidence of infertility

48
Q

What is endometrial hyperplasia?

A

overabundance of growth of endometrium

usually result of unopposed persistent E2

49
Q

What can cause endometrial hyperplasia?

A

PCOS

granulosa theca cells tumors - E2 producing

obesity - conversion of androgens to Es in adipose cells

exogenous estrogens

tamoxifen

50
Q

What are the rules for risk of cancer w/ endo hyperplasia?

A

rule of 3s

simple w/out atypia - 1%

complex w/out atypia - 3%

simply w/ atypia - 9%

complex w/ atypia - 27%

51
Q

what are the types of endometrial cancer discussed?

A

type 1: adenocarcinoma = most common

type 2: clear cell and papillary serous

52
Q

What are the common presentations of endometrial hyperplasia?

A

postmenopausal bleeding = most common

irregular uterine bleeding - perimenopause

53
Q

What lab tests would you do to evaluate AUB?

A

pregnancy test

CBC

targeted screening for bleeding disorders (von Willebrands profile, PT and PTT)

TSH

chlamydia trachomatis

54
Q

what are indications for in office endo biopsy (EMBX)?

A

postmenopausal women - sample w/ any spotting or bleeding; endomedrial lining> 4mm

age 45 to menopause: any AUM

<45: any bleeding that occurs in setting up unopposed E2 exposure or prolonged amenorrhea

if + glandular cells on cervical cytology

55
Q

What is an EMBX good for?

A

better when pathology is global (hyperplasia) rather than a focal polyp

56
Q

What are absolute contraindications of an EMBX?

relative?

A

absolute = pregnancy

relative = bleeding diathesis

57
Q

What are the medication treatments of AUB?

A

normalize prostaglandins (NSAIDs prior to and during menses)

antifibrinolytic therapy

coordinate endometrial sloughing (OCPs)

endometrial suppresion (progesterone continuous)

58
Q

What are surgical tx for AUB?

A

polypectomy

myomectomy

dilation and currettage

uterine endo ablation

hysterectomy

59
Q

What is a D and C used for?

A

diagnostic = for irregular bleeding or postmenopausal bleeding

therapeutic = to remove endometrial structural abnormalities

60
Q

What is endometrial ablation?

A

uses radiofrequency to bipolar mesh electrode while at same time applying suction

perforation safety mechanism

ablation time is 90 sec

61
Q

What are the 4 routes for hysterectomy?

A
  1. total abdominal hysto (TAH)
  2. vaginal hysterectomy (TVH)
  3. laparascopic assisted vaginal (small abdominal and vaginal incisions)
  4. da Vinci assisted (small abdominal and vaginal incisions)
62
Q

How long is puberty?

when does it occur?

A

avg is 4-5 yrs

usually occurs btw 10-16 y/o (mean is 12.4)

63
Q

When is the H-P-O axis suppressed?

A

btw ages 4-10

64
Q

What occurs to onset puberty?

A

age 11: loss of sensitivity by gonadostat to negative feedback of sex steroids

sleep-associated increases in GnRH –> adult patterns

increase in GnRH –> ovarian follicle maturation and sex steroid production

by mid to late puberty - ovulatory cycles established

65
Q

What is pubarche/adrenarche?

A

pubic hair/axillary hair development (requires androgens)

66
Q

When does maximal growth/ height velocity occur?

A

1 yr before onset of menses (2 yrs earlier than boys)

67
Q

What are the Tanner stages of breast development?

A
  1. preadolescent, elevation of papilla only
  2. breast bud, elevation of breast and papilla is small w/ enlargement of areolar region
  3. further enlargement of breast and areola w/out separation of their contours
  4. projection of areola and papilla to form secondary mound above breast
  5. mature stage, projection of papilla only, areola goes w/ general contour of breast
68
Q

What are the Tanner stages of pubic hair?

A
  1. preadolescent, absence
  2. sparse hair along labia, hair downy w/ slight pigment
  3. hair spreads sparsely over jxn of pubes, darker and coarser
  4. adult-type hair, no spread to thighs
  5. adult-type hair w/ spread to medial thighs

ENRE (21 decks)

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