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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
When should a pap smear first be performed?
age 21
26
What did the first gardasil vaccine protect against? what about gardasil 9?
1 series age 9-45 gardasil: HPV 6, 11, 16, 18 G 9: 6, 11, 16, 18, 31, 33, 45, 52, 58
27
What is the median age of menarche?
12.43 yrs 10% at 11.11 yrs 90% menstruating by 13.75 yrs
28
What is thelarche?
breast budding
29
What defines primary amenorrhea?
absence of menarch by age 13 w/out 2ndary dev OR by 15 w/ secondary dev
30
When do cycles start to become regular?
by 3rd year after menarche: 80% 21-35 days long, as is typical in adults
31
What is mean cycle interval in 1st gyno year? menstrual flow length? Menstrual product use?
32.2 days 7 days or less 3-6 pads or tampons per day
32
what defines secondary amenorrhea?
absence of menstruation x 6 months rare for girls and adolescents to remain amenorrheic for more than 3 mos --\> workup if \> 90 days
33
What are endocrine causes of menstrual irregularity?
poorly condrolled DM PCOS cushing's thyroid dysfunction premature ovarian failure late-onset CAH
34
What is mean blood loss per menstrual period? What is associated w/ anemia?
avg = 30 cc = 3-6 pad changes per day \> 80 cc = assoc w/ anemia = changing pad q 1-2 hrs
35
What is polymenorrhea?
abnormally frequent menses at \<21 days
36
Menorrhagia
excessive/prolonged menses occuring at regular intervals
37
metrorrhagia?
irregular episodes of uterine bleeding
38
menometrorrhagia
heave and irregular uterine bleeding
39
intermenstrual bleeding
scant bleeding at ovulation for 1-2 days
40
oligomenorrhea
menstrual cycles at \> 35 day cycles
41
What are the structural causes for abnormal bleeding in repro-age women?
PALM Polyp Adenomyosis Leiomyoma (submucosal or other) Malignancy and hyperplasia
42
What are the nonstructural causes for AUB?
COEIN Coagulopathy Ovulatory Dysfunction Endometrial Iatrogenic Not yet classified
43
What is an endometrial polyp and how are they detected?
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
What is Adenomyosis?
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
What are uterine leiomyomas?
"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
What can cause leiomyomas to enlarge?
pregnancy causes dramatic enlargement
47
What are common symptoms of leiomyomas?
most asymptomatic pelvic/low back pain seve pain not common freq of urination prolonged/heavy bleeding (submucosal or intramural) increased incidence of infertility
48
What is endometrial hyperplasia?
overabundance of growth of endometrium usually result of unopposed persistent E2
49
What can cause endometrial hyperplasia?
PCOS granulosa theca cells tumors - E2 producing obesity - conversion of androgens to Es in adipose cells exogenous estrogens tamoxifen
50
What are the rules for risk of cancer w/ endo hyperplasia?
rule of 3s simple w/out atypia - 1% complex w/out atypia - 3% simply w/ atypia - 9% complex w/ atypia - 27%
51
what are the types of endometrial cancer discussed?
type 1: adenocarcinoma = most common type 2: clear cell and papillary serous
52
What are the common presentations of endometrial hyperplasia?
postmenopausal bleeding = most common irregular uterine bleeding - perimenopause
53
What lab tests would you do to evaluate AUB?
pregnancy test CBC targeted screening for bleeding disorders (von Willebrands profile, PT and PTT) TSH chlamydia trachomatis
54
what are indications for in office endo biopsy (EMBX)?
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
What is an EMBX good for?
better when pathology is global (hyperplasia) rather than a focal polyp
56
What are absolute contraindications of an EMBX? relative?
absolute = pregnancy relative = bleeding diathesis
57
What are the medication treatments of AUB?
normalize prostaglandins (NSAIDs prior to and during menses) antifibrinolytic therapy coordinate endometrial sloughing (OCPs) endometrial suppresion (progesterone continuous)
58
What are surgical tx for AUB?
polypectomy myomectomy dilation and currettage uterine endo ablation hysterectomy
59
What is a D and C used for?
diagnostic = for irregular bleeding or postmenopausal bleeding therapeutic = to remove endometrial structural abnormalities
60
What is endometrial ablation?
uses radiofrequency to bipolar mesh electrode while at same time applying suction perforation safety mechanism ablation time is 90 sec
61
What are the 4 routes for hysterectomy?
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
How long is puberty? when does it occur?
avg is 4-5 yrs usually occurs btw 10-16 y/o (mean is 12.4)
63
When is the H-P-O axis suppressed?
btw ages 4-10
64
What occurs to onset puberty?
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
What is pubarche/adrenarche?
pubic hair/axillary hair development (requires androgens)
66
When does maximal growth/ height velocity occur?
1 yr before onset of menses (2 yrs earlier than boys)
67
What are the Tanner stages of breast development?
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
What are the Tanner stages of pubic hair?
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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