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GIGU > Menarche, Puberty and Menstrual Disorders > Flashcards

Menarche, Puberty and Menstrual Disorders Flashcards

1
Q

How does the HPO axis control ovulation, fertilization and menstruation?

A

GnRH–> FSH and LH–> estrogen and progesterone

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2
Q

Where is oxytocin secreted and stored?

A

posterior pituitary

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3
Q

What can the normal ovulatory cycle be divided into?

A

Follicular phase
–> onset of menstruation to preovulatory surge of LH

Luteal phase
–> LH surge to first day of menses

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4
Q

What initiates an increase in FSH via feedback mechanism after oocyte is expelled?

A

Decreasing levels of estrogen and progesterone form the corpus luteum
—> decrease when no pregnancy, tell body to increase FSH to stimulate follicular growth and estradiol secretion

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5
Q

What initiates the FSH and LH surge when an oocyte is not fertilized?

A

Degenerating corpus luteum stimulates increase in FSH that + follicular development and ESTRADIOL secretion

–>increasing estradiol causes FSH and LH surge

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6
Q

How is estradiol formed?

A

in THECA cell:

cholesterol +via LH
–> androgens (androstenedione and test)

in GRANLUOSA cell:
+ FSH–> estrogens (estradiol)

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7
Q

Why are FSH and LH suppressed via negative feedback?

A

suppressed by estradiol and progesterone

–>fall if not fertilized, stimulate FSH to secrete more estradiol, cause LH (mostly) and FSH to rise rapidly to ovulate

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8
Q

Where does FSH bind?

A

granulosa cells

–>produce estrogen

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9
Q

What day is ovulation of the cycle?

A

14

–> when you would start having intercourse for pregnancy

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10
Q

What enhances hypothalamic release of GnRH and induces midcycle LH surge?

A

estradiol

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11
Q

When do estradiol levels begin to increase?

A

low during early follicular development (when menstruating) but rises 1 week before ovulation

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12
Q

When are estrogen levels maxed out during the ovarian cycle?

A

1 day before LH peak (ovulation)

–>sharp decline, but then maxed out 5-7 days after ovulation, returns to baseline prior to menstruation

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13
Q

Describe progesterone in the ovarian cycle

A

Very little amount during follicular development

Begins being produced by unruptured graafian follicle prior to ovulation

Peaks 5-7 days after ovulation d/t corpus luteum, returns to baseline prior to menstruation

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14
Q

When is the primordial follicle formed?

A

oocyte surrounded by precursor granulosa cells

–> 8-10 weeks of fetal development

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15
Q

When does most of the atresia of oogonia occur?

A

at birth (7 million in womb to 1-2 million)

–> continued atresia until only 400 actually ovulate

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16
Q

What is the corona radiata?

A

elongated inner cumulus oophorus cells attached to oocyte

–>type of granulosa cells

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17
Q

What initiates sequence of biochemical and structural changes that result in ovulation?

A

preovulatory LH surge

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18
Q

How does ovulation take place functionally?

A

Cells on follicular wall surface degenerate–> forms stigma–> basement membrane bulges through stigma–> oocyte expelled into peritoneal cavity

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19
Q

Describe the peaks of estrogen and progesterone during the ovarian cycle

A

Estrogen: 2 peaks

  • -> 1 day prior to ovulation
  • -> 5-7 days post ovulation

Progesterone: 1 peak
–> 5-7 days after ovulation d/t corpus luteum secretion

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20
Q

What forms the corpus luteum?

A

lutenized granulosa cells, theca cells, capillaries, CT

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21
Q

What is the normal functioning lifespan of corpus luteum?

A

9-10 days

–>replaced by corpus albicans during menses (if no pregnancy)

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22
Q

What test should you order to dx menopause?

A

FSH

–>if ovaries not responding, GnRH continuously secreting FSH to stimulate follicles for pregnancy

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23
Q

What are the 2 portions of the endometrium?

A

1: Functionalis (outer)
- -> cyclic changes in morphology during menstrual cycle, sloughed off
- -> spiral As

2: Basalis (inner)
- -> unchanged during cycle, provides stem cells for renewal of functionalis layer
- -> basal As

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24
Q

What are the cyclic changes the functionalis layer of endometrium undergoes?

A

1: Menstrual
- –> only one can physically see
2: Proliferative/estrogenic
3: Secretory/progestational

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25
Q

Day 1 of the menstrual cycle coincides with what?

A

first day of menstruation

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26
Q

What occurs during the menstrual phase?

A
  • Disruption of endometrial glands and stroma
  • Leukocyte infiltration
  • RBC extravasation
  • Sloughing of functionalis layer
  • Compression of basalis layer
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27
Q

What occurs during the proliferative phase of endometrial cycle?

A

endomaterial growth
–>secondary to estrogen stimulation

increase in length of spiral As

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28
Q

What occurs during the secretory phase of endometrial cycle?

A
  • secretion of mucus and glycogen after ovulation via + by progesterone
  • tortuous glands
  • edematous stroma
  • mitosis is RARE
  • spiral As extend to superficial layer of endometrium
  • endometrium reaches maximal thickness
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29
Q

Corpus luteum begins to regress with decline in estrogen and progesterone if conception doesn’t occur by day ___

30
Q

When does ischemia of endometrium (d/t constriction of spiral As), leukocyte infiltration and RBC extravasation occur?

A

1 day prior to menstruation

–>results in sloughing

31
Q

What does the secretory phase require?

A

coagulation pathway

32
Q

What causes heavy bleeding during secretory phase or menstruation?

A

warfarin, aspirin, etc impairs coagulation pathway in secretory phase

33
Q

When should first OBGYN occur?

A

13-15 years

34
Q

What is the median age of menarche?

35
Q

When does menarche occur r/t Tanner staging?

A

wihtin 2-3 years of breast budding (thelarche) at tanner stave 4

–>rarely before stage 3

36
Q

Define primary amenorrhea

A

Absence of menarche by age 13 without secondary sexual development

OR

absence by age of 15 with secondary sexual development

37
Q

Are menstrual cycles often irregular?

A

Yes throughout adolescents

–>especially first to second cycle

38
Q

What is the range of normal cycles in the first gynecological year?

A

21-45 days

–>median length of first cycle after menarche is 34 days

39
Q

Define secondary amenorrhea

A

Absence of menstruation by 6 months

–>rare to not have one more than 3 months
check hCG

40
Q

What is the mean loss per menstrual period?

41
Q

What menstrual loss is associated with anemia?

A

more than 80cc

42
Q

Define polymenorrhea

A

Abnormally frequent menses at intervals less than 21 days

43
Q

Define menorrhagia (hypermenorrhea)

A

excessive and/or prolonged menses occurring at regular intervals

–> more than 80mL more than 7 days

44
Q

Define metrorrhagia

A

irregular episodes of uterine bleeding

45
Q

Define menometrorrhagia

A

heavy and irregular uterine bleeding

46
Q

Define intermenstrual bleeding

A

scant bleeding at ovulation for 1-2 days

47
Q

Define oligomenorrhea

A

menstrual cycles greater than 35 days per cycle

–> go more than 35 days without cycle

48
Q

What is the PALM acronym for structural causes of abnml bleeding in reproductive aged women?

A
  • Polyo
  • Adenomyosis
  • Leiomyoma
  • Malignancy and Hyperplasia
49
Q

What is the COEIN acronym for nonstructural causes of abnml bleeding in reproductive aged women?

A
  • Coagulopathy
  • Ovulatory Dysfxn
  • Endometrial
  • Iatrogenic
  • Not yet classified
50
Q

What is adenomyosis?

A

extension of endometrial glands and stroma into uterine musculature

–>15% have endometriosis

51
Q

What are uterine leiomyomas?

A

Fibroids

–> benign tumors from SM of myometrium

–> most common neoplasm of uterus

52
Q

What causes endometrial hyperplasia?

A

unopposed estrogen

–> overabundance of growth of endometrial lining

53
Q

What is the average duration of puberty?

54
Q

What is the onset of puberty determined by?

A

12.4 (between 10-16)

  • -> AA and Hispanic girls earlier
  • -> Metro, altitudes near sea level earlier
  • -> Obese earlier
  • -> Malnourished or chronically ill later
55
Q

What weight is essential to start menarche?

56
Q

When is the HPO axis suppressed?

A

4-10 yrs old

57
Q

What are initial endocrine changes a/w puberty?

A

androgen production via zona reticularis

58
Q

What activates HPO axis around 11 years of age?

A

gradual loss of sensitivity to negative feedback of sex steroids

Loss of CNS inhibition of GnRH

59
Q

What is the first physical sign of puberty?

A

Thelarche (breast development)

~~~9-10 yrs

**requires estrogen

60
Q

What do pubarche/adrenarche require?

A

androgens

–> hair development

61
Q

When does the maximal growth of height occur during puberty?

A

1 year before onset of menses

2 years earlier than males

62
Q

What is Tanner stage 1 of breast?

A

Preadolescent

elevation of papilla only

63
Q

What is Tanner stage 2 of breast?

A

Breast bud stage

small mound of elevation of breast and papilla, enlargement of areolar region

64
Q

What is Tanner stage 3 of breast?

A

Further enlargement of breast and areola WITHOUT separation of contours

65
Q

What is Tanner stage 4 of breast?

A

Projection of aroela and papilla to form secondary mound above level of breast

66
Q

What is Tanner stage 5 of breast?

A

Mature stage

projection of papilla only

–>general contour of breast

67
Q

What is Tanner stage 1 of pubic hair?

A

Preadolescent

absence of pubic hair

68
Q

What is Tanner stage 2 of pubic hair?

A

Sparse hair along labia

Hair downy with slight pigment

69
Q

What is Tanner stage 3 of pubic hair?

A

Hair spreads sparsely over jxn of pubes

hair is darker and coarser

70
Q

What is Tanner stage 4 of pubic hair?

A

Adult-type hair WITHOUT spread to medial thighs

71
Q

What is Tanner stage 5 of pubic hair?

A

Adult-type hair with spread to medial thighs

–>inverted triangle pattern

GIGU (37 decks)

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