Menarche, puberty, menstrual disorders Flashcards
Menstrual cycle is responsible for what?
pathway starting from the hypothalamus?
Where are FSH and LH produced and stored?
Ovulation, maybe fertilization, then menstruation
GnRH of the hypothalamus releases FSH and LH from anterior pituitary –> stimulates estrogen and progesterone from the ovarian follicle
Gonadotrophs in the anterior pituitary
Normal ovulatory cycle is divided into what phases?
Follicular –> begins with the onset of menstruation and ends with the preovulatory surge of LH
Luteal Phase –> begins with onset of LH surge and ends with the first day of menses (menstruation)
Decreased levels of estrogen and progesterone from the regressing corpus luteum of the preceding cycle causes what?
what happens as estrogen gets a bit higher?
we want some more growth so it initiates an increase in FSH by negative feed back, stimulating follicular growth and estradiol secretion
as the estradiol gets a little bit higher it causes a positive feedback, and that’s what initiates the FSH and LH surge (mostly LH)
so follicular growth is mediated by LH surge.
How is estrogen made?
LH stimulates the thecal cell to convert the cholesterol into androstenedione and testosterone
these both go into the granulosa cell
FSH comes on the granulosa cell, takes the androstenedione and testosterone and changes it to Estrone and Estradiol (through aromatization)
a woman is given a ton of estrogen and develops a tumor.. what is that tumor going to be called?
Granulosa cell tumor
What is day one of the menstrual cycle?
starts to bleed..
LH and FSH are significantly suppressed through elevated circulating estradiol and progesterone.. if she does not become pregnant the progesterone and estradiol will decline due to the corpus luteal regression (becoming the corpus albicans)
FSH starts to rise which initiates new follicular growth for next cycle.. creates more estrogen.
so FSH rises, getting a little bit of estrogen.. originally it’s a negative feedback but eventually it becomes a positive feedback which is what causes the mid cycle ovulation for LH surge.
What does Estradiol do to releasing GnRH and mid cycle LH surge?
increases the hypothalamic release of GnRH to induce midcycle LH surge
when do estradiol levels begin to increase?
when is the maximum estrogen level?
1 week before ovulation
1 day before mid cycle LH peak
maximum progesterone levels?
5-7 days after ovulation.
what color is the corpus luteum?
what if it becomes avascular?
if we have the corpus luteum. it would be yellow if it were producing copious amounts of progesterone.
if she doesn’t get pregnant, it gets Avascular and forms corpus albicans.
what labs do you order for menopause?
FSH and LH are going to be super high. (but usually FSH)
Endometrium?
2 layers?
Outer portion or the functionalis –> changes morphology during menstrual cycle and sloughed off through menstration –> has spiral arteries
Basilis is the inner portion –> unchanged.. has basal arteries and straight arteries and such.
3 phases of the endometrial cycle?
Menstrual phase
Proliferative or estrogenic phase
Secretory or pro gestational phase
when are spiral arteries constricted if there is no pregnancy?
1 day before menstruation so you get ischemia of the endometrium –> necrosis causes sloughing off.
What is needed to regulate menstruation?
intact coagulation pathway
so if you have warfarin, aspirin, or other things that are blood thinners, you can have heavy bleeding because they’re anticoagulants
first visit for OBGYN visit?
first Pap smear?
HPV vaccine time to get?
13-15 years
21
one series between 9 and 26.
HPV 6 and 11.. what are the presentations?
16 and 18?
external genital warts
cervical cancer
average age of menarche?
2-3 years after what?
what tanner stage?
12.43
2-3 years after breast budding (trelarche), at tanner stage 4
what is primary amenorrhea?
absence of menarche by age 13 without secondary sexual characteristics
OR
by the age of 15 with secondary sexual development
Secondary Amenorrhea?
what is it rare for girls to have?
if more than 90 days, what do you do?
absence of menstruation for 6 months
it’s rare for girls and adolescents to remain this way for more than 3 month.
Pregnancy test to rule that out.
first menses reported as what flow?
mean blood loss permenstrual period? how many pads changed?
what’s considered anemia?
medium flow
30cc –> 3-6x a day
80cc –> 1 every couple hours
Polymenorrhea?
Menorrhagia?
Metrorrhagia?
Menometrorrhagia?
Intermenstrual bleeding?
Oligomenorrhea?
abnormally frequent menses, less than 21 days (too many periods)
excessive or prolonged menses
irregular episodes of uterine bleeding
heavy and irregular uterine bleeding
scant bleeding at ovulation
cycles more than 35 days
Adenomyosis
extension of endometrial glands and stroma into the uterine musculature.. sometimes seeing an adenoma (hyperplastic nodules of myometrium)
uterus feels soft and boggy.
Fibroids (leiomyomas)
benign tumors derived from smooth muscles cells of the myometrium
most common
excessive uterine bleeding, pelvic pressure, infertility
African Americans
Leiomyoma locations?
abnormal uterine bleeding.
outside –> subsurosal fibroid
muscle –> interstitial
inside –> submucosal
Endometrial Hyperplasia
overabundance growth of the endometrial lining as a result of persistent unopposed estrogen.
precursor to endometrial cancer.
granulosa theca cell tumors –> estrogen producing tumors
4 precursors to endometrial cancer?
risk factors?
simple without atypia –> 1% chance
complex without atypia –> 3%
simple with atypia –> 9%
complex with atypia –> 27%
obesity, unopposed estrogen.
endometrial cancer in postmenopausal women.. what’s going to happen?
postmenopause bleeding
Coagulapathies?
heavy flow.. Von willebrand disease (1 in 6)
Tissue sampling methods?
endometrial biopsy
hesteroscopy
who would you biopsy?
postmenopausal women with spotting
how do you regulate someones irregular bleeding?
coordinate endometrial sloughing by giving them progesterone and have them come off it.
also birth control pills and take them all the time.
Tanner Stage 1?
2?
3?
4?
5?
elevation of the papilla
breast bud
enlargement of breast and contours
projection of areola
retraction
