Menarche, puberty, menstrual disorders

Question 1

Menstrual cycle is responsible for what?

pathway starting from the hypothalamus?

Where are FSH and LH produced and stored?

Answer 1

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

Question 2

Normal ovulatory cycle is divided into what phases?

Answer 2

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)

Question 3

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?

Answer 3

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.

Question 4

How is estrogen made?

Answer 4

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)

Question 5

a woman is given a ton of estrogen and develops a tumor.. what is that tumor going to be called?

Answer 5

Granulosa cell tumor

Question 6

What is day one of the menstrual cycle?

Answer 6

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.

Question 7

What does Estradiol do to releasing GnRH and mid cycle LH surge?

Answer 7

increases the hypothalamic release of GnRH to induce midcycle LH surge

Question 8

when do estradiol levels begin to increase?

when is the maximum estrogen level?

Answer 8

1 week before ovulation

1 day before mid cycle LH peak

Question 9

maximum progesterone levels?

Answer 9

5-7 days after ovulation.

Question 10

what color is the corpus luteum?

what if it becomes avascular?

Answer 10

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.

Question 11

what labs do you order for menopause?

Answer 11

FSH and LH are going to be super high. (but usually FSH)

Question 12

Endometrium?

2 layers?

Answer 12

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.

Question 13

3 phases of the endometrial cycle?

Answer 13

Menstrual phase
Proliferative or estrogenic phase
Secretory or pro gestational phase

Question 14

when are spiral arteries constricted if there is no pregnancy?

Answer 14

1 day before menstruation so you get ischemia of the endometrium –> necrosis causes sloughing off.

Question 15

What is needed to regulate menstruation?

Answer 15

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

Question 16

first visit for OBGYN visit?

first Pap smear?

HPV vaccine time to get?

Answer 16

13-15 years

21

one series between 9 and 26.

Question 17

HPV 6 and 11.. what are the presentations?

16 and 18?

Answer 17

external genital warts

cervical cancer

Question 18

average age of menarche?

2-3 years after what?

what tanner stage?

Answer 18

12.43

2-3 years after breast budding (trelarche), at tanner stage 4

Question 19

what is primary amenorrhea?

Answer 19

absence of menarche by age 13 without secondary sexual characteristics

OR

by the age of 15 with secondary sexual development

Question 20

Secondary Amenorrhea?

what is it rare for girls to have?

if more than 90 days, what do you do?

Answer 20

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.

Question 21

first menses reported as what flow?

mean blood loss permenstrual period? how many pads changed?

what’s considered anemia?

Answer 21

medium flow

30cc –> 3-6x a day

80cc –> 1 every couple hours

Question 22

Polymenorrhea?

Menorrhagia?

Metrorrhagia?

Menometrorrhagia?

Intermenstrual bleeding?

Oligomenorrhea?

Answer 22

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

Question 23

Adenomyosis

Answer 23

extension of endometrial glands and stroma into the uterine musculature.. sometimes seeing an adenoma (hyperplastic nodules of myometrium)

uterus feels soft and boggy.

Question 24

Fibroids (leiomyomas)

Answer 24

benign tumors derived from smooth muscles cells of the myometrium

most common

excessive uterine bleeding, pelvic pressure, infertility

African Americans

Question 25

Leiomyoma locations?

Answer 25

abnormal uterine bleeding.

outside –> subsurosal fibroid

muscle –> interstitial

inside –> submucosal

Question 26

Endometrial Hyperplasia

Answer 26

overabundance growth of the endometrial lining as a result of persistent unopposed estrogen.

precursor to endometrial cancer.

granulosa theca cell tumors –> estrogen producing tumors

Question 27

4 precursors to endometrial cancer?

risk factors?

Answer 27

simple without atypia –> 1% chance
complex without atypia –> 3%
simple with atypia –> 9%
complex with atypia –> 27%

obesity, unopposed estrogen.

Question 28

endometrial cancer in postmenopausal women.. what’s going to happen?

Answer 28

postmenopause bleeding

Question 29

Coagulapathies?

Answer 29

heavy flow.. Von willebrand disease (1 in 6)

Question 30

Tissue sampling methods?

Answer 30

endometrial biopsy

hesteroscopy

Question 31

who would you biopsy?

Answer 31

postmenopausal women with spotting

Question 32

how do you regulate someones irregular bleeding?

Answer 32

coordinate endometrial sloughing by giving them progesterone and have them come off it.

also birth control pills and take them all the time.

Question 33

Tanner Stage 1?

2?

3?

4?

5?

Answer 33

elevation of the papilla

breast bud

enlargement of breast and contours

projection of areola

retraction