Menarche/Puberty/Menstrual Disorders Flashcards
How does the hypothalamus and pituitary effect menstruation?
GnRH from hypothalamus stimulates anterior pituitary to release FSH and LH which stimulates estrogen and protegesterone release from ovarian follicle
LH stimulates theca cells to produce what?
FSH stimulates granulosa cells to convert androgens into what?
androgens (androsenedione and testosterone)
estrogens
What is the average age of menarche?
12.43 years old
occuts 2-3 years after thelarche at tanner stage IV
Primary amenorrhea defined
absense of menarche by age 13 without secondary sexual development
Or
absence of menarche by age 15 with secondary sexual developement
Within the first year of menstrual cycles, what is the typical cycle length?
21-45 days
by third year after menarche, most menstural cycles are 21-35 days long
What is a normal menstrual cycle in a young female?
median age 12.43
32.2 days in first GYN year
menstural cycle interval 21-45 days
flow length is 7 days or less
flow rate is 3-6 pads/tampons per day
What is secondary amenorrhea?
absence of menstriation for 6 months
if greater than 90 days at time of presentation, get pregnancy test
may be associated with other conditions
Excessive menstrual flow is quantified by?
changing pads/tampons every 1-2 hours, esp if longer than 7 days
What is polymenorrhea?
abnormally frequent menses at intervals at <21 days
What is menorrhagia?
excessive and or prolonged menses (>80ml and >7 days) occuring at regular intervals
What is metrorrhagia?
irregular episodes of uterine bleeding (not nec. heavy)
What is menometrorrhagia?
heavy and irregular uterine bleeding
What is intermenstrual bleeding?
scant bleeding at ovulation for 1-2 days
What is oligomenorrhea
too few periods
menstrual cycles at >35 day cycles
What are structural causes for abnormal uterine bleeding?
PALM
polyp
adenomyosis
leimyoma
malignancy and hyperplasia
What are nonstructural causes of abnormal uterine bleeding?
COEIN
coagulopathy
ovulatory dysfunction
endometrial
iatrogenic
not classified
What is the most common neoplasm of the uterus?
Fibroids
what are coagulopathic causes of AUB?
present with heavy flow, assx with von willebrand disease
what can cause ovulatory dysfunction related AUB?
PCOS
what can be an endometrial cause of AUB?
infection
What can be a cause of an iatrogenic AUB?
IUD, IUS (mirena), exogenous hormones (Prometrium)
What are the average ages of the following in white populations
Thelarche
Adrenarche
Menarche
- 3yrs
- 5yrs
- 5 yrs
earlier in african american and hispanic populations
Tanner Staging Breast Development
- preadolescent elevation of papilla only
- breast bud stage with elevation of breast and papilla and enlargement of areolar region
- further enlargement of breast and areola without separation of contours
- projection of areola and papilla to form secondary mound above the level of the breast
- mature stage, projection of papilla only, recession of areola to general contour of breast
Tanner Staging of Hair Growth
- preadolescent absence of pubic hair
- Sparse hair along labia, slight pigment
- hair spreads sparsly over junciton of pubes, darker
- adult type hair without spread to medial thigh
- adult type hair with spread to medial thigh and inverted triangle shape
What are treatment options for AUB?
Depends on cause: If polyp or fibroid can remove those, or do a hysterectomy. Can try ablation to remove endometrium, Mirena or continous OCP to avoid cycling/bleeding, or tranexamic acid, or scheduled NSAIDs, or Provera/daily progesterone.
If nonstructural, can treat underlying condition.
