Menarche, Puberty, Menstrual Disorders Flashcards
What does the follicular phase begin and end with?
- onset of menstruation and ends with preovulatory LH surge
What does the luteal phase begin and end with?
- onset of preovulatory LH surge and ends with first day of menses
What happens with the corpus luteum regresses, regarding FSH?
Decreasing levels of estrogen and progesterone initiate increase in FSH by negative feedback, stimulating follicle growth and estradiol secretion
What is GnRH synthesized by, specifically?
The arcuate nucleus
What does estradiol do in regards to GnRH?
Enhances release of GnRH and induces midcycle LH surge
How much progesterone does the ovary secrete during follicle development? Prior to ovulation? When does it peak?
- very little
- lots more
- reaches max 5-7 days after ovulation then returns to baseline
What are the two zones of the endometrium?
- the functionalis
- the basalis
What happens in the functionalis? What does it contain?
- this is the part that undergoes cyclic changes during menstrual cycle and is sloughed off during menstruation
- contains spiral arteries
What happens in the basalis? What does it contain?
- this layer remains unchanged during menstrual cycle, contains stem cells for renewal of functionalis layer
- contains basal arteries
What happens during the menstrual phase? (5)
- disruption and disintegration of endometrial glands and stroma
- leukocyte infiltration
- red blood cell extravasation
- sloughing of functionalis layer
- compression of basalis layer
When does menarche occur with regards to Thelarche and Tanner stages?
- 2-3 years after Thelarche
- at tanner stage IV, usually
What is primary amenorrhea?
Absence of menarche by age 13 without secondary sexual development OR by the age of 15 with secondary sexual development
What is secondary amenorrhea?
absence of menstruation for six months or longer
What are the 4 categories for causes of menstrual irregularity?
- pregnancy
- endocrine causes
- acquired conditions
- tumors
What is dysfunctional uterine bleeding (DUB)? (5)
Abnormal uterine bleeding that can’t be attributed to:
- medications
- blood dyscrasias
- systemic disease
- trauma
- organic conditions
What is D.U.B. usually caused by?
Aberrations in the H-P-O axis resulting in anovulation
What is polymenorrhea?
Abnormally frequent menses at intervals of less than 21 days
What is menorrhagia? What specific qualifiers does it have?
- Excessive and/or prolonged menses occurring at regular intervals
- greater than 80ml of blood and greater than 7 days
What is metrorrhagia?
Irregular episodes of uterine bleeding
What is menometrorrhagia?
Heavy and irregular uterine bleeding
What is intermenstrual bleeding?
Scant bleeding at ovulation for 1 or 2 days
What is oligomenorrhea?
Menstrual cycles at greater than 35 day cycles
What are the structural causes of AUB?
PALM
- Polyp
- Adenomyosis
- Leiomyoma
- Malignancy and Hyperplasia
What are the Nonstructural causes of AUB?
COEIN
- Coagulopathy
- Ovulatory dysfunction
- Endometrial
- Iatrogenic
- Not yet classified
What is adenomyosis? How deep specifically?
- Extension of the endometrial glands and stroma into the uterine musculature
- greater than 2.5 mm below basalis layer
It’s basically endometriosis of the myometrium
What are leiomyomas?
benign smooth muscle tumors
What are leiomyomas also called?
fibroids
What are risk factors for leiomyomas? (4)
- increasing age during reproductive years
- african american women have increased risk
- nulliparity
- family history
What is the pathogenesis of leiomyomas? (what is it caused by)
Estrogen stimulates the proliferation of smooth muscle tissue
(so typically they don’t grow before menarche or after menopause)
What are symptoms of leiomyomas? (4)
Typically asymptomatic, but:
- pelvic or lower back pain
- frequency of urination
- prolonged or heavy bleeding
- increased incidence of infertility
What is endometrial hyperplasia? What is it usually caused by?
- Overabundant growth of the endometrial lining
- unopposed estrogen
What can cause endometrial hyperplasia? (4)
- PCOS
- obesity
- exogenous estrogens
- tamoxifen (estrogen receptor antagonist)
Why is endometrial hyperplasia significant?
It is a precursor to endometrial cancer
What is the average duration of puberty?
4-5 years
What is the order of the stages of normal pubertal development in females?
- thelarche
- pubarche/adrenarche
- maximal growth/peak height
- menarche
What hormone does thelarche require?
estrogen
What happens in each Tanner stage of breast development?
- Stage 1 = papilla only elevated
- Stage 2 = ‘breast bud’ stage, elevation of breast and papilla, enlargement of areola
- Stage 3 = further enlargement of breast and areola
- Stage 4 = areola and papilla form secondary mound over breast
- Stage 5 = only papilla projects now
What happens in each Tanner stage of pubic hair development?
- Stage 1 = preadolescent, no pubic hair
- Stage 2 = sparse, downy hair w/little pigment
- Stage 3 = hair spreads, becomes darker and coarser
- Stage 4 = adult-type hair that hasn’t spread to medial surface of thighs
- Stage 5 = adult-type hair spread to medial thighs
