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GIGU Exam 2 > Menarche, Puberty, Menstrual Disorders > Flashcards

Menarche, Puberty, Menstrual Disorders Flashcards

1
Q

What needs to mature in order to have menstruation

A

Maturation of the hypothalamic-pituitary- ovarian axis

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2
Q

FSH and LH are released from

A

Gonadotrophs

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3
Q

Where is GnRH made and how does it travel to the AP

A

The Arcuate Nucleus

Through the Hypothalamic portal system

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4
Q

Follicular stage

A

Day 1 menstruation - preovulation (LH Surge)

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5
Q

Luteal Phase

A

At oneset of preovulation (LH Surge) - 1st day of menstruation

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6
Q

Regression of corpus luteum feedback loop

A

Causes low estradiol and progesterone—> increased FSH secreted = follicular growth and estradiol secretion

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7
Q

LH goes to what cell in the follicle

A

THECAL CELL (causes Cholesterol —> Androstenedione + Testosterone)

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8
Q

FSH goes to what cell in the follicle

A

GRANULOSA CELL (causing androstenedione + testosterone—> Estrone (E1)+ Estradiol (E2)

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9
Q

How does estradiol change over ovulation

A 
ESTRADIOL——I FSH + LH (*during mentruation and preovulation + post ovulation)
ESTRADIOL increases (as follicle grows) until a level where it —> FSH +LH = LH surge (*just for ovulation)
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10
Q

Why does FSH rise a little bit after the ovulation and end of cycle

A

after ovulation the E +P decrease due to corpus luteum regression
At the end of the cycle the corpus luteum is basically gone (no estradiol + progesterone)
= rise in FSH (* which stimulates new follicular growth)

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11
Q

What 5 hormones does the Hypothalamus secrete

A
  1. GnRH
  2. TRH (Thyroptropin RH)
  3. SRIF(somatostatin)
  4. CRF (corticotropin RF)
  5. PIF (prolactin releasing inhibiting factor)
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12
Q

How is GnRH secreted

A

Pulsitile
higher f + low amplitude during follicular stage
Low f + high amplitude during luteal stage
REGULATED : estradiol

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13
Q

What makes GnRH get released

A

Estradiol = increase it during ovulation

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14
Q

Estrogen peaked at

A

1 day before ovulation

Has a small rise after is decreases post-ovulation (5-7days) after ovulation

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15
Q

When is the progesterone peak

A

5-7 days after ovulation
The folliculars make not as much P as E
The P rises before ovulation also *Graafian follicle

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16
Q

How many oocytes actually ovulate

A

400

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17
Q

Primordial follicle

A

8-10 weeks gestation of fetus oocyte becoming surrounded by precursor granulosa cells

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18
Q

Cumulus oophorus

A

inner most 3-4 layers of granulosa cells (cuboidal)around ovum
*inner most layer of this elongates and = corona radiata

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19
Q

Inside graffian follicle is

A

Primary oocyte

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20
Q

What is released from ovary

A

Primary oocyte surrounded by corona radiate + ZP

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21
Q

What does the LH surge cause

A

Degeneration of follicular wall , BM bulges and oocyte can rupture though

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22
Q

What makes up the Corpus Luteum

A

Granulosa cells, thecal cells, capillaries, CT
= secrete more P then E
= (9-10 day lifespan unless fertilization)

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23
Q

What does the growing follicles secrete

A

Some estrogen ——I FSH and causes the rise of FSH to rapidly fall at the beginning of the cycle

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24
Q

What happens when FSH falls after its original small increase at the beginning of the cycle

A

Causes atresia of all other non-dominant follicles

This is when a lot of estrogen starts to get secreted

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25
When lots of estrogen is secreted what happens
LH surge
26
What happens in menopause and how do you Dx it
Ovaries don’t function at well X feedback of E to —I GnRH = high levels os FSH made
27
What happens to the endometrium when menstruating
Slough away functional layer | Compress the basal layer
28
4 phases of the menstrual cycle
1. Menstrual Stage : bleeding 2. Proliferative Stage : endometrial growth (pre-ovulation) 3. Secretory Stage : after ovulation, (mucus + Glycogen), more growth, involution if no fertilization -> blood starts
29
Coagulation of endometrium after mentruation
Platelets , clotting factors, | Aspirin, and other medication can impair coagulation
30
When should you have your first Pap test
21 years old
31
HPV vaccine
Ages 9-45yo Protects against many Gardasil strains: 6,11- warts 16,18 - cervical cancer
32
Menarche
Having first menstruation | Median : 12.43 years old
33
When does menarche happen
2-3 years after Thelarche (breast budding) during Tanner stage 4 (Rare before Tanner stage 3)
34
Primary amenorrhea
No menarche by age 13 + X secondary sex features | No menarche by age 15 + has secondary sex features
35
1st year menstrual cycle average length | Normal cycle length after 3rd year on
21-45 days | 21-35 days
36
Secondary amenorrhea
X period for 6 months | If more then 3 mo for any pt, test for preg. ——> urine or serum B-hcG
37
What other things besides preg can stop period
``` Poor control of Diabetes Crushing syndrome Polycystic Ovary Syndrome Thyroid probs Medication, stress, exercise, eating disorder Tumors ```
38
Mean blood loss and number of times you change pad per day | 1st MENSTRUATION
30cc, 3-6 times per day * more then 80cc (change 1-2hrs) —> anemia, especially if bleed longer then 7days * MOST LIKELY VAN WILLEBRAD DISEASE
39
Dysfunctional Uterine Bleeding (DUB)
Abnormal bleeding not associated with medication, blood disease, Von Willebrand, Systemic Disease, Trauma, Preg, polyps =DUE TO aberrations in the H-A-O axis * usually 11-14yo menarche or premenopause
40
Polymenorrhea
Bleeding too after, less then 21 days
41
Menorrhagia
Excessive bleeding or prolonged bleeding
42
Metrorrhagia
Irregular bleeding episodes
43
Menometrorrhagia
Heavy and irregular bleeding
44
Intermenstrual bleeding
Bleeding at ovulation for 1-2 days
45
Oligomenorrhea
Cycles are greater then 35days apart
46
Polyp
Can cause abnormal bleeding Common in premenopausal women (39%) (30% of postmenopause) * DX: by ultrasound to look at endometrial thickness, Hysteroscope -> more diagnostic + theraputic(sends camera up uterus)
47
Endometrial Polyps occurs and look like Can cause : Can be missed when doing : Reason to remove
To creat a soft friable protrusion of cavity Menorrhagia, spontaneous bleeding Endometrial Sampling Remove with hysteroscopy to avoid endometrial hyperplasia or tumor that looks the same or inside one
48
Ultrasound + sonohysterogram
To look at polyps | And inject saline to see the thickening (should not be greater then 4mm, or it could be cancer)
49
Adenomyosis
Can cause abnormal bleeding also Endometrial glands + stroma extend to musculature (2.5mm)(myometrium) - 15% of these patients have endometriosis *these places cant undergo normal cycles Sx: none, secondary dysmenorrhea + menorrhagia + dyspareunia(sex pain)
50
Endometriosis
Endometrial glands and stroma ——> get on the outside of the uterus
51
How to Dx Adenomyosis
HYSTOPATHOLOGY | No US or hysterectomy
52
Hallmark of adenomyosis
Soft and enlarged uterus
53
Hallmark of fibroids
Hard and enlarged uterus
54
Uterine Leiomyomas
``` Fibroids Benign tumors from myometrium 45% women by 50years Sx : none, excessive bleeding, pelvic pressure, pelvic pain, infertility, urination, Dx: Hysterectomy * ```
55
Risk factors for fibroids
Age increase AA women Nulliparity : no pregnancy FH
56
fibroid in muscle Outside layer of uterus Inside layer of uterus
Interstitial Subserosal Submucosal
57
What stimulates proliferation of myometrium | Reason fibroids don’t usually grow before menarche and postmenopause
Estrogen | Not a lot of estrogen
58
Fibroids can cause pain when they
Dentate or calcify especially in postmenopause | They look spherical and white firm lesions
59
Endometrial Hyperplasia
Overabundance growth of endometrium (due to estrogen persisting , no feedback) Can be due to tumors(thecal cells), obesity, medication, PCOS RISK of developing endometrial cancer (or polyps)
60
Change of this type of hyperplasia getting cancer 1. Simple NO atypia 2. Complex NO atypia 3. Simple + Atypia 4. Complex + Atypia
1. 1% 2. 3% 3. 9% 4. 27%-29%
61
Endometrial adenocarcinoma Type 1 and Type 2 RISK Sx:
TYPE 1 : most common TYPE 2 : clear cell with papillary serous Obesity, unopposed E Postmenopause bleeding, irregular bleeding (perimenopuse)
62
Nonstructural bleeding disorders | 5 types and Ex per
1. Coagulopathies : heavy flow -> Van Willebrand 2. Ovulation you Dysfunction : unpredictable cycles -> PCOS 3. Endometrial Causes : -> infection 4. Iatrogenic : IUD, exogenous Hs. 5. Non classified : -> arteriovenous malformation
63
Available imaging for abnormal bleeding | 4
1. MRI 2. Hysteroscopy 3. Saline sonohysterogrpahy 4. Transvaginal ultrasonography
64
2 way to tissue sample
1. Endometrial biopsy | 2. Hysteroscopy for endometrial sampling
65
When to do biopsy (postmenopause)
Bleeding | Endometrium is greater then 4mm
66
When to do biopsy (45yo-menopause)
Abnormal bleeding :intermittent bleeding, menorrhagia
67
When to do biopsy (less then 45yo)
Bleeding due to unopposed E : obesity, chronic anovulation-> PCOS, prolonged amenorrhea
68
Cervical cytology shows + glandular cells
Do biopsy on cervix
69
When to use in office EMBX (biopsy sample)
Blind biopsy getting 90% of endometrium When pathology is local like hyperplasia NOT polyp NEVER DO IF: preg, bleeding diathesis
70
How to Tx: abnormal bleeding | Mx
1. NSAIDS : before period -> normaliza prostaglandins 2. Antifibrinolytic therapy 3. Medication coordinating shedding of endometrium 4. Endometrial suppression
71
Tx: for abnormal bleeding | Surgery
1. Polypectomy : remove polyp 2. Myomectomy : remove fibroid 3. Dilation and Currettage 4. Uterine Endometrial Ablation 5. Hysterectomy
72
Instruments for dilating cervix
Dilators : to open cervix | Curettes : to sample
73
D&C Diagnostic
For irregular bleeding or postmenopause bleeding | = rule out cancer or hyperplasia
74
D&C Therapeutic
For endometrial structures like polyps or submucosal fibroids = to resolve abnormal bleeding
75
Endometrial Ablation
Put a mesh net up in the uterus : radiofrequency electrode + suction =complete endometrial ablation (NovaSure) 90sec = burn inside to help with bleeding
76
Hysterectomy
Incision right above the pubic bone , cut rectum abdominus, and look at uterus Or though ABD or though vagina = remove uterus, ovary, cervix DO if hyperplasia/cancer
77
The other surgical approach to remove uterus is
Robotic assisted Laparoscopic Hysterectomy
78
When is puberty
4-5 years long (10-16 years old) AA and Hispanics, sea-level altitude, obese = earlier then whites and Asians, malnutrition = later
79
Average weight to start period
106lb
80
2 reasons you have low levels of gonadotropins and sexual steroids during prepubertal period
1. Ganadostat (sense E) ——I GnRH | 2. CNS ——I GnRH
81
When is there an increase in DHEA and androstenedione
Age 8-11, causing axillary and pubic hair
82
What happens at round 11yo and GnRH
1. Loss of —I 2. Sleep increases GnRH = ovarian follicles maturation and sex steroids made = secondary sex features
83
what happens mid puberty
Estrogen gets + feedback to cause LH surge | = mentruation starts
84
ORDER of Puberty development
1. Thelarche : breast -E 2. Adrenarche/ Pubarche : hair -androgens 3. Maximal growth (1year before periods) 4. Menarche : periods - GnRH pulsitile + FSH +LH, P, E * TAGMe
85
Tanner Stages BREASTS
1. Election of papilla (prepubertal) 2. Breast bud 3. Enlargement of areolar bud 4. Projection of papilla and Areola from secondary mound 5. Areola degenerated and only papilla projections, mature breast
86
Tanner Stages Pubic Hair
1. Preadolescent; none 2. Sparse on labia , some pigment 3. Hair over junction of pubic bone, more dark/coarse 4. Adult type no thigh 5. Spread to medial thigh , inverted triangular pattern

GIGU Exam 2 (13 decks)

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