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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
Q

When lots of estrogen is secreted what happens

A

LH surge

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26
Q

What happens in menopause and how do you Dx it

A

Ovaries don’t function at well
X feedback of E to —I GnRH
= high levels os FSH made

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27
Q

What happens to the endometrium when menstruating

A

Slough away functional layer

Compress the basal layer

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28
Q

4 phases of the menstrual cycle

A
  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
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29
Q

Coagulation of endometrium after mentruation

A

Platelets , clotting factors,

Aspirin, and other medication can impair coagulation

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30
Q

When should you have your first Pap test

A

21 years old

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31
Q

HPV vaccine

A

Ages 9-45yo
Protects against many Gardasil strains:
6,11- warts
16,18 - cervical cancer

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32
Q

Menarche

A

Having first menstruation

Median : 12.43 years old

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33
Q

When does menarche happen

A

2-3 years after Thelarche (breast budding) during Tanner stage 4
(Rare before Tanner stage 3)

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34
Q

Primary amenorrhea

A

No menarche by age 13 + X secondary sex features

No menarche by age 15 + has secondary sex features

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35
Q

1st year menstrual cycle average length

Normal cycle length after 3rd year on

A

21-45 days

21-35 days

36
Q

Secondary amenorrhea

A

X period for 6 months

If more then 3 mo for any pt, test for preg. ——> urine or serum B-hcG

37
Q

What other things besides preg can stop period

A 
Poor control of Diabetes 
Crushing syndrome
Polycystic Ovary Syndrome
Thyroid probs
Medication, stress, exercise, eating disorder 
Tumors
38
Q

Mean blood loss and number of times you change pad per day

1st MENSTRUATION

A

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
Q

Dysfunctional Uterine Bleeding (DUB)

A

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
Q

Polymenorrhea

A

Bleeding too after, less then 21 days

41
Q

Menorrhagia

A

Excessive bleeding or prolonged bleeding

42
Q

Metrorrhagia

A

Irregular bleeding episodes

43
Q

Menometrorrhagia

A

Heavy and irregular bleeding

44
Q

Intermenstrual bleeding

A

Bleeding at ovulation for 1-2 days

45
Q

Oligomenorrhea

A

Cycles are greater then 35days apart

46
Q

Polyp

A

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
Q

Endometrial Polyps occurs and look like
Can cause :
Can be missed when doing :
Reason to remove

A

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
Q

Ultrasound + sonohysterogram

A

To look at polyps

And inject saline to see the thickening (should not be greater then 4mm, or it could be cancer)

49
Q

Adenomyosis

A

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
Q

Endometriosis

A

Endometrial glands and stroma ——> get on the outside of the uterus

51
Q

How to Dx Adenomyosis

A

HYSTOPATHOLOGY

No US or hysterectomy

52
Q

Hallmark of adenomyosis

A

Soft and enlarged uterus

53
Q

Hallmark of fibroids

A

Hard and enlarged uterus

54
Q

Uterine Leiomyomas

A 
Fibroids
Benign tumors from myometrium 
45% women by 50years
Sx : none, excessive bleeding, pelvic pressure, pelvic pain, infertility, urination, 
Dx: Hysterectomy *
55
Q

Risk factors for fibroids

A

Age increase
AA women
Nulliparity : no pregnancy
FH

56
Q

fibroid in muscle
Outside layer of uterus
Inside layer of uterus

A

Interstitial
Subserosal
Submucosal

57
Q

What stimulates proliferation of myometrium

Reason fibroids don’t usually grow before menarche and postmenopause

A

Estrogen

Not a lot of estrogen

58
Q

Fibroids can cause pain when they

A

Dentate or calcify especially in postmenopause

They look spherical and white firm lesions

59
Q

Endometrial Hyperplasia

A

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
Q

Change of this type of hyperplasia getting cancer

  1. Simple NO atypia
  2. Complex NO atypia
  3. Simple + Atypia
  4. Complex + Atypia
A
  1. 1%
  2. 3%
  3. 9%
  4. 27%-29%
61
Q

Endometrial adenocarcinoma Type 1 and Type 2
RISK
Sx:

A

TYPE 1 : most common
TYPE 2 : clear cell with papillary serous
Obesity, unopposed E
Postmenopause bleeding, irregular bleeding (perimenopuse)

62
Q

Nonstructural bleeding disorders

5 types and Ex per

A
  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
Q

Available imaging for abnormal bleeding

4

A
  1. MRI
  2. Hysteroscopy
  3. Saline sonohysterogrpahy
  4. Transvaginal ultrasonography
64
Q

2 way to tissue sample

A
  1. Endometrial biopsy

2. Hysteroscopy for endometrial sampling

65
Q

When to do biopsy (postmenopause)

A

Bleeding

Endometrium is greater then 4mm

66
Q

When to do biopsy (45yo-menopause)

A

Abnormal bleeding :intermittent bleeding, menorrhagia

67
Q

When to do biopsy (less then 45yo)

A

Bleeding due to unopposed E : obesity, chronic anovulation-> PCOS, prolonged amenorrhea

68
Q

Cervical cytology shows + glandular cells

A

Do biopsy on cervix

69
Q

When to use in office EMBX (biopsy sample)

A

Blind biopsy getting 90% of endometrium
When pathology is local like hyperplasia
NOT polyp
NEVER DO IF: preg, bleeding diathesis

70
Q

How to Tx: abnormal bleeding

Mx

A
  1. NSAIDS : before period -> normaliza prostaglandins
  2. Antifibrinolytic therapy
  3. Medication coordinating shedding of endometrium
  4. Endometrial suppression
71
Q

Tx: for abnormal bleeding

Surgery

A
  1. Polypectomy : remove polyp
  2. Myomectomy : remove fibroid
  3. Dilation and Currettage
  4. Uterine Endometrial Ablation
  5. Hysterectomy
72
Q

Instruments for dilating cervix

A

Dilators : to open cervix

Curettes : to sample

73
Q

D&C Diagnostic

A

For irregular bleeding or postmenopause bleeding

= rule out cancer or hyperplasia

74
Q

D&C Therapeutic

A

For endometrial structures like polyps or submucosal fibroids
= to resolve abnormal bleeding

75
Q

Endometrial Ablation

A

Put a mesh net up in the uterus : radiofrequency electrode + suction
=complete endometrial ablation (NovaSure) 90sec
= burn inside to help with bleeding

76
Q

Hysterectomy

A

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
Q

The other surgical approach to remove uterus is

A

Robotic assisted Laparoscopic Hysterectomy

78
Q

When is puberty

A

4-5 years long (10-16 years old)
AA and Hispanics, sea-level altitude, obese = earlier then
whites and Asians, malnutrition = later

79
Q

Average weight to start period

A

106lb

80
Q

2 reasons you have low levels of gonadotropins and sexual steroids during prepubertal period

A
  1. Ganadostat (sense E) ——I GnRH

2. CNS ——I GnRH

81
Q

When is there an increase in DHEA and androstenedione

A

Age 8-11, causing axillary and pubic hair

82
Q

What happens at round 11yo and GnRH

A
  1. Loss of —I
  2. Sleep increases GnRH
    = ovarian follicles maturation and sex steroids made
    = secondary sex features
83
Q

what happens mid puberty

A

Estrogen gets + feedback to cause LH surge

= mentruation starts

84
Q

ORDER of Puberty development

A
  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
Q

Tanner Stages BREASTS

A
  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
Q

Tanner Stages Pubic Hair

A
  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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