OBGYN: Puberty, MS, Amenorrhea, Dysmenorrhea Flashcards
define puberty
- series of what two events
- what develops?
- series of neuroendocrine + physiological events
- results in develop of secondary sex characteristics, menarche and ovulation
puberty
-onset is determined by? (5)
- genetic factors
- geographical location
- nutritional status
- excessive exercise
- psychological factors
what happens 1 yr before puberty
- nocturnal pulses of gonadotropin secretion—FSH and LH
- incr resp in the pituitary to GnRH
results in stimualtion of gonadal maturation with ESTRADIOL and TESTOSTERONE secretion
age of onset of puberty
- girls + anatomically whats starting?
- boys + anatomically whats starting
girls: 8-9–thelarche (breast enlargement)
boys: 11— enlargement of testes and thining of scrotal skin
define thelarche
breast enlargement
what causes development of breasts, maturation of repro organs and deposition of fat in female hips
estradiol
list the repro organs in girls
vagina
uterus
ovaries
3 things that estradiol does to female body during puberty
- breast maturation
- develop of repro organs—vagina, uterus, ovaries
- deposition of fat in female hips
what causes rapid skeletal growth of testes, scrotum and penis
- incr in prod of growth factors
2. estrogen
when is male puberty complete
first ejaculation that contains mature sperm
when is female puberty is complete
time of first ovulatory menstrual period
—can take up to 1-2 years after menarche
how do we describe the stages of puberty
tanner stages
no sexual hair (both), flat appearing chest with raised nipple (girl)
-age + stage?
stage 1
pre-pubertal
pubic hair appears (both), testicular enlargement, breast bud forms
-age + stage?
stage 2
8-11.5 YO
coarsening of pubic hair (both), -penis size/length incrs,
- breast enlarge, mound forms
- age + stage?
stage 3
11.5-13 YO
coarse hair across pubis—sparing thigh (both),
- penis width/glans incr,
- breast enlarges, raised areola, mound on mound
- age + stage?
stage 4
13-15YO
coarse hair across pubis and medial thigh (both)
- penis and testies enlarge to adult size
- adult breast contour, areola flattens
- age + stage?
stage 5
usually >15 YO
define precocious puberty
too early
both delayed and precocious puberty involve?
-inappropriate onset of sex hormone production by gonads
define delayed puberty in girls and boys
- girl hasnt developed breast buds by age 13
- boys havnt had enlargement of the testes by 14.5 yrs old
in about 95% of delayed puberty cases— what is cause
-tx? when to do it?
normal physiologic event
- **everything is happen normally but SLOWLY
- *tx rarely needed—>causing psychosocial problems
% of cases that delayed puberty is normal physiologic event
95
% of delayed puberty cases caused by genetic mutations, disruption of HPG axis or outcomes of systemic dz
5%
causes of the 5% of delayed puberty cases (3)
- genetic mutations
- disruption of HPG axis
- by outcomes of systemic dz
two main general causes of delayed puberty causes
-exs for each one
HypERgonadotropic HyPOgonadism–>increased FSH and LH
- ***Gonadal dysgenesis turner syndrome
- ***Klinefelter syndrome (47, XXY)
- Bilateral gonadal failure from traumatic, infectious or autoimmune causes
HyPOgonadotropic HyPOgonadism—>decr LH and FSH
- Kallmann syndrome (GnRH deficiency)
- pituitary adenomas
- drug use
- anorexia/extreme exercise
MCC for delayed puberty in the 5% of cases that is not physilogic normal
- Turner syndrome–Gonadal dysgenesis
2. Klinefelter syndrome—47 or XXY
what is Kallmann syndrome
GnRH deficiency causing Hypogonadatropic Hypogonadism delayed puberty
define precocious puberty–girls and boys
- sexual maturation occuring b4 age 6 in black girls or 7 in white girls
- b4 age 9 in boys
causes of precocious puberty (3)
- obesity
- endocrine disruptions in common household products–pesticides, plasticizers and pharmaceuticals
- lethal central nervous system tumors
complete precocious puberty
- define
- what is the axis?
- cause in 10% of cases?
- premature development of appropriate characteristics
- hypothalamic-pituitary-ovarian axis functioning normally BUT prematurely
10% cases–lethal CNS tumor is cause
partial precocious puberty
- define
- can develop to?
- cause?
partial development of appropriate secondary sex characteristics
can progress to complete precocious puberty
cause: estrogen secreting neoplasms or may be variant of normal pubertal development
mixed precocious puberty
- define
- cause
- partial development of some secondary sex characteristics of the OPPOSITE gender
- commonly caused by adrenal hyperplasia or androgen-secreting tumors
MC congenital mullerian anomalies–>which class is MC
Biconuate uterus
follicular phase also called
menses + proliferative phase
Luteal phase also called
Secretory phase
Seccretory phase?
luteal phase
proliferative and menses phase?
Follicular phase
days 0-14
follicular phase/proliferative
days 14-28
secretory phase/luteal phase
surge in what hormone causes ovulation
LH
hormone predominating the luteal phase
progesterone
hormone predominating follicular phase
estradiol + FSH
what is phase 1 of reproductive cycle
Menstruation and Follicular phase
LMP really means?
first day of menstrual bleeding=day ONE of the menstrual cycle
day one of menstrual cycle?
first day of menstrual bleeding
The average cycle is how long?
21-35 days
avg=28
average menses lasts ?
3-7 days
average volume of blood loss during menses
30-50 mL
If a woman is not using hormonal birth control, you can assume that ??
women are ovulating (releasing an egg) each time they have a period
having a period means?
you are fertile
two days before start of menses, what hormone increases
-what does this hormone cause
FSH
- causes maturation of a group of ovarian follicles (oocytes/eggs)
- dominant follicle emerges
what marks the beginning of follicular phase
menses starting—-DAY 1 of cycle!!!
**egg/follcile is starting to mature and getting ready for ovulation
during follicular phase, what hormone does the oocyte/follicle start to secrete?? what happens due to this hormone being secreted
it starts to secrete estradiol–>provides (-) feedback to PG to stop producing FSH (+) feedback to start incr LH
which hormones are at its lowest during follicular phase
estradiol
LH
Progesterone
what hormone is highest at the start of the menstrual cycle
FSH
what is phase 2 of the reproductive cycle
ovulation
Ovulation
-by day 11-13 of normal cycle, what happens
LH surge— triggers ovulation
what triggers ovulation and what day of cycle
days 11-13= LH SURGE
after LH surge, what happens during ovulation
Oocyte is expelled from follicle
where does the expelled oocyte travel to next
fallopian tubes–>uterus–>awaiting fertilization
after expulsion of the oocyte, what does the empty follicle turn into?
corpus luteum
define ovulation
mature egg or oocyte released from follicle in the ovary
what is the follicle
protective sac around the egg giving the maturing egg nutrients and protection
what is left behind after ovulation
follicle– turns into corpus luteum
follicular phase is dominated by?
estradiol
luteal phase is dominated by?
progesterone
after ovulation, how long does it take to produce progesterone
24 hours after ovulation
***rises rapidly thereafter
when is the peak of progesterone
**maintained for how long?
3-4 days after ovulation
**maintained approx for 11 days
what happens to progesterone levels if fertilization and implantation do not occur
progesterone production diminishes rapidly
what is making the progesterone
corpus luteum
“prime” time to get pregnant
2-4 days after ovulation—oocyte is now in uterus waiting for fertilization
- surge in LH=?
- day 1 of menstrual cycle, the highest hormone=?
- what happens after egg is released?
- ovulation
- FSH
- corpus luteum makes progesterone—the egg that would be fertilized and implanted needs progesterone to IMPLANT
why does a fertilized egg need progesterone
to implant into endometrium and sustain the pregnancy into early first trimester
life span of corpus luteum
13-14 days unless pregnancy occurs
if oocyte becomes fertilized and implants within endometrium— early pregnancy begins secreting?
Human Chorionic Gonadotripin (hCG)
what does hCG do early on in pregnancy
sustain the life span of corpus luteum for another 6-7 weeks—-so progesterone continues to be produced
progesterone produces ____ feedback to PG to ____ levels of what hormone(s)
progesterone provides negative feedback on PG–>both FSH and LH levels are suppressed
what happens when corpus luteum gets HCG hormone
it sustains the life of the corpus luteum for another 6-7 weeks so more progesterone can be secreted to sustain early pregnancy
what happens when progesterone levels fall due to egg not being fertilized?
FSH begins to rise—- preparing woman for another reproductive cycle
what inhibits FSH and LH
Progesterone
what hormones are highest at days
7
14
21
7= FSH
14=LH
21=progesterone
ammenhorrhea define
absence of menstruation
primary amenhorrhea define
menarche has not occured by age 13-15
causes of primary amenorrhea (3)
- anatomical defects—absence of vagina and uterus
- genetic disorders–Turner syndrome
- problems with AP—tumors or problems with CNS that affect hypothalamic defects—prevents release of GnRH–which means no signaling of AP to release FSH and LH
how to diagnose primary amenorrhea
labs–abnormal levels of gonadotropins or ovarian hormones or precense of genetic conditions
diagnositc imaging–US and MRI`
tx for primary amenhorrhea
correction of underlying disorders and implementation of HRT
surgery only to correct structural abnormalities
number one cause of secondary amenohorrhea
pregnancy
define secondary amenorrhea
absense of menstration for a time equivalent to three or more cycles in women who have previously menstruated
how many cycles missed to call it secondary amenorrhea
THREE+
causes of secondary amenorrhea (7)
- PREGNANCY *****
- hypothryoidism
- hyperprolactinemia
- excessive exercise
- stress
- weight loss
- PCOS
define dysmenhorrhea
painful menstruation
s/s of dysmenorrhea
- pelvic pain associated with onset of menses
- backache
- anorexia
- vom/dia
- syncope
- HA
what is causing HA with dysmenorrhea
prostaglandins enter the systemic circulation
define primary dysmenhorrea and what causes it pathophys wise
-painful menstruation caused by release of prostaglandins in NORMAL OVULATORY CYCLE
prostaglandin is a vasodilator or contrisor
vasoconstrictor–constricts endometrial BVs a
prostaglandin is myometrial inhibitor or stimulant
stimulant—increases myometrial contractions
pathophysiology to the pain caused in dysmehorrhea
prostaglandin is released into systemic circulation–>excess prostaglandin increases myometrial contractions, constricts endometrial BVs and enhances nerve hypersensitivity——–results in PAIN
primary dysmenorrhea always correlates to?
menses
**ovulatory cycle is releasing the prostaglandins causing the pain **
secondary dysmenorrhea
- define
- manifests when?
- occurs when?
pathologic pelvic conditions
–manifests later in reproductive years and can occur ANY TIME during the menstrual cycle
causes of secondary dysmenhorrhea–including the MC (8)
- endometriosis—MC
- PID
- adhesions
- Uterine fibroids
- polyps
- tumors
7 cysts - IUDs
secondary dysmenorrhea has no correlation to?
period
wherehas primary always correlates to period
tx for primary and secondary dysmenorrhea
- NSAIDS—– reduce COX enzyme activity–>reducing prostaglandins
- hormonal contraception—stops ovulation and creates atrophic endometrium—-decring prostaglandin synthesis and myometrial contractility
what hormone is responsible for
- ovulation
- menses
- LH
2. FSH
