Puberty&menopause Flashcards
- def
- age
- pathophysiology of puberty
- normal transition from non reproductive to reproductive phase
-8:14 y - gnRH pulsatile manner
Cp of puberty
1-Growth spurt: peak velocity at 11 years, with a slow growth at 15 years until closure of bone epiphysis)
2-Breast development, (thelarche) :5 stages under the effect of estrogen.
3-pubarche :under the effect of androgen ,ACTH , also 5 stages
4-Menarche :average age in Egypt is 12.5 years
5-Axillarche :under the effect of androgen.
What are the disorders of puberty
1- precocious
2- delayed
Talk about delayed
Delayed = 1st amennorrhea
Talk about precocious pub
- def
- comp
-types
- secondary sexual before 8 y with or without menstruation
- short stature, psychological impact
- isosexual , heterosexual
Talk about isosexual
1- agreement with phenotypic sex
• central or true ( the common) ( gnRH dependent, ovulation ~> preg can occur)
- constitutional ( the common) : idiopathic premature stimulation of gnRH gene
- organic : cns lesion that causes gnRH ++
Tumor
Inf
Malformation
Head trauma
• pericphral or pseudo ( gnRH independent, no ovulation, preg)
- ovarian secreting ovarian tumor
- ocp
- primary hypothyroidism: TSH ~> + FSH
Talk about heterosexual
Disagreement with phentypic sex
Peripheral or pseudo
- androgen secretingnovarian tumor
- androgen intake
- congeital adranal hyperplasia
Diagnosis of precocious
1- history and examination :
هعرف اشخص انها عندها بلوغ بدري ونوعه iso or heteo
2- inv
Lab
-To diff betwwen central , periphral
~> fsh /lh ( + in central )
- androgen , E2 if ovarian tumor
- thyroid function
Imaging
- XRAY FOR BONE AGE
- Ct or mri : pit adenoma
- pelvic us : ovaries and adrenal gland
Ttt of precious
- ttt of cause
- idiopathic is ttt by gnRH agonists Due to downregulation receptor effect~> decreased GnRH, FSH, and LH continued until the age of puberty
Talk about perimenopause
(3)
1-Before the menopause
2-menopausal transition from ovulatory cycles to anovulatory cycles
3- characterized by
* irregular period
* associated with menopausal symptoms as hot flushes, mood changes
*++ inhibin b thus decreasing FSH and LH
*Preserved E2 until the late perimenopausal phase
Talk about menopause
- def
- etiology
- defind by
- types
1-Normal transition from reproductive to non-reproductive phase
2-depletion of oocytes
3- year of amenorrhea or Six months with high FSH.
4- Types :
*Natural :
-Due to depletion of the perimordial follicles.
-At the age 45 to 55 with median age of 51 or 52 due to +OCP intake
-types :
Premature below 45
delayed after 55
*Induced :Menopause is done artificially by
-excision of ovarian ovaries due to ovarian tumor
-Ablation of ovarian function due to radiation or chemotherapy or medical ttt
Why is it misnomer
Mens - ovulation as ovarian tumor ✅
Ovulation - mens as hysterectomy ❌
Endocrine changes
1-Increased inhibin B that started at perimenopause
2-High FSH and LH
3-Decreased E2
4- Decreased SEBG
5-Increased free T hormone.
Changes in body system
(4)
Mainly due to low E2
( resp for mucus regeneration, elasticity)
• Pelvic ligament : weakness, tendency to pelvic organ prolapse
• urethra and urinary bladder :loss of elasticity, urinary dysfunction,urinary stress incontinence due to weakness of pelvic ligament
•uterus: smaller
•endometrium: thinner, below 5 mm
•cervix: thinner
•vagina : dryness, thinner, atrophic, low vascularity, high pH,
•breasts :become small and flabby due to fat replacement with atrophy of active glandular elements,
•skin :low thickness, low collagen.
Cp of menopause
(9)
1-Vasomotor disorders :Hot flushes with cold sweats (4)
-Due to inappropriate stimulation of thermoregulatory center in the hypothalamus with vasodilation of vessels in the skin of the neck,chest ~> + temperature in skin, although the core temperature is normal
-takes 5 minutes
-starts at perimenopause and become aggressive at menopause
-more aggressive in الستات الرفيعة
2-psychological: aniexty, insomnia, mood changes
3- GIT symptoms :constipation, abdominal distension, tendency to weight gain
4-urinary :frequency, dysuria, urinary stress incontinence
5- genital :dryness of vagina
6-tendency to pelvic organ prolapse
7-androgenic symptoms : hirsutim
8-risk of cardiovascular disease: +LDL ,–HDL
9- risk of osteopenia and osteoporosis due to decreased mineral bone density.
- inv
- management
Of menopause
Inv
1-1 year with amenorrhea
2- 6 months with high FSH
3- low E2
4- menopausal symptoms
Ttt
1- reassurance about the physiological symptoms
2- education about healthy lifestyle : food with high phytoestro ,vitamin D, calcium ,exercising, no smoking(– estrogen)
3-symptomatic treatment
4- following up INV by
Dexa, lipid profile, mammography, TVS ( ut) ,pap smear cytology ( cervix , vagina)
Comp of menopause
1- CVS disease :
-high LDL, low HDL
-susceptible for coronary heart disease, MI, HTN, atherosclerosis
2-osteoporosis
-DEF:decreased mineral bone density
- etiology : Bone mineral calcium loss, Osteoclasts >Osteoplasts
- sites :Vertebrae, Radius, Femur
- cp : with Minor trauma, there is a risk of fracture
-Risk factors :Premature menopause, Lack of exercise, Smoking
-P :
*food with high calcium ,Vitamin d Phytoestrogen
*No smoking
*Exercising
- inv : DEXA
- TTT :
- for Slowing Down Bone Breakdown : -Biphosphonate :Orally Intaken Once a Week
-Calcitonin: Nasal Spray
- for bone Anabolic
- Teraparatide : im
- HT :
-Not the Primary Therapy
-Selective Estrogen Receptor Modulator ( serm) ( raloxifene ) : Effective but se is Hot Flushes
-Phytoestrogens.
Talk about ht in menopause
1- artificial ~> gyn ,,, naturanl ~> obs
2- H used
-Estrogen :not used due high risk for endometrial hyperplasia, carcinoma except in hysterectomy
-Estrogen with prg ( distract) to avoid endometrial hyperplasia, carcinoma
-Indications:
*Menopausal symptoms as hot flushes, mood swings
*vaginal dryness
* secondary therapy for osteoporosis
-Contra :
*CVS disorders as synthetic estrogen +LDL, -HDL.
*History of any tumor
*Undiagnosed abnormal bleeding from genitalia
*Acute liver disease
-Schedule:
* Continuous :
~No menses
~ but irregular bleeding due to overgrowing of the endometrium, (alarming in menopause)
- Cyclic :
~3 weeks then 1 off
~Menses - Local vaginal cream for dryness of the vagina. *Estrogen :oral , transdermal, subdermal, in hysterectomy only.
