Puberty/Menopause

Question 1

Adrenarche/ Gonadarache

Answer 1

Zona reticularis in adrenal starts making androgens, then gonadarche (pulsatile GnRH)

Adrenarche: ages 6-8
Gonadarche around age 8

Question 2

Thelarche / pubarche / menarche

Answer 2

Thelarche (~10 y/o)→ pubarche (~11)→ growth spurt peak velocity (9-10)→ menarche (12-13, or usually ~2.5yrs after thelarche).
Earlier in AA, later in Caucasians / thin girls / etc.

Question 3

True precocious puberty

Answer 3

Due to pulsatile GnRH secretion

Question 4

True precocious puberty treatment

Answer 4

Treat with nonpulsatile GnRH

Question 5

Menopause

Answer 5

Definition: 12 months of amenorrhea after last menstrual period.
Avg age 51, but big range.

Question 6

Perimenopause

Answer 6

Before menopause
Can still have periods!
Get OCPs, not HRT

Question 7

Symptoms of menopause

Answer 7

Hot flashes, mood changes, insomnia, dyspareunia.

Sx usually disappear w/in 12 mo

Question 8

Signs of menopause

Answer 8

Vaginal / cervical atrophy

Decreased estrogen, FSH elevation / LH too, but just supportive (not diagnostic)

Question 9

Menopause risks

Answer 9

Increased coronary artery disease risk Accelerated bone resorption → osteoporosis

Question 10

If history of osteoporotic fx…

Answer 10

Can treat with bisphosphonates right away without waiting for dexa results

Question 11

Osteoporosis risk: when to order DEXA scan

Answer 11

Everybody @ 65 y/o, or @ 60 y/o if high risk

Question 12

Treatment of osteoporosis

Answer 12

Bisphosphonates (if pathologic fx of hip or vertebrae, other fx and T-score -1.0 to -2.5, or Tscore < -2.5).
Should be taking 1000-1500 mg Ca daily no matter what; if osteoporotic, 800 IU vitD too
SERMs help with osteoporosis too.

Question 13

Hormone replacement therapy: risk of unopposed estrogen

Answer 13

Unopposed estrogen → endometrial hyperplasia → endometrial cancer
If still have a uterus, need progestins too

Question 14

Combined HRT dosing

Answer 14

Short period of time (6-12 mo), smallest dose

Question 15

Combined HRT helps prevent

Answer 15

Helps prevent osteoporosis

Question 16

Combined HRT contraindications

Answer 16

Contraindicated if chronic liver dz, pregnant, breast / ovarian / uterine Ca, hx DVT
Irregular vaginal bleeding-need to get a biopsy first
In WHI, actually more CV-related complications in combined hormonal group.

Question 17

Treatment for menopause

Answer 17

Can also try SSRIs for flushing / mood sx, but not great; also vaginal estrogen for atrophy / dryness
Resumption of bleeding is the #1 reason that women stop hormone replacement therapy