Puberty, Menstrual Cycle and Menopause

Question 1

Typical order of events in puberty

Answer 1

accelerated growth
thelarche (breast development)
pubarche (pubic hair development)
menarche (onset of menstruation)

Question 2

Ovarian Cycle

Answer 2

Follicular

Luteal

Question 3

Endometrial cycle

Answer 3

Proliferative

Secretory

Question 4

b/w 6 and 8 years

adrenal gland begins regeneration of the ZONA RETICULARIS – sex steroid hormones

Answer 4

Adrenarche

Question 5

8 years old

increased pulsatile secretion from the hypothalamus – pulsatile secretion of LH and FSH from anterior pituitary

Answer 5

Gonadarche

Question 6

around 9-10 years

increased pituitary growth hormone secretion in response to sex steroids

Answer 6

Accelerated growth

Question 7

10 years old

the FIRST PHENOTYPIC sign of puberty

Answer 7

Thelarche

Question 8

11 years

onset of pubic hair years

accompanied by axillary hair

Answer 8

Pubarche

Question 9

Between 12 and 14 years or 2.5 years after development of breast buds

Answer 9

Menarche

Question 10

Average age of menopause

Answer 10

51 years old

Question 11

Diagnosis of menopause

Answer 11

Diagnosed after 12 mos of amenorrhea and consistently elevated FSH levels > 40 IU/L

Question 12

Early menopause

Answer 12

occurs b/w 40 and 45 years

MORE COMMON IN

history of cigarette smoking
short cycles
nulliparity
type I diabetes
in utero exposure to DES
family history of early menopause

Question 13

Menopausal Symptoms and Long Term Effects

FSH > 40 IU/L

Answer 13

Flushes, forgetful

Sweats at night, sad, stroke, skeletal changes, skin changes, sexual dysfunction

Headaches, heart disease

Insomnia

Urinary symptoms, urogenital atrophy

Libido decreases

Question 14

Contraindications to Menopausal Hormone Therapy

Answer 14

Chronic Liver Impairment
Pregnancy
Known estrogen dependent neoplasm (breast, ovary, uterus)
history of thromboembolic disease (DVT, PE, CVA)
unevaluated vaginal bleeding

Question 15

Only indication for MHT

Answer 15

moderate to severe vasomotor symptoms – hot flashes and night sweats