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OB > Puberty, menstrual cycle, menopause > Flashcards

Puberty, menstrual cycle, menopause Flashcards

1
Q

Order of puberty

A
  • Adrenarche/gonadarche (age 6-8/8)- adrenarche is when the adrenal gland starts regenerating its zona reticularis for sex hormone synth
  • Accelerated growth (age 9-10)
  • Thelarche (age 10)- breast development
  • Pubarche (age 11)
  • Menarche (age 12-13 OR 2.5 years after the development of breast buds)

*Thelarche often comes after pubarche in AA girls

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2
Q

First phenotypic sign of puberty

A

Breat buds aka thelarche

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3
Q

What causes accelerated growth?

A
  • Sex steroids DIRECTLY affect epiphyseal growth

- Sex steroids CAUSE the release of growth hormone

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4
Q

What causes breast development?

A

inc levels of circulating ESTROGEN

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5
Q

What causes pubic/axillary hair development?

A

Androgens

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6
Q

Precocious puberty

A

Before 6 in caucasian girls

Before 7 in AA girls

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7
Q

Delayed puberty

A

Absence of incomplete breast development by age 12

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8
Q

Initial workup for precocious AND delayed puberty?

A

H & P, hormone assessment, bone age determination

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9
Q

What happens during the follicular phase?

A

FSH inc stims the growth of 5-15 primordial follicles, 1 becomes the dominant follicle which produces ESTROGEN (and will eventually be released during ovulation).

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10
Q

How is estrogen produced by the follicle?

A

LH causes theca interna cells make androstenedione

FSH stims the granulosa cells to convert the androstenedione to estradiol

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11
Q

What does the LH surge do?

A

Triggers the resumption of meiosis in the oocyte.
Induces production of progesterone and prostaglandins in the follicle.
Causes the RUPTURE of the follicular wall with release of ovum.

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12
Q

What makes HCG in the first 8 weeks of gestation?

A

The trophoblast. It maintains the corpus luteum so that IT can produce E&P to support the endometrial growth.

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13
Q

What makes HCG after 8-10 weeks of gestation?

A

The placenta

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14
Q

Normal range for menstrual cycle?

A

24 days up to 35 days

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15
Q

What happens to hormones during menstrual cycle?

A

FSH gradually rises again

E&P levels drop

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16
Q

When can perimenopause start?

A

2-8 years before menopause

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17
Q

Pathyophysiology of menopause?

A

Low number of follicles left, so there aren’t many to secrete inhibin B which normally downregulates FSH. FSH levels RISE, progesterone levels low.

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18
Q

Menopause is defined as

A

12 months without a period

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19
Q

Average age of menopause in USA

A

51 yrs

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20
Q

Premature ovarian insufficiency?

A

Menopause before age 40

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21
Q

Risk factors for early menopause

A
  • Smoking
  • Short menstrual cycles
  • Nulliparity
  • TYPE 1 DIABETES
  • Family hx of early meno

Slightly earlier in tubal ligation & hysterectomy pts

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22
Q

Symptoms of menopause

A

Hot flashes, NIGHT SWEATS, mood swings, vaginal dryness (vaginal, urethral, cervical atrophy), dyspareunia, dysuria, urinary symptoms, headaches, dec libido

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23
Q

Test to confirm menopause

A

FSH > 40 IU/L (blood test)

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24
Q

When do symptoms generally disappear

A

1-2 years after onset (some can take 5 yrs)

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25
Q

What are 2 major systemic affects that a drop in estrogen during menopause can result in?

A
  • Estrogen normally inc HDL and dec LDL so it’s cardioprotective
  • Also regulates osteoclastic activity thereby preventing osteoporosis
26
Q

What is HRT

A

it’s E&P menopausal therapy for women who STILL HAVE UTERUS

27
Q

What is ERT

A

Estrogen only for women who had a hysterectomy and therefore no inc risk of endometrial cancer with estrogen only

28
Q

Benefits of HRT?

A

Dec risk of colorectal cancer

29
Q

Benefits of HRT and ERT?

A

Prevents osteoporosis, improves vasomotor flushing, atrophy, improves muscle tone, skin

30
Q

Risks of HRT?

A

Coronary artery events, DVTs/PEs, risk of invasive breast cancer

31
Q

Risks of ERT?

A

Stroke (age-independent), DVTs. NO IMPACT ON HEART ATTACKS.

32
Q

General rule with hormone replacement therapy?

A

Shortest dose for shortest amount of time. Basically only 1-5 years.

33
Q

Contraindications to HRT?

A 
Chronic liver disease
Pregnancy
Known estrogen-dependent neoplasm
Hx of thromboembolic disease
Undiagnosed vaginal bleeding
34
Q

Nonhormonal rx of vasomotor symptoms (hot flashes/night sweats)

A

Clonidine, SSRIs like Paroxetine, SNRIs like venlafaxine

Gabapentin low-dose

35
Q

Osteoporosis rx

A 
Vit D and Calcium
Bisphosphonates,
Calcitonin
Raloxifen/tamoxifen
Weight bearing exercise
36
Q

What medications predispose to bone loss?

A

Levothyroxine, steroids, heparin.

Scan these ladies earlier.

37
Q

Primary dysmenorrhea

A

No obvious cause. Possibly from inc levels of endometrial prostaglandin production.

38
Q

Rx of primary dysmenorrhea

A

NSAIDs. OCPs second line. Progestin-only ok too.

39
Q

Secondary dysmenorrhea

A 
Cervical stenosis
Pelvic adhesions
Adenomyosis
Endometriosis
Fibroids
40
Q

Rx of cervical stenosis

A

Surgical dilation or laminaria.

Delivering vaginally often leads to permanent cure (duh).

41
Q

Rx of pelvic adhesions

A

Laparoscopy for dx and rx.

42
Q

Key to remember about adhesions

A

NOT VISIBLE on imaging like MRI, CT, U/S.

43
Q

PMS possible etiology

A

Serotonin and cyclic change sin ovarian steroids.

They have normal levels of estrogen and progesterone but may have an ABNORMAL RESPONSE to them.

44
Q

Rx of PMDD

A

SSRIs, SNRI venlafaxine, the benzo alprazolam (Xanax)

Yaz- has drospirenone, a spironolactone

Exercise and relaxation

Vitamin supplementation

Carb-rich beverages

45
Q

Definition of abnormal uterine bleeding

A

Too much or too little

46
Q

Normal menstrual cycle

A

21-35 days, 3-5 days long, 30-50mL blood loss

47
Q

Dysfunctional uterine bleeding

A

Idiopathic heavy and/or irregular bleeding

48
Q

Menorrhagia?

MCCs?

A

Excessive flow- either TOO LONG or TOO MUCH.
Often described as “flooding” or “gushing”.

Fibroids, adenomyosis, endometrial polyps. Evaluate for bleeding disorders as well.

49
Q

Hypomenorrhea

A

Regular timing of menses but LIGHT FLOW.

Could be from OCPs, Depo, progestin IUDs

50
Q

Metrorrhagia

A

Bleeding BETWEEN menses (usually is lighter)

51
Q

Menometrorrhagia

A

Abnormal intervals AND excessive or prolonged bleeding

52
Q

Oligomenorrhea

MCCs?

A

Cycles more than 35 days apart.

PCOS, chronic anovulation, pregnancy, thyroid disease

53
Q

Polymenorrhea?

A

Less than 21 day cycles.

54
Q

Tests to do for light or skipped cycles?

A

Pregnancy test, TSH, PRL, FSH

55
Q

Tests to do for heavy, frequent, or prolonged cycles?

A

Pregnancy test, TSH, CBC

56
Q

Who should get an endometrial biopsy?

A

Patients over 45 with abnormal uterine bleeding (excessive OR insufficient)

Obese patients with prolonged oligomenorrhea, even if younger than 45.

57
Q

When is MRI useful in these situations?

A

To differentiate between fibroids and adenomyosis.

58
Q

Rx of endometrial hyperplasia?

A

No atypia: progestin

With atypic: D&C/hysterectomy

59
Q

In acute hemorrhage from DUB, give what?

A

IV estrogen

For hemodynamically stable, give high-dose oral estrogens. Or, OCP taper to stabilize endometrium (High to low).

60
Q

Causes of postmenopauseal bleeding in descending order?

A
  1. Vaginal/endometrial atrophy, exogenous estrogens

2. Endometrial cancer, endometrial polyps, endometrial hyperplasia, other

61
Q

Tests for postmenopausal bleeding

A

pap smear, high-risk HPV screen, CBC, TSH, prolactin, FSH levels
Pelvic u/s, sonohysterogram, MRI

OB (8 decks)

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