Puberty, Menstrual Cycle, Menopause Flashcards
1
Q
What is Puberty?
A
Transition from childhood to sexual maturity
2
Q
What are signs that you are going through puberty?
A
Hips broaden
Breasts develop
Pubic & axillary hair
Menarche
3
Q
Define Menarche
What age does menarche occur?
A
Onset of menstruation
Age 8-16 (avg is 12.5)
4
Q
? Average menstruation cycle length total?
A
Around 38 days but 28-29 days when they aren’t on their actual period.
but it can vary per woman
5
Q
? Average period amount
What contraceptive method can influence amount?
A
1-2 ounces
25-80 mL
Varies per woman.
The pill can affect how heavy your flow is.
6
Q
What health condition can heavier or irregular menses (bleeding, periods) lead to?
A
Anemia!
7
Q
One young girl lives in Alaska. Another lives in Southern America.
Which girl will more than likely have their menarche first?
What does menarche mean again?
A
The girl living in South America. A warmer climate correlates with an earlier menarche.
Menarche means onset of menstruation
8
Q
A pregnant mother complains of feeling constipated and having to use the restroom frequently.
Should she be too concerned? Why or why not?
A
Constipation and frequent urination are normal in pregnancy.
This has to do with the uterus growing and putting pressure on the bladder and bowel.
9
Q
Name 3 layers of the uterine corpus (uterus).
A
Perimetrium
Myometrium
Endometrium
10
Q
What is the perimetrium?
A
Perimetrium is the outer layer.
11
Q
What is the myometrium?
A
Myometrium is the middle, muscular layer,
12
Q
What is the endometrium?
What happens to this layer during menstruation?
A
Endometrium is the inner, mucus layer.
We shed this layer off.
13
Q
What is the physical structure of the uterus like?
Why is it this way?
A
It’s made of fibers that run in different directions and inner lace with each other.
The overlapping fibers help to prevent PPH or post partum hemorrhage.
14
Q
Is the uterus a stagnant organ?
A
No, it is very mobile in the abdominal cavity. It is not fixed.
15
Q
Three different sections to the Follopain tubes
A
Isthmus
Ampulla
Fimbria
16
Q
Which section of the Fallopian tubes is closest to the uterus?
What site is it?
A
The isthmus is the closest to the uterus.
Site of tubal ligation.
17
Q
What section of the Fallopian Tubes is the distal or outer portion?
What site?
A
The ampulla is the outer portion.
Site of fertilization
18
Q
What is the very edge of the Fallopian Tube called?
What does it resemble?
A
Edge is the Fimbria.
Resembles fingerlike projections.
19
Q
What if the Fimbria part of the fallopian tube has adhesions?
What does adhesion mean?
A
The adhesions could stop the egg from being caught and therefore the egg would fall to the peritoneal cavity and thus no chance of conception.
Adhesion could be an obstruction or even scarring from inflammation or infection.
20
Q
What function keeps the ovum/egg moving while in the fallopian tube (to get to the uterus)?
A
Ciliary movement from cilia hairs that creates a current for the egg to be transported by.
21
Q
The ovary releases the ovum.
Then the ciliary movement moves it through the tube.
Where do the ovum and sperm unite for conception?
A
The outer third (ampulla , I think but need to double check)
22
Q
Name of the fallopian tube fluid that provides nourishment?
A
Serous fluid
23
Q
Good & Bad of the ovaries lacking a peritoneal cavity?
A
Good is that it allows for ovulation
Bad is it allows for spread of cancer to be easier
24
Q
Where are follicles stored and developed?
How many follicles are we born with?
What does hyper-ovulator mean?
A
Ovaries.
We are born with all our follicles at birth. One by one, once we go through puberty, we begin to release one egg at a time.
Hyper-ovulator means that you release more than one egg at a time. End up with twins. (Can have hysterectomy to fix)
25
Which two hormones are secreted by ovaries?
Estrogen & Progesterone
26
What is the nickname for Estrogen?
“Femaleness hormone” meaning it helps the follicle to mature for ovulation.
Female sex characteristics; puberty
Growth hormone in pregnancy : breasts increase in size, uterine growth, blood vol increase
27
Nickname of progesterone?
What is your progesterone levels are low?
Why?
Is it treatable?
“Pregnancy hormone” or released after the ovulation which keeps you pregnant.
Low progesterone is tied to increased risk of miscarriage - so it is keeping you pregnant.
It is supposed to calm the uterus - and so without it, you can contract yourself into a miscarriage. Also can calm the CNS.
Can be treated with replacement therapy usually around 16-36 weeks IM. Comes in many forms though; pill, vaginal, IM, etc
28
What are some issues that can arise because the progesterone calms the entire CNS?
Sedate feeling, sleepy
Constipation
UTI
Etc
Because it calms and halts things.
29
Main 3 parts of the ovarian cycle
Follicular
Ovulation/Graafian
Luteal
30
What occurs in the follicular phase?
Variance
Follicle/egg/ovum matures before releasing
Yes, this part of the cycle is what gives you the variance in your cycle.
31
What happens in ovulation/Graafian?
Ovum/egg is released by the ovary = ovulation
Graafian follicle or house of the egg remains within the ovary.
32
What occurs in the Luteal phase of the Ovarian cycle?
This is the post-ovulation phase where progesterone takes over because it is released from the Graafian follicle house.
Because progesterone is now in the picture, estrogen levels decrease.
And then the luteal phase ends completing the ovarian cycle. After you have your period, the cycle begins all over again. (Bc you have to ovulate in order to bleed)
33
Name the Menstrual Cycle hormones
```
FSH
Estrogen
LH
Progesterone
Prostoglandin E
Prostoglandin F
```
34
Where is FSH released?
What does FSH do?
Pituitary
The FSH release stimulates ovary to release estrogen for the follicle to begin maturing
35
What does LH peak do?
It triggers ovulation and the release of progesterone = to keep uterus quiet
* How does this trigger ovulation?
* Well FH triggers release of estrogen which is just the female hormone.
* But when it's time to ovulate, the progesterone has to come in and so LH is responsible for it.
36
Recap of hormones
FSH from pituitary causes release of estrogen so that the follicle matures.
Once matured, LH peak occurs so ovulation occurs. And the Graafian house causes the release of progesterone.
Yep
37
Pg E purpose
Good for?
Relaxes the uterus
Vasodilator relaxer to lower BP
Good for onset of labor
38
Pg F does what?
Good for?
Vasoconstrictor
Increases contraction of uterus and arteries
Good for use of hemorrhage
39
Menstrual phase
Begins on the first day of period
Lasts 3-5 days on average
40
Proliferative phase
You stop bleeding. Build up and proliferation of the lining to prepare for next period.
41
Secretory Phase
| What happens to the lining in the secretory phase?
At this point, ovulation has occurred by now due to LH. The Graafian house was left behind, and so progesterone is now released.
This is where the lining becomes extremely thick and vascular.
{At this point your body is still anticipating conception.}
42
Ischemic phase is described as?
At this point the body realize you aren’t going to get pregnant. Less progesterone now. Lining shrinks up and atrophies. And next comes your period.
43
What happens to mucus with ovulation?
Mucus will increase in volume while being thin, watery, and clear.
44
Spinnbarkeit means?
Stretchy mucus that occurs as a sign of ovulation
45
Pattern of fertile mucus during ovulation?
What if a pregnant woman has a ferning pattern in her fluid?
What if your saliva mucus is tested and there’s ferning?
```
Ferning Pattern (super organized plant like)
Can only be seen under microscope.
```
If a pregnant woman has a ferning pattern, it means she has ruptured or her water has broken.
46
What can a basal temp thermometer do?
What is the temp trend?
When do you take the temperature during the day?
Basal temp thermometer is often used for fertility and pregnancy indication.
If your temp is elevated a few tenths, then you are around your fertile time of the month.
This is because of progesterone elevating body temp after its release.
```
Estrogen = drop in temp
Progesterone = jump in temp
```
So, if you see a drop then rise, that means you are in the right time frame.
But if you don’t end up pregnant, the temp will come back down.
Take the temp right after you get out of bed. Don’t do anything else beforehand.
47
How accurate is the saliva test for fertility?
Test guidelines?
98% accurate
Place a drop of saliva on slide before eating, drinking, or brushing teeth. Let it dry too
If the ferning pattern is present in your saliva = fertile
48
Amenorrhea means
Two types?
Absence of menses
Primary & Secondary
49
Primary amenorrhea meaning
Age 16 and menstruation hasn’t started
50
Secondary amenorrhea meaning?
What is the most typical cause of this?
Some other causes?
Menstruation period used to come but now its stopped.
Pregnancy usually causes this.
```
Lactation/breast feeding
Hormone imbalance
Nutrition or being too thin
Stress
Diseases
```
51
Dysmenorrhea definition
How many types?
Painful menstruation or periods
This is just your typical cramping. Usually goes away after bleeding stops.
Two. Primary and Secondary
52
Primary Dysmenorrhea
Painful periods due to hormones such as prostaglandins since it causes vasoconstriction and contraction
53
Secondary Dysmenorrhea
```
Causes: describe them
Endometriosis
PIC
Cysts
Tumors
IUD
Fibroids
```
Painful cramping due to pathology
Endometriosis - endothelial lining outside of uterus
Pelvic inflammatory disease - due to infection
Cysts
Tumors
Intra-uterine device
Fibroids - uterine tumors that are benign that pop up during child baring years due to estrogen
(So won’t be there for menopause)
54
Drug treatments for primary dysmenorrhea
Oral contraceptives - inhibits ovulation all together
NSAIDS - can inhibit prostaglandins
55
Self care measures to treat primary dysmenorrhea on your own
Exercise + pelvic rocks
Heating pad
Yoga
Herbal remedies
56
Which two food groups can help dysmenorrhea?
Complex carbs
| Proteins
57
Supplements that can help dysmenorrhea?
Vitamins:
```
B6
E
Calcium
Magnesium
Natural diuretics : asparagus, cranberry juice, peaches, parsley, watermelon
```
58
Which foods should you avoid if you have dysmeorrhea?
Which foods should you restrict?
Methylxanthine containing foods:
Chocolate
Cola
Coffee
Alcohol & nicotine
Red meat, animal fat
Salt
Refined sugar
59
What is pre-menstrual syndrome (pms)?
What day does it typically end?
What age group does it affect?
It’s just a collection of symptoms that occur during or around your period
Usually ends by day 4 of menstruation
Affects late 20 & early 30’s
60
What hormones can cause PMS?
What other things can cause pms?
Hormones like serotonin can cause pms
Conditions:
Depression
Stress
Poor eating
61
PMS symptoms
Mood
Body
Behavioral
Mood:
Emotional, social withdrawal
Behavioral:
Insomnia, poor concentration, altered libido
Body:
Fatigue, body aches, migraines, breast sore, bloating, acne
Also women can have their own set of unique symptoms
62
PMS med supplements
PMS medications
```
Calcium (1200)
Magnesium
B6 - anxiety, depression
D
E
```
Antidepressants-ssris
Antiprostaglandins-nsaids
Yaz - can increase blood clots though
Herbal
63
PMS self treatment
Exercise
Natural progesterone: yams and soybean creams
Herbal: ginger, raspberry, primrose oil
64
What is PMDD
Can this occur in PG or menopause?
More severe PMS essentially.
Most changes are in mood.
No, it cannot occur unless there’s ovarian function.
65
PMDD symptoms
Severe depression & hopelessness
Fatigue & sleep problems
Anxiety & tension
66
PMDD treatment
Will need a prescription by a psychiatric consultant since it addresses more mood related symptoms
SSRI’s
Prozac, zoloft, paxil, celexa, lexapro
OCP - yaz
67
Menopause definition
Peri-menopause
Absence of menstruation for 1 full year & thereafter
Peri-menopause: when menopause starts to set in
68
Menopause age?
Climacteric definition
Symptoms
39-51
Climacteric: psychologic and physiologic changes
PMS & mood changes, hot flashes, insomnia, , & irregular menses
^
Ovulation occurs randomly & can lead to later in life PG so contraception may be a priority
69
Postmenopausal age?
What influences when menopause & post menopause occur?
By 59
Health
Weight & nutrition
Lifestyle & ethnicity
Genes
70
Hormone changes in menopause
FSH level rises - in an effort to get ovaries to release estrogen since there is no response by the ovum
Estrogen decreases - also bc ovum isn’t responding
Androgens are converted to estrone (hair growth)
71
1. What happens to the reproductive organs in menopause? What about muscular wise?
2. What happens to vaginal secretions in menopause? How does this affect pH?
3. What happens to the puberty organs (hair, breasts, vagina)?
4. What happens to the GU tract?
5. What happens to temp?
1. Reproductive organs atrophy
Prolapse of uterus due to loss of muscle and fascia
2. Vagina mucus dryness, PH increases (alkaline)
3. Pubic hair thins
Labia shrinks & pigmentation disappears
Saggy breasts
4. Urinary frequency and incontinence due to the urethra shortens
5. Hot flashes
72
Menopause is correlated with increase risk of (5)
Hypertension
CAD
Stroke
(First 3 due to aging more)
Changes in cognitive functioning
Osteoporosis - diminished bones
73
What do professionals think about taking hormone replacement therapy (HRT) for approaching menopause?
What is the recommended dosage for taking hormone replacement therapy?
The opinions are mostly mixed.
Largely due to side effects that come along with it.
Want the lowest dose for the least amount of time possible to bridge you through the transition
74
Risk associated with taking hormone replacement therapy for menopause?
Breast Cancer
Stroke
Thromembolic disease
Due to estrogen
75
A woman has had a hysterectomy and is wanting hormone replacement therapy for menopause.
Which variation should she take?
Which would someone who has a uterus still need to take?
Estrogen only due to no lining left to shed.
Now, if someone has a uterus, then they should take the estrogen and progesterone.
(The progesterone is needed to take care of the lining by making it shed. Bc if it didn’t, then it would develop into cancer)
76
Who should be tested for osteoporosis?
Women 65+
Anyone who has a hx of fractures
But if a woman is under the age of 65 with a high risk then she should get tested too.
77
Why do we check a woman’s height when assessing for osteoporosis?
We also do a Dowager’s hump-vertebra test. What is it?
We check height bc the vertebrae of her spine can become compressed and cause her to shrink - especially around menopause.
Dowager’s hump is when there is a hump in the upper back. It means the vertebrae are no longer able to support the upper body.
It is also a great indicator that someone is going through menopause.
So, both these tests are essentially menopause checks as well as osteoporosis tests.
78
Which vitamins should women take to prevent osteoporosis?
What if the woman is taking hormone therapy?
Calcium (over age 50)
Vitamin D
If hormone therapy is being used then women should be taking
1200 mg Calcium. If not taking hormone therapy then she’ll need to take more - 1500 mg Calcium.
79
T/F
Weight bearing exercises and walking can help prevent osteoporosis
Docs recommend drinking caffeine to help prevent osteoporosis.
What about alcohol & smoking?
True. Exercising is good.
False. Avoid caffeine
Avoid alcohol and smoking, too. Both of these have negative bone resorption effects.
80
What do Bisphoshonates do and treat?
Examples? (5)
Bisphoshonates are Ca regulators.
They increase bone mass to treat Osteoporosis.
Boniva
Actonel
Reclast (oral)
Fosamax
Zometa (IV)
81
What are SERMS and what do they treat?
Do they stimulate breasts or uterine tissue?
Selective-estrogen-receptors-modulators. They treat Osteoporosis.
No, they don’t due to not containing estrogen.
Evista; raloxifene
82
Parathyroid hormone for osteoporosis is taken with which instructions?
Why?
SubQ daily
Take for 2 years maximum.
Parathyroid hormone can increase bone formation.
83
Salmon Calcitonin is used to treat?
| What is the route?
Salmon Calcitonin treats osteoporosis.
| It is used asa nasal spray to be absorbed through the mucus membrane so to not be destroyed by gastric juices.
84
What is Prolia used to treat?
How?
Route instructions?
Prolia treats osteoporosis by increasing bone mass.
Give subQ every 6 months
85
Complementary Therapies of menopause issues
| 3
Phytoestrogens (plant based estrogen)
Acupuncture
Herbal supplements
86
What are phytoestrogens (for osteoporosis)?
Plants with estrogen properties
```
Carrots
Wild yams
Cherries
Alfalfa sprouts
Black beans
Soy products
```
87
What does acupuncture specifically target?
It’s really meant for hot flashes
88
Are herbal supplements fda regulated?
No, not really.
If the supplement is proven to be dangerous the fda will get involved for recall but that’s it.
Make sure to have these written down in patient history. And ask the pt to discuss supplements w their provider.
89
When a woman is pregnant, do we generally want her to gain weight? Why?
Yes, she needs to gain weigh. It makes for a healthier baby.
90
How do we determine how much weight a pregnant mother should gain?
BMI
Pre-pregnant nutrition
Needed calories for weight gain
BUT, keep in mind that weight gain does not mean the baby is healthy. Quality of food matters.
91
How many ibs can an underweight mother gain
28-40 ibs for underweight mother
92
Normal wt gain for pregant mother?
25-35 ibs is fo the average mother
93
Overweight mother needs to gain how many ibs?
What if she is obese?
15-25 ibs for overweight
If she is obese then she’ll need to gain less. 11-20 ibs
94
Weight needed for twins?
35 -45 ibs
This is a lot but it is because the mom is carrying two babies!
95
Pounds distributed to fat stores
4-6 ibs
96
Ibs distributed to maternal stores and ECF fluids
3-8 ibs
97
Breast changes usually take up how many ibs?
1-4 ibs
98
Uterus growth is how many ibs?
2 ibs
99
Fetus, placenta, and amniotic fluid take up how many ibs?
12 ibs or more
100
Why is it bad to restrict calories during pregnancy?
Can affect rna/dna synthesis leading to preterm labor, miscarriages, or SGA (small for age).
101
Wt gain pattern
One Ib a month in 1st trimester (3 mo)
So 3 Ibs
One ib a week in 2nd & 3rd trimesters (26 weeks)
S0 26 ibs
102
A woman is gaining 4 ibs every week while pregnant. Is this ok?
To gain anything more than 2 ibs a week is abnormal. A serious health issue could be going on.
103
1st trimester calories needed?
2nd trimester?
3rd trimester?
1800 cals
2200 cals
2400 cals
With each trimester, the baby will need more. Most growth takes place in later 2/3 of pregnancy.
104
T/F
Obesity rarely affects pregnancy
False. Obesity will put you in a high risk category.
```
Miscarriages
Gestational diabetes
Preeclampsia/hypertension
Induction of labor
C secction
Abnormal fetal development
maternal morbidity
Thromboembolism
PPH
Depression
```
