Puberty, the menstrual cycle, menopause

Question 1

how long from thelarche to menarche?

Answer 1

average of 2.5 years

Question 2

what is adrenarche & when does it occur?

Answer 2

adrenal gland begins to regenerate the zona reticularis, producing androgens.
age 6-8

Question 3

what androgens are produced by adrenal ctx?

Answer 3

DHEAS, DHEA, androstenedione

Question 4

what is gonadarche and when does it occur?

Answer 4

pulsatile GnRH sec’n from hthal is increased; mostly occur during sleep, don’t => any pht’c changes
age 8

Question 5

when does thelarche usually occur?

Answer 5

age 10; is the first sign of puberty

Question 6

what is pubarche and when does it occur?

Answer 6

growth of pubic & axillary hair

age 11. Can precede thelarche in AfAms

Question 7

when does growth spurt occur?

Answer 7

growth rate peaks at age 12

Question 8

what are the 5 tanner stages of breast dvpt?

Answer 8

1) papilla elevated
2) breast buds
3) further enlargement of breast & areola w/o separation of contours
4) secondary mound (areola and papilla project off of breast)
5) mature stage;

Question 9

average age of menarche?

Answer 9

12-13

Question 10

char’ics of first cycles?

Answer 10

irregular for first 1-2 years due to anovulatory cycles

Question 11

5 tanner stages of pubic hair growth?

Answer 11

1) none
2) presexual hair (just on labia majoras)
3-4) extends, but not onto thighs
5) adult; on thighs.

Question 12

what are the 2 phases of endometrial dvpt during menstrual cycle?

Answer 12

proliferative phase - occurs during follicular phase. Endometrium builds up in response to ES.
Secretory phase - occurs during luteal phase; PG sec’d by CL maintains endometrial lining, prepared for implantation of fertilized ovum.

Question 13

what are the 2 cell types in a dvp’ing follicle and what do they do?

Answer 13

theca cells - respond to LH, produce androgens

granulosa cells - respond to FSH, produce estradiol

Question 14

how does the LH surge occur?

Answer 14

the ES prod’d by Graafian follicle stimulates a change from - fdbk to + fdbk in ant pit => LH surge

Question 15

how is the dominant follicle selected?

Answer 15

it grows more FSH R’s. As more and more ES is produced by dvp’ing follicles, it provides - fdbk on FSH sec’n => lower FSH levels. All the other follicles stop growing as FSH stim drops off, but the Graafian follicle survives b/c it has more FSH R’s.

Question 16

how long does ovulation take?

Answer 16

3-4d

Question 17

window of opportunity to fertilize ovulated egg?

Answer 17

24h

Question 18

what is average of menopause? why does it occur?

Answer 18

50-51

occurs b/c nearly all oocytes have undergone atresia

Question 19

how to define premature menopause?

Answer 19

if before age 40

Question 20

what are first sx’s of menopause and why?

Answer 20

menstrual irregularities - b/c # of follicles that can respond to FSH and LH decrease, cycles become anovulatory.

Question 21

sx’s of menopause:

Answer 21

hot flashes
mood changes
insomnia
depression
osteoporosis
vaginal atrophy

Question 22

how to dx menopause:

Answer 22

amenorrhea for 1 year

elevated FSH levels

Question 23

how long will menopause sx’s last?

Answer 23

1 year

Question 24

what are the 2 major negative consequences of menopause?

Answer 24

drop in ES => loss of vasoprotective benefits (keeps HDL high, LDL low, prevents atherogenesis, increases vdil’n, inh’s plt adherence) => increased risk CAD
drop in ES => increased rates bone abs’n => osteoporosis

Question 25

what are the 2 major indications for HRT?

Answer 25

short-term tx of postmenopausal sx’s
prevention of bone loss
used only for 6-12 mos at smallest dose possible.

Question 26

what are CI’s to HRT?

Answer 26

chronic liver dis
pg'y
ES-dependent cancer (breast, ovary, endometrial)
hx of VTE dis
undx'd vag bleeding

Question 27

when is unopposed ES safe?

Answer 27

only in pts who no longer have a uterus. If they have a uterus, need ES-PG combo.

Question 28

recs for bone density measurements?

Answer 28

all postmenopausal women should have a DXA scan at age 65. If at higher risk of o’porosis (thin, white, smoker, FHx, using steroids or levothyroxine), start at age 60

Question 29

tx options for:

CV changes of menopause

Answer 29

BP and lipid control meds
smoking cessation
weight loss
exercise

Question 30

tx options for:

osteoporosis risk

Answer 30

HRT
Ca2+ and Vit D
calcitonin
bisphosphonates
raloxifene
weight-bearing ex

Question 31

tx options for:

hot flashes

Answer 31

HRT
clonidine
SSRIs
black cohosh
evening primrose oil
dong quai

Question 32

tx options for:

vaginal dryness of menopause

Answer 32

topical ES
HRT
lubricant
chasteberry
ginseng

Question 33

tx options for:

mood disturbances of menopause

Answer 33

HRT
SSRIs
St. John wort
black cohosh