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ESA2 LKM > Repro - puberty and abnormalities of menstruation > Flashcards

Repro - puberty and abnormalities of menstruation Flashcards

1
Q

When do changes in the male at puberty begin?

A

9-14 years

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2
Q

When do changes in the female at puberty begin?

A

8-13 years

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3
Q

What is adrenarche?

A

The onset of an increase in the secretion of androgens.

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4
Q

What is the first sign of puberty in males?

A

Genital development - testicular enlargement

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5
Q

What is the first sign of puberty in females

A

Breast bud (thelarche) development

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6
Q

What is the series of changes that occur in males at puberty?

A
  1. Genital development begins
  2. Pubic hair growth (puberarche)
  3. Spermatogenesis begins
  4. Growth spurt (~10cm/year)
  5. Genitalia adult
  6. Pubic hair adult
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7
Q

Describe the changes that occur to male pubic hair:

A

PH1: none
PH2: Sparse, pigmented, long, mainly along labia and base of penis
PH3: dark, coarse, curlier
PH4: filling out towards adult distribution
PH5: adult in quantity and type with spread to medial thighs

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8
Q

Describe the changes that occur to male genitalia:

A

G1: preadolescent
G2: lenghening of penis
G3: further growth in length and circumference
G4: Development of glans penis, darkening of scrotal skin
G5: adult genitalia

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9
Q

What is the series of changes that occur in females at puberty?

A
  1. Breast bud (thelarche) development
  2. Pubic hair growth (puberarche)
  3. Growth spurt (9cm/year)
  4. Onset of menstrual cycles (Menarche)
  5. Pubic hair adult
  6. Breasts adult
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10
Q

Describe the changes that occur to breasts during puberty:

A 
B1: Prepubertal
B2: Breast bud
B3: juvenial smooth contour
B4: Areolar and papilla project above breast
B5: adult
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11
Q

What causes the onset of puberty?

A

A steady rise in FSH and LH secretion caused by pulsatile GnRH secretion. This could be due to a reduction in sensitivity to the negative feedback by steroids but is more likely due to ‘maturation’ of central mechanisms e.g. the brain initiates it.

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12
Q

What is the most important factor in the timing of pubert?

A

Body weight

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13
Q

What is the critical weight for menarche?

A

47kg

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14
Q

What may be the cause of secondary amenorrhoea with low body weight?

A

Reproductive cycle stops - this may be due to leptin signalling to the brain.

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15
Q

What is the rough growth spurt start weight in boys and girls?

A

Boys - 55kg

Girls - 30kg

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16
Q

What has happened to the average age of menarche in the last 200 years?

A

It has fallen - it used to be 17 and now it is 13 years. This is though to be because children are bigger now.

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17
Q

What cause puberarche?

A

Androgens in males and females. In females these androgens are from the adrenal glands.

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18
Q

Why are growth spurts shorter in females?

A

Oestrogen closes the epiphyses earlier in females. Oestrogen is needed to initiate the growth spurt, but once levels reach a certain point it causes epiphyses to fuse.

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19
Q

What is the difference between the growth spurts males experience versus females?

A

Males: longer and slightly faster
Females: earlier and shorter

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20
Q

What hormones does the growth spurt depend upon?

A

Growth hormone and steroids

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21
Q

What hormone is thelarche dependent upon?

A

Oestrogen

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22
Q

What hormone is male genital development dependent upon?

A

Testosterone

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23
Q

What is precocious puberty?

A

The development of the signs of puberty before the age of 8 in girls and 9 in boys.

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24
Q

What is the cause of precocious puberty?

A
  1. Unknown in the majority of cases
  2. Neurological causes - early stimulation of central maturation giving early inappropriate GnRH secretion e.g. pineal tumours and meningitis
  3. Uncontrolled gonadotrophin or steroid secretion e.g. hormone secreting tumours
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25
Q

What pre-menopause changes do woman experience?

A
  1. Changes to their menstrual cycle: follicular phase shortens, with ovulation early or absent
  2. Reduced fertility - though still possible to get pregnant
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26
Q

When do woman experience pre-menopause changes?

A

> 40

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27
Q

What hormonal changes occur in pre-menopause woman?

A

Less oestrogen and inhibin is secreted therefore reduced negative feedback occurs and FSH and LH levels rise.

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28
Q

What hormonal changes occur in the menopause?

A

Female has run out of follicles therefore:

  1. Oestrogen and inhibin levels fall dramatically
  2. Negative feedback lost and therefore GnRH, FSH and LH levels increase
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29
Q

What is the menopause?

A

Cessation of the menstrual cycle for 12 months.

30
Q

When is the average age of the menopause?

A

49-50, but varies

31
Q

What are the vascular effects of the menopause?

A

Transient rises in skin temperature and flushes (affects ~80% to some degree). Somehow caused by decrease in oestrogen.

32
Q

What changes occur to oestrogen-sensitive tissues after the menopause?

A
  1. Uterus: regression of endometrium, shrinkage of myometrium, shrinks to a small organ
  2. Thinning of cervix
  3. Vaginal rugae lost - thinner, less distensible
  4. Involution of some breast tissue
  5. Changes in skin
  6. Reduction in bladder tone
33
Q

What changes occur to bone after the menopause?

A

Bone mass reduced by 2.5% per year for several years due to an increased reabsorption relative to production. This can cause osteoporosis.

34
Q

What are the advantages of hormone replacement in post-menopausal women?

A
  1. Relieves symptoms of the menopause

2. Can limit osteoporosis (but is no longer recommended as first line protection (bisphoshonates are)

35
Q

How is HRT administered?

A

Orally or topically by patch or gel.

36
Q

What are the disadvantages of HRT?

A

a

37
Q

What is amenorrhoea?

A

Absence of periods for at least 6 months

38
Q

What is primary amenorrhoea?

A

Absence of menses by age 14 with absence of secondary sexual characteristics e.g. breast development or absence by age 16 with normal secondary sexual characteristics.

39
Q

What is secondary amenorrhoea?

A

Established menstruation has ceased for three months in a woman with a history of regualr cyclic bleeding or nine months in a woman with a history of irregular periods.

40
Q

What is the most common cause of amenorrhoea?

A

Pregnancy and menopause

41
Q

What is oligomenorrhoea?

A

Infrequent periods occurring at intervals of 35 days - 6 months

42
Q

What is dysmenorrhoea?

A

Painful periods

43
Q

What is menorrhagia?

A

Heavy periods (>80ml), prolonged (>7 days) uterine bleeding.

44
Q

What is cryptomenorrhoea?

A

Periods occur but not visible due to obstruction in outflow tract.

45
Q

What is dysfunctional uterine bleeding?

A

Abnormal bleeding - no obvious organic cause

46
Q

What are anovulatory cycles?

A

Menstrual cycles with no ovulation/luteal phase. This cause oligo-/amenorrhoea +/- menorrhagia.

47
Q

What are the main categories of causes of amenorrhoea?

A
  1. Hypothalamic/pituitary
  2. Ovarian
  3. Outflow tract (uterus, vagina, cervix)
48
Q

Why can hypothalmic/ pituitary problems cause amenorrhoea?

A

Inadequate levels of FSH lead to inadequately stimulated ovaries, which then fail to produce enough oestrogen to stimulate the endometrium of the uterus.

49
Q

What is a cause of primary hypothalamic amenorrhoea?

A

Kallmann syndrome - inability to produce GnRH

50
Q

What are some causes of secondary hypothalamic amenorrhoea?

A
  1. Exercise amenorrhoea
  2. Stress amenorrhoea
  3. Eating disorders and weight loss (below critical weight)
51
Q

What are causes of secondary pituitary amenorrhoea?

A
  1. Sheehan syndrome - hypopituitarism
  2. Hyperprolactinaemia (inhibits GnRH secretion)
  3. Haemachromatosis -> pituitary damage
  4. Can be cause by hyp-/hyper-thyroidism
52
Q

What is the general mechanism of gonadal amenorrhoea?

A

Ovary does not respond to pituitary stimulation, giving low oestrogen levels. The lack of negative feedback raises FSH levels to the menopausal range.

53
Q

What are some primary causes of gonadal amenorrhoea?

A
  1. Gonadal dysgenesis - e.g. Turner’s syndrome
  2. Androgen insensitivity syndrome
  3. Receptor abnormalities for FSH and LH
  4. Specific forms of adrenal hyperplasia
54
Q

What are some secondary causes of gonadal amenorrhoea?

A
  1. Pregnancy
  2. Anovulation
  3. Menopause (or premature menopause)
  4. Polycystic ovarian syndrome
  5. Drug-induced
55
Q

What is outflow tract amenorrhoea?

A

Amenorrhoea where the HPG axis is functional, therefore FSH levels are normal but the outflow tract is obstructing the blood flow during menses.

56
Q

What are primary causes of outflow tract amenorrhoea?

A
  1. Uterine - Mullerian agenesis (15% of primary amenorrhoea)

2. Vaginal - vaginal atresia, cryptomenorrhoea, imperforate hymen

57
Q

What are secondary causes of outflow tract amenorrhoea?

A
  1. Intrauterine adhesions (Asherman’s syndrome)
58
Q

What is the major cause of dysfunctional uterine bleeding (DUB)?

A

90% occurs when ovulation is not occurring. The corpus luteum does not form to release progesterone and therefore oestrogen is produced continuously which cause overgrowth of uterus and subsequent bleeding.

59
Q

How is dysfunctional uterine bleeding diagnosed?

A

It is a diagnosis of exclusion. The following is tested to rule out other causes:

  1. hCG, TSH (exclude pregnancy and thyroid disease)
  2. Coagulation work up
  3. Smear if appropriate (exclude cancer)
  4. Sample endometrium
60
Q

What is the usual cause of menorrhagia?

A

It is usually secondary to distortion of the uterine cavity, leaving the uterus unable to contract down on open venous sinuses in the zona basilis.

61
Q

What are other causes of menorrhagia?

A

Organic, endocrine, haemostatic and iatrogenic

62
Q

Is menorrhagia normally ovulatory?

A

Yes

63
Q

How is menorrhagia managed?

A

Progesterone - taken in days 15-26 of the menstrual cycle in order to help coordinate shedding.

64
Q

What is the difference between menorrhagia and dysfunctional uterine bleeding?

A

DUB reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining, whereas menorrhagia is heavy bleeding.

65
Q

What is puberarche?

A

Development of axillary and pubic hair.

66
Q

A pulse of what hormone may account for some of the early pubertal changes seen in males?

A

Sleep-dependent nocturnal rise in LH, causing a nocturnal rise in testosterone. (A similar pattern is seen in females with concomitant increase in oestrogen).

67
Q

What is spermarche?

A

Mature spermatocytes in secretions.

68
Q

Precise timing of LH surge and therefore ovulation are affected by what environmental triggers?

A

Altitude and lattitude, light and dark phases etc…

69
Q

What is delayed puberty?

A

When the initial changes of puberty are not present by age 13 years in girls (or primary amenorrhoea at 15-16) and age 14 in boys. Or pubertal development is inappropriate - the interval between the first signs of puberty and menarche in girls/ completion genital growth in boys is >5 years.

70
Q

What are the causes of delayed puberty?

A
  1. Gonadal failure

2. Gonadal deficiency

71
Q

What are causes of gonadal failure?

A
  1. Turner’s syndrome
  2. Post-malignancy chemo/radiotherapy/surgery
  3. Polyglandular autoimmune syndromes
72
Q

What are causes of gonadal deficiency?

A
  1. Congenital hyporgonadotrophic hypogonadism
  2. Hypothalamic/ pituitary lesions (tumours, post-radiotherapy)
  3. Rare gene mutations inactivating FSH/LH receptors

ESA2 LKM (45 decks)

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