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Pathophysiology 3 > REPRODUCTIVE: Puberty & Female Reproductive Cycle > Flashcards

REPRODUCTIVE: Puberty & Female Reproductive Cycle Flashcards

1
Q

What is puberty?

A

Series of neuroendocrine and physiological events that results in the development of secondary sex characteristics, menarche and ovulation.

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2
Q

What is onset of puberty determined by?

A

Genetic factors
Geographical location
Nutritional status
Excessive exercise Psychological factors

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3
Q

When does girl puberty occur?

A

At 8-9 years with thelarche (breast development).

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4
Q

When does boy puberty occur?

A

At about age 11, with enlargement of the testes and thinning of the scrotal skin.

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5
Q

What happens 1 year before puberty?

A

Nocturnal pulses of gonadotropin secretion (follicle-stimulating hormone [FSH] and luteinizing hormone [LH]) and an increased response in the pituitary to gondatropin-releasing hormone (GnRH) occur which stimulates gonadal maturation with estradiol & testosterone secretion.

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6
Q

Estradiol causes development of what?

A

Breasts, maturation of the reproductive organs (vagina, uterus, ovaries) and deposition of fat in the female’s hips.

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7
Q

Estrogen and increased production of growth factors cause what?

A

Rapid skeletal growth, growth of the testes, scrotum and penis.

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8
Q

When is male puberty completed?

A

First ejaculation that contains mature sperm.

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9
Q

What is female puberty completed?

A

At time of the first ovulatory menstrual period, however this can take up to 1-3 years after menarche.

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10
Q

What stage does the pubic hair appear, testicular enlargement and breast buds?

A

Stage 2

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11
Q

When is puberty considered delayed?

A

3% .
Girl –> hasn’t developed breast buds by age 13.
Boy –> haven’t had enlargement of testes by 14.5 years old.

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12
Q

What are the most common causes of delayed puberty?

A

5%

Turner’s syndrome and Klinefelter syndrome.

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13
Q

What happens with normal delayed puberty?

A

95%.
Hormone levels are normal and hypothalamic pituitary gonadal (HPG) axis is intact and maturation is occurring but just slowly.

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14
Q

Hypergonadotropic and Hypogonadism?

A 
Increased FSH and LH.
Gonadal dysgenesis (Turner syndrome)
Klinefelter syndrome (47, XXY)
Bilateral gonadal failure from traumatic, infectious or autoimmune causes.
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15
Q

Hypogonadatropic and Hypogonadism?

A 
Decreased LH and FSH.
Kallmann syndrome (GnRH deficiency)
Pituitary adenomas
Drug use
Anorexia/extreme exercise
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16
Q

What is precocious puberty?

A

Sexual maturation occurring before age 6 in black girls or 7 in white girls and before age 9 in boys.

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17
Q

How rare is precocious puberty?

A

1 in 10,000 girls and fewer than 1 in 50,000 boys.

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18
Q

What may precocious puberty be caused by?

A 
Obesity
Endocrine disruptors in common household products
Pesticides
Plasticizers 
Pharmaceuticals 
Lethal central nervous system tumors
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19
Q

What is complete precocious puberty?

A

Premature development of appropriate characteristics; Hypothalamic-pituitary-ovarian axis functioning normally but prematurely. In 10% of cases, lethal central nervous system tumor may be the cause.

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20
Q

What is Partial Precocious Puberty?

A

Partial development of appropriate secondary sex characteristics; can progress to complete precocious puberty; may be caused by estrogen secreting neoplasms or may be a variant of normal pubertal development.

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21
Q

What is Mixed precocious Puberty?

A

Partial development of some secondary sex characteristics of the OPPOSITE gender. Commonly caused by adrenal hyperplasia or androgen-secreting tumors.

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22
Q

What hormone is highest at start of menstrual cycle at day 1?

A

FSH

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23
Q

What is the MC uterine abnormality?

A

Class IV: Bicornuate Uterus

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24
Q

What is considered day one of the menstrual cycle?

A

First day of menstrual bleeding.

25
Q

How long is the average cycle?

A

21-35 days (avg: 28 days)

26
Q

How long is average menses?

A

3-7 days

27
Q

What is the average volume of blood loss?

A

30-50 ml

28
Q

What does an increase in FSH cause?

A

Maturation of a group of ovarian follicles and a dominant follicle to emerge to get ready for ovulation.

29
Q

What marks the beginning of the follicular phase?

A

Menses

30
Q

When is LH, estradiol, and progesterone at its lowest?

A

During follicular phase

31
Q

What does the follicle/oocyte secrete?

A

Estradiol

32
Q

What does the follicle/oocyte decrease?

A

FSH

33
Q

What does follicle/oocyte increase?

A

LH

34
Q

What happens at day 11-13 of a nml cycle?

A

LH surge triggering ovulation.

35
Q

What happens during ovulation?

A

Oocyte will be expelled from the follicle and travel to Fallopian tube and into uterus and wait for fertilization.

36
Q

What does the empty follicle become?

A

Corpus luteum.

37
Q

What is the follicular phase dominated by?

A

Estradiol

38
Q

What does the luteal phase get dominated by?

A

Progesterone

39
Q

When does the production of progesterone begin?

A

24 hours before ovulation and rises after rapidly.

40
Q

When is the peak of progesterone levels?

A

3-4 days after ovulation

41
Q

How long is progesterone maintained for?

A

11 days

42
Q

What happens to progesterone if fertilization and implantation do not occur?

A

Diminishes rapidly.

43
Q

What secretes progesterone?

A

Corpus luteum

44
Q

What is progesterone necessary for?

A

To facilitate implantation of the fertilized oocyte into endometrium and to sustain pregnancy into the early first trimester.

45
Q

What is the fixed life span of the corpus luteum?

A

13-14 days unless pregnancy occurs.

46
Q

What happens if the oocyte becomes fertilized and implants within the endometrium?

A

Human chorionic gonadotripin (hCH) gets secreted which sustains the corpus luteum for 6- 7 wks.

47
Q

What does progesterone do to LH and FSH?

A

Negative feedback on pituitary gland decreasing FSH and LH to low levels.

48
Q

When were the FSH and LH at their lowest?

A

During luteal phase.

49
Q

What happens as corpus luteum fails?

A

Progesterone secretion diminishes and FSH begins to rise to prepare a women for the next reproductive cycle.

50
Q

Primary amenorrhea?

A

Menarche has not occurred by age 13-15 years old. Absence of vagina/uterus, genetic disorders, or problems w/ AP gland or CNS preventing secretion of GnRH.

51
Q

Diagnose primary amenorrhea?

A

Abnml levels of gonadotropins or ovarian hormone or genetic conditions. US and MRI.

52
Q

Treatment of primary amenorrhea?

A

Tx underlying disorders and hormone replacement therapy. Surgery for structural abnormalities.

53
Q

What is secondary amenorrhea?

A

Absence of menstruation for three or more cycles in women who have previously menstruated.

54
Q

What is the number one cause of secondary amenorrhea?

A

Pregnancy.

55
Q

When is secondary amenorrhea most common and normal?

A

Early adolescence, pregnancy, lactation, and during peri menopausal period.

56
Q

Primary dysmenorrhea?

A

Painful menstruation caused by release of prostaglandins in nml ovulatory cycles.

57
Q

Secondary dysmenorrhea?

A

Pelvic pain caused by pelvic conditions that manifest later in reproductive years and may occur at any time of cycle.

58
Q

Causes of secondary dysmenorrhea?

A

Endometriosis (MC), PID, adhesions, uterine fibroids, polyps, tumores, cysts, or IUDs.

59
Q

Dysmenorrhea treatment?

A

NSAIDS- reduces COX enzyme activity and prostaglandin activity.
Hormonal contraception- Stops ovulation and creates an atrophic endometrium, thereby decreasing prostaglandin synthesis and myometrial contractility.

Pathophysiology 3 (3 decks)

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