REPRODUCTIVE: Puberty & Female Reproductive Cycle Flashcards by Jessica Maldonado

What is puberty?

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

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What is onset of puberty determined by?

Genetic factors
Geographical location
Nutritional status
Excessive exercise Psychological factors

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When does girl puberty occur?

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

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When does boy puberty occur?

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

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What happens 1 year before puberty?

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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Estradiol causes development of what?

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

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Estrogen and increased production of growth factors cause what?

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

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When is male puberty completed?

First ejaculation that contains mature sperm.

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What is female puberty completed?

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

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

Stage 2

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When is puberty considered delayed?

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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What are the most common causes of delayed puberty?

Turner’s syndrome and Klinefelter syndrome.

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What happens with normal delayed puberty?

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

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Hypergonadotropic and Hypogonadism?

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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Hypogonadatropic and Hypogonadism?

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

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What is precocious puberty?

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

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How rare is precocious puberty?

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

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What may precocious puberty be caused by?

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

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What is complete precocious puberty?

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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What is Partial Precocious Puberty?

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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What is Mixed precocious Puberty?

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

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

FSH

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What is the MC uterine abnormality?

Class IV: Bicornuate Uterus

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What is considered day one of the menstrual cycle?

First day of menstrual bleeding.

How long is the average cycle?

21-35 days (avg: 28 days)

How long is average menses?

3-7 days

What is the average volume of blood loss?

30-50 ml

What does an increase in FSH cause?

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

What marks the beginning of the follicular phase?

Menses

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

During follicular phase

What does the follicle/oocyte secrete?

Estradiol

What does the follicle/oocyte decrease?

FSH

What does follicle/oocyte increase?

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

LH surge triggering ovulation.

What happens during ovulation?

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

What does the empty follicle become?

Corpus luteum.

What is the follicular phase dominated by?

Estradiol

What does the luteal phase get dominated by?

Progesterone

When does the production of progesterone begin?

24 hours before ovulation and rises after rapidly.

When is the peak of progesterone levels?

3-4 days after ovulation

How long is progesterone maintained for?

11 days

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

Diminishes rapidly.

What secretes progesterone?

Corpus luteum

What is progesterone necessary for?

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

What is the fixed life span of the corpus luteum?

13-14 days unless pregnancy occurs.

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

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

What does progesterone do to LH and FSH?

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

When were the FSH and LH at their lowest?

During luteal phase.

What happens as corpus luteum fails?

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

Primary amenorrhea?

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.

Diagnose primary amenorrhea?

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

Treatment of primary amenorrhea?

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

What is secondary amenorrhea?

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

What is the number one cause of secondary amenorrhea?

Pregnancy.

When is secondary amenorrhea most common and normal?

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

Primary dysmenorrhea?

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

Secondary dysmenorrhea?

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

Causes of secondary dysmenorrhea?

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

Dysmenorrhea treatment?

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