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ESA 4 - Repro > Session 3 - Puberty and Abnormalities of Menstruation > Flashcards

Session 3 - Puberty and Abnormalities of Menstruation Flashcards

1
Q

During what ages doees puberty occur for males and females?

A

Females: 8-13

Males: 9-14

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2
Q

What is the female process of puberty?

A
  1. Breast bud (thelarche)
  2. Pubic hair growth begins (adrenarche)
  3. Growth spurt
  4. Onset of menstrual cycle (menarche)
  5. Pubic hair adult
  6. Breasts adult
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3
Q

What is the male process of puberty?

A
  1. Genital development begins
  2. Pubic hair growth
  3. Spermatogenesis begins
  4. Growth spurt
  5. Genitalia adult
  6. Pubic hair adult
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4
Q

Why are men on average taller than women?

A

Men larger because growth spurt longer and slightly faster

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5
Q

What is precocious puberty? What causes it? What are its outcomes?

A
  • Puberty occurring at an unusually early age.
  • Can be triggered by disease or tumour of the brain, e.g. pineal tumours, meningitis, or hormone secreting tumours
  • Can reduce adult height potential
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6
Q

How is puberty initiated?

A

Puberty initiated by the brain:

Due to rise in GnRH secretion which leads to steady rise in FSH and LH secretion

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7
Q

What is menarche? What determines the age of menarche?

A

Age of menarche dependent on weight. Critical weight of 47kg, if Body weight is below the repro cycle ceases, signalled to brain by leptins.

Menarche = age of first menstrual cycle

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8
Q

What are the 3 phases of menopause?

A
  • Pre-menopause
  • Menopause
  • Post menopause
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9
Q

What are the changes that occur which are associated with pre-menopause? What age does pre-menopause occur?

A
  • Typically at around age 40
  • Changes in menstrual cycle:
    • Follicular phase shortens – ovulation early or absent
    • Less oestrogen secreted
    • LH and FSH levels rise, FSH more
    • Reduced fertility
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10
Q

What age does menopause occur on average? What happens to hormones in the body during menopause?

A
  • Av age 50
  • Oestrogen levels fall dramatically
  • FSH and LH levels rise, FSH dramatically due to no inhibin
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11
Q

What are the effects on the body of menopause on oestrogen sensitive tissue? What about on bone? How can you reverse the changes done to bone?

A

Vascular changes – hot flushes, relieved by oestrogen treatment

On oestrogen sensitive tissues:

  • Uterus – regression of endometrium, shrinkage of myometrium
  • Thinning of cervix
  • Vaginal rugae lost
  • Involution of some breast tissue
  • Changes in skin
  • Changes in bladder

Bone:

  • Bone mass reduces 2.5% per year
  • Increased reabsorption relative to production
  • Osteoporosis
  • Limited by oestrogen therapy
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12
Q

How can you relieve symptoms of menopause?

A

HRT

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13
Q

Define amenorrhoea

A

absence of menstruation

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14
Q

Define menorrhagia

A

Heavy periods

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15
Q

Define dysmenorrhoea

A

Painful periods

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16
Q

Define oligomenorrhoea

A

Lots of small periods

17
Q

Define cryptomenorrhoea

A

hidden periods

18
Q

What is dyfunctional uterine bleeding (DUB)?

A

Excessively heavy, prolonged or frequent bleeding of uterine origin that is not due to pregnancy, pelvic or systemic disease

Anovulatory

19
Q

Define primary amenorrhoea and secondary amenorrhoea. To what age group does secondary amenorrhoea usually occur?

A

Primary amenorrhea – Absence of menses by age 14 with absence of 2ndary sexual characteristics (SSC)

Secondary amenorrhoea: Where an established menstruation has ceased.

  • 3 months in a women with a history of regular cyclic bleeding
  • 9 months in a woman with a history of irregular periods
  • Usually happens to women aged 40-55 (menopause)
20
Q

What are the 3 areas from which amenorrhoea can originate?

A
  • Hypothalamic / pituitary
  • Ovarian
  • Outflow tract ie uterus, vagina, cervix
21
Q

What are gonadal disorders?

A

Gonad or ovary does not respond to pituitary stimulation.

22
Q

What would investigations reveal in a gonadal disorder?

A

Low oestrogen and high FSH

23
Q

Name 2 primary and 2 secondary causes of gonadal disorder

A

Primary causes:

  • Gonadal dysgenesis, inc Turner syndrome
  • Androgen insensitivity syndrome (testicular feminisation syndrome)

Secondary causes:

  • Pregnancy
  • Anovulation (menstrual cycle where oocyte not released)
24
Q

How does low levels of FSH lead to amenorrhoea?

A

Low levels of FSH –> not stimulated ovaries –> low oestrogen –> endometrium thin –> amenorrhoea

25
Q

What are the consequences of central regulatory disorders? What are central regulatory disorders

A

Pituitary and hypothalamic disorder

Potential infertility

26
Q

What are the primary causes of central regulatory disorders?

A

hypothalamic cause - kallman syndrome

27
Q

Give a secondary cause for hypothalamic and for pituitary regulatory disorder

A

hypothalamic - exercise amenorrhoea

Pituitary - hyperprolactinaemia

28
Q

Describe the pathophysiology of DUB

A
  • Disturbance in the HPO axis thus changing in the length of menstrual cycle
  • No progesterone withdrawal from an oestrogen-primed endometrium
  • Endometrium builds up with erratic bleeding as it breaks down
29
Q

How do you manage DUB?

A
  • HCG, TSH
  • Smear if appropriate
  • Possible malignancy
  • Oestrogen therapy
  • Followed by cyclic progesterone for 10 to 12 days each cycle
30
Q

What is menorrhagia?

A

Heavy bleeding that isnt DUB

Usually ovulatory

31
Q

What is the pathophysiology of menorrhagia?

A
  • Usually secondary to distortion of uterine cavity – heavy with or without prolongation
  • Uterus unable to contract down on open venous sinuses in the zona basalis
32
Q

How do you manage menorrhagia?

A

NSAIDS or combined oral contraceptibe pill

33
Q

How does meningitis stimulated precocious puberty?

A

Irritation and inflammation stimulates early rises in GnRH secretion

34
Q

How can you delay puberty?

A

inhibitors of GnRH

35
Q

What are the disadvantages of HRT?

A

Increased risk of thromboembolism and breast cancer

36
Q
A

ESA 4 - Repro (15 decks)

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