Week 2 pt 1 highlights Flashcards
1) When is the menstrual cycle established?
2) When does it end?
1) Established at menarche (~ age 12)
2) Continues to perimenopause (~ age 51)
Mittelschmerz means what?
Ovulation pain
What are the 3 distinct phases of the menstrual cycle?
1) Follicular
2) Ovulation
3) Luteal
What 3 things are the stimulatory and inhibitory actions of the Hypothalamic-pituitary-gonadal axis related to?
1) Oocyte development and ovulation
2) Endometrial development
3) Menstruation
What happens if the feedback loops of the Hypothalamic-pituitary-gonadal axis are disrupted?
Disruption > alterations of hormone levels > disorders of reproductive cycle
Disruptions mean ovulation, reproduction, and menstruation can be affected
What hormone spikes just before ovulation?
LH (and estrogen)
Follicular phase:
1) What do granulosa cells make?
2) What do theca cells make?
1) Estrogens (estrone and estradiol)
2) Androgens (androstenedione and testosterone)
Luteal phase: If fertilization does not occur, what happens?
“main takeaway”
Corpus luteum degenerates, progesterone levels fall, the endometrium is not maintained > menstruation occurs.
Endometrial cycle:
1) What are the 2 phases?
2) What is expelled during menstruation? What helps this happen?
1) Proliferative and secretory phases
2) Entire endometrium (except basal layer); prostaglandin-associated uterine contractions
Endometrial cycle
1) When is the endometrium at max thickness?
2) What results in endometrial breakdown and sloughing?
3) If no ovulation, endometrium continues to thicken and estrogen production continues; eventually, it outgrows its blood supply and ______________________ occurs
1) Maximum thickness at ovulation
2) Withdrawal of progesterone (end of luteal phase)
3) sloughing intermittently (abnormal uterine bleeding AUB)
1) When is gender acknowledged?
2) Self-awareness about sexuality (gender role, gender identity) evolves when?
1) By as early as 3yo
2) During childhood
1) Puberty is a ______________ process
2) From around 10-11 y/o, Androgens rise leading to ______________.
3) Axis reactivates during puberty triggering ____________________ production (from hypothalamus) leading to pulses of LH and FSH
1) endocrine
2) adrenarche
3) GnRH production
Puberty: Gonadotropins (LH, FSH) control production of ____________________ (estrogen, progesterone) from ovaries
sex steroids
Higher levels of ___________________ lead to physical changes of puberty
sex steroids
1) Sexual maturation process takes ~______years
2) Involves an orderly & predictable ______________change sequence (usually starts earlier in children with higher BMI):
2) What is the first physical sign of puberty that is often missed as the first step?
1) ~4
2) physical
3) Growth acceleration
Precocious Puberty: Onset of secondary sexual characteristics prior to age ____ in African-American girls & age ____ in Caucasian girls
6; 7
Precocious puberty:
1) What is central precocious puberty?
2) What is peripheral precocious pseudopuberty?
1) GnRH-dependent sex hormone production; true precocious puberty
2) GnRH-independent sex hormone production; precocious pseudopuberty
Is GH-dependent (central), or independent precocious puberty more common?
GnRH-dependent (central)
GnRH-dependent (central) precocious puberty:
1) Early activation of HPG axis; ____________ cause most common.
2) Elevated ____________ can lead to short stature in adulthood
1) idiopathic
2) estrogen
GnRH independent (peripheral) precious puberty:
1) Sex hormone production (androgens or estrogens) ______________ of HP stimulation
2) Exam may reveal a palpable __________________ > further evaluation/imaging
1) independent
2) pelvic mass
1) GnRH agonist is appropriate for the Tx of what kind of precocious puberty?
2) When should you suppress gonadal steroidogenesis (based on cause)?
1) GnRH-dependent (central)
2) GnRH-independent (peripheral)
Hypergonadotropic hypogonadism:
1) Primary ovarian insufficiency results in _________ levels of estradiol, but ___________ levels of gonadotropins (LH, FSH).
2) Most common cause of delayed puberty with an ___________ FSH is Turner syndrome.
1) low; elevated
2) elevated
Hypergonadotropic hypogonadism:
1) You should Tx with growth hormone & estrogen. Use ______ very early to normalize adult height.
2) Use _______________ at Tanner stage IV
1) GH
2) progestin
Hypogonadotropic hypogonadism:
1) What is the most common cause?
2) What are some other causes?
3) What are 2 specific conditions/ disorders/ syndromes that can cause this?
1) Constitutional (physiologic) delay
2) Weight loss, anorexia, bulimia, extreme exercise
3) Kallmann syndrome and Craniopharyngioma (pituitary tumor)
1) Kallmann syndrome is characterized by no _______ secretion.
2) most common tumor associated with delayed puberty is what?
1) GnRH
2) Craniopharyngioma (pituitary)
Name an anatomic cause of delayed puberty
Müllerian Agenesis (Paramesonephric agenesis)
“Menarche occurs at appropriate time but not apparent since outlet is blocked” describes what?
Imperforate hymen
Most common cause of primary amenorrhea in women with normal breast development (and normal ovarian function) is what?
Müllerian Agenesis (Paramesonephric agenesis)
Define imperforate hymen
Incomplete genital plate canalization so hymen is closed
Moderate premenstrual syndrome (PMS): Changes that occur in regular, cyclic relationship to __________ phase of menstrual cycle AND interferes with some aspect of patient’s life (that occur in most cycles)
luteal
Premenstrual dysphoric disorder (PMDD):
1) Define this
2) How many Sx to Dx?
3) When does it occur?
1) More severe form of PMS (3-5% of women)
2) At least 5 of 11 possible symptoms (of PMS) with at least 1 core symptom
3) Occur regularly during luteal phase
PMDD diagnosis ____________ mood-related symptoms
requires
PMS & PMDD:
1) Diagnosis relies on relationship of symptoms to _______ phase
2) What 2 lab tests are reasonable to order?
3) Should use menstrual ______ in 2 or more cycles
1) luteal
2) CBC & TSH
3) diary
Give 2 examples of Nonpharmacologic Treatment for PMS/ PMDD
Aerobic exercise (instead of static/weight-lifting)
Calcium carbonate & magnesium supplementation
What is the gold standard for PMDD Tx?
SSRIs
(know this)
What PMDD Tx has Significant (often prohibitive) side effects?
Danazol & GnRH agonists
