Womens Health M to M Flashcards
define Adenarchey
Is an early sexual matruirty stage in females
When does andenarchy occur?
6-8 years old
what changes are seen during adenarchey:
the adrenal gland secretes increased levels of androgens such as DHEA., which can be converted into more potent androgens, which prepares the body for the secondary sexual maturation.
When do DHEA levels peak and when do they decline?
They peak at about 25 years old and decline slowly to low level after age 60.
Explain the HPO axis from birth to puberty?
The HPO axis is active during fetal life for a few weeks after birth and then is is suppressed in childhood due to an enhanced negative feedback of estrogen. During Puberty the HPO axis resumes its activity triggering the release of GnRH which will stimulate LH and FSH (sex steroids) produced in the ovaries which ill trigger the secondary sexual characteristics.
Define Pubety:
Endocrine process that involves the physical, emotional and sexual transformation from childhood to adulthood.
What will affect the development of secondary sexual characteristics?
Ethinicty ( blacks and Mexicans earlier), body fat (decreased amount of leptin released from the adipose cytes)
How long does it take for secondary sexual maturation to occur?
It takes approximately 4 years.
Secondary sexual maturation is a predictable and orderly process what is the process?
Growth acceleration Thelarche (breast development) Pubarche (Pubic hair development) Menarche ( onset of menstaration) Ovulation
What scale is used to grade the secondary sexual characteristics?
The tanner scale
a. Stage I – Pre-puberty, no breast tissue or pubic hair
b. Stage II – Breast bud, enlarged areolar diameter, straight hair along lateral vulva
c. Stage III – Enlargement of breast without separation of areolar contour from breast, hair darker and coarser
d. Stage IV – areola and papilla project above breast, pubic hair similar to adult
e. Stage V – Recession of areola to match contour of breast, adult pubic hair
How long is the average menstrual cycle?
28-35 days
there is cyclical variability that is common during the teen years, when should you have a relatively stable cycle?
From age 20-40 years.
What is the average age of Menarche?
12 years old and is getting younger in each generation
what is the range of menarche:
8-16 years old
when must you start a work up of no period?
Must work up after the age of 16 to find cause if menarche has not occurred.
When is the follicular phase?
1st day of your periods until the LH surge
What is the Luteal phase?
LH surge until the 1st day of your periods
What is the roles of the hypothalamus?
To release GnRH in a pulsatile fashion to stimulate the pituitary release of FSH and LH
What is the function of FSH?
Stilumate the ovarian follicular growth- as the follicle grows it releases Estrogen which thickens the endometrium
What is the function of LH?
Surge of LH stimulates follicle to break open and discharge ovum and follliclar fluid containing estrogen.
The follicular phase is _____ predominant?
Estrogen
The Luteal phase is ______ predominant?
Progesterone
Luteal phase begins once
The oocyte is release
The follicle is then changes into the what?
The corpus leteum
What does the copus letuem produce?
Progesterone- the LH and FSH cause the Granulosa cells of the corpus letem to produce a lot of progesterone, since there is not enough aromatase around it does not convert all the way to estrogen- hence the high increase
What is Mittelschmerz?
Pain with ovulation
What effect does Follicular and Luteal phase on the endometrium?
Durring the Follicular phase: estrogen stimulated the endometrial growth
In the Luteal phase: progesterone cuases changes in the endometrial cells (secretory endometrium)
What is Anovulation?
No oocyte is release
What is a cause of anovulation in adolescence?
Cycle no fully funcyioning in a coordinated fasion ( hormones)
What is a cause of Anovulation perimenopause?
No more eggs
What is the cause of Anovulationin extremely obese individuals?
Increased levels of estrogen
What is the most common cause of amenorrhea?
Pregnancy
What is the difference in primary and secondary amenorrhea?
Primary: Lack of menstruation by age 16 in the presence of normal gowth and secondary sexual characteristics. Or no evidence of pubertal onset by the age of 13 (ie breast buds) or lack of menstruation within 2 years of the onset of breast development
Secondary Amenorrhea: Lack of mestration for greater than 6 mo in a qomen with a previously normal menstration. OR absence of menstruation for 12 mo in a women with a pervious history of Oligomenorrhea
What is Ologomenorrhea?
Infrequent menstruation
Abnormal Menstrual Cycle- In order to determine where there is an issue in the HPO axis we divide it into 4 components what are they?
Compartment I: Outflow problem
Compartment II: Ovarian dysfunction
Compartment III: Pituitary dysfunction
Compartment IV: Hypothalmic dysfunction
In primary Amenorrhea what are some causes? ( compartments)
Compartment I: Outflow problem- Imperforate hymen, Mullerian agenesis
Compartment II: Ovarian dysfunction –Gonadal dygenesis, Turner syndome
Compartment III: Pituitary dysfunction -Hypogonadotropic hpogonadism, Kallmann syndrom and female athlete triad.
Compartment IV: Hypothalmic dysfunction- Hypogonadotropic hpogonadism, Kallmann syndrom and female athlete triad.
What is Turner Syndrome?
Absence of one of the X chromonsoes in all cells lines, which will lead to the absence of ovarian follicles, which will cause primary amenorrhea.
What will a turners syndrome patient look like?
Short, webbed neck, shield chest with wide spaced nipples, high arched palate, cubitus valgus increase carrying ange of the elbow.
What is the treatment of Turners Syndrome?
Estrogen to stimulate breast development and prevent the development of ostioperosis but you will want to give slowly- they are already short do not want to close the epi plates
Hypogonadotropic Hypogonadism: dysfunction: most common cause:
constitutional or physiologic delay (20%) often runs in families, considered a normal variant.
what is Kallmann syndrome:
GnRH is not secreated. Easy to detect as the ofacyroy tracts are not normal (children cant smell)
Secondary Amenorrhea: Compartment I II III IV
Compartment I: Endometrial atrophy - Ashermans syndrome: scarring of the uterus D&C Ablation Radiation tx
Compartment II:
Premature ovarian failure- FSH will be high
Pregnancy
Comartment III: pituitary dysfunction
Sheehans syndrome necrosis of the ant pit, postpartum hemmorage
Comartment IV:
Hypothalmic dysf- eating disorder or weight loss
What is a progesterone Challenge, and how does it work?
Give 10 days of progesterone this will mimic ovarian function in the luteal phase, if bleeding occurs you know Compartemnt I is normal (Outflow) and Endometrium is normal, and that the patient is NOT ovulating.
Treatment of amenorrhea?
BCP, Cyclic progesterone, Ovulation inducers, and surgery.
What is DUB:
Dysfunctional uterine bleeding: a change in frequency duration and amunt of bleeding
What is the most common cuase of premenopausal irregular bleeding:
it is due to the overgrowth of the endometrium- overgrowth of the endometrium can lead to endometrial cancer
Define Deysmenorrhea:
Painful menstration that inhibits ADLs
Differentiate primary and secondary Dysmenorrhea:
Primary: begins soon after menarche and has no pathologic findings
Secondary: new onset in an older women and usually has an organic cause
What is the work up and treatment of primary dysmenorrheal?
Associated with ovulatiory cycles, prostaglandin mediated, r/o STDs
Treatment: NSAIDs treat paiin by reducing prostaglandins and BCPs suppress ovulation
What is your work up for secondary Dysemenorrhea?
Complete PE, usually will have a normal pelvic may have some tenerness around the cul de sac, adnexal mass, diagnosis laproascopy with laser ablation. Treatment with medical and surgical.
What is Menorrhagia:
normal period intervals but it is very heave and or prolonged flow, NO intermestrual spotting.
What is a cause of Menorrhagia:
thick endometrial wall or fibroids
What is Metrorrhagia?
Normal flow but spotting in between
What is a cause of Metorrhagia?
Non compliance with BCP, Pregnancy, CA
What is Menometrorrhagia?
Frequent menstrual bleeding that is excessive and irregular in amount and duration.
What is Hypomenorrhea:
reduction of the number of days or the amount of mentral flow
what is Oligomenorrhea:
reduction of the frequency of menses, with cycle lengths of over 35 days but less than 6 mo per year
what is polymenorrhea:
Frequent menstrual bleeding ( less than 21 days inbetween periods)
Causes of Post coital bleeding:
This always needs a work up
Cervical cancer- post coital bleeding is the #1 symptsom
Cervicitis
Causes of Post Menopausal bleeding:
CA
What symptoms suggest severe PMS?
Depression, hopelessness, anger, anxiery, low self esteem, poor concentration.
What is Climacteric phase?
AKA for perimenopause: ovarian function gradually declines and sestrogen levels flucturate
What is premature ovarian failure:
Menopause before age 40 , suspect if hot flashes and other S and S of low estrogen
What is premature ovarian failure:
Menopause before age 40 , suspect if hot flashes and other S and S of low estrogen
What are some causes of premature ovarian failure?
Genetic: Partial deletion of the long arm of the X chomosome or taotal loss of X (Turner)
Savage syndrome: Ovaries are resistant to FSH and LH but have normal number of follicle
Autoantibodies: to thyroid, adrenal and ovarian tissue.
Smoking: Menopause 3-5 years earlies
Chemo: affects ovarian follicle membrane and hasten follicurlar atresia
Hysterectomy: 3-5 years earlier
What are some causes of premature ovarian failure?
Genetic: Partial deletion of the long arm of the X chomosome or taotal loss of X (Turner)
Savage syndrome: Ovaries are resistant to FSH and LH but have normal number of follicle
Autoantibodies: to thyroid, adrenal and ovarian tissue.
Smoking: Menopause 3-5 years earlies
Chemo: affects ovarian follicle membrane and hasten follicurlar atresia
Hysterectomy: 3-5 years earlier
What is menopause:
1 year with no periods
What is menopause:
1 year with no periods
what is postmenopause:
about 1/3 of a women’s life
what is postmenopause:
about 1/3 of a women’s life
what are symptoms of perimenopuase:
caused by decreased estrogen levels:
Flushing, depression, sweathing, insomnia, atrophic vaginits, fatigue, HA
what are symptoms of perimenopuase:
caused by decreased estrogen levels:
Flushing, depression, sweathing, insomnia, atrophic vaginits, fatigue, HA
What effect will perimenopause have on menstrual cycle?
Transition form regular cycle intercals to permanent amenorrhea, characterized by a phase of marked menstrual irregularity.
What effect will perimenopause have on menstrual cycle?
Transition form regular cycle intercals to permanent amenorrhea, characterized by a phase of marked menstrual irregularity.
The phase from regular cycles to permanent amenorrhea varies depending on what?
Menopause at early age- relatively short duration of cycle variability before amenorrhea
Later age: Usually longer.
The phase from regular cycles to permanent amenorrhea varies depending on what?
Menopause at early age- relatively short duration of cycle variability before amenorrhea
Later age: Usually longer.
What lab test is used to test for Menopause?
FSH ( High)
What lab test is used to test for Menopause?
FSH ( High)
What is the average age of menopause?
50-52
why do heavier women experience menopause later and have less hot flashes:
due to exogenous estrogen also increased risk for endometrial hyperplasia
slightly earlier onset of menopause in who?
Thin and smokers
What is the most common symptom of decreased estrogen production?
Vasomotor symptoms ( hot flashes)
What affect does low esteradiol have on sleep cycles?
Increased latent phase ( time to fall asleep), sleep cycles shorten
What is the difference between psychologic menopause and artificial menopause
Psycholgoic: spontaneous cessation of menses
Artificial: surgical removal of ovaries or by radiation tharpy
