B8.062 Prework 1: Missed Female Period

Question 1

what stimulates menses

Answer 1

the progression of E > P > withdrawal of P from the endometrium

Question 2

effect of stress on thyroid function

Answer 2

elevated cortisol (stress) > decreases TRH (hypothalamus) > decreased TSH (pituitary) > inhibition of conversion of T4 to T3

Question 3

impact of stress on menstrual cycle

Answer 3

1. stress stimulates a neuronal input to hypothalamus
2. stimulation of increased CRH synthesis and release
3. increased CRH stimulates ACTH release from anterior pituitary
4. ACTH stimulates cortisol release from adrenal cortex
5. elevated cortisol inhibits GnRH (hypothalamus)
6. decreased GnRH release leads to decreased FSH/LH release
7. decreased FSH/LH leads to reduced ovarian E production

Question 4

impact of hypothyroidism on menstrual cycle

Answer 4

1. low T4, T3 triggers TRH release
2. TRH stimulates prolactin from anterior pituitary
3. prolactin stimulates CRH release which inhibits GnRH and decreases kisspeptin
4. decreased GnRH release leads to decreased FSH/LH release
5. decreased FSH/LH leads to reduced ovarian E production

Question 5

impact of hyperthyroidism on menstrual cycle

Answer 5

1. elevated T4, T3 triggers SHBG production in the liver
2. increased SHBG binds with circulating E
3. SHBG binding reduces biologicall active estrogen in the circulation
4. reduced free R leads to reduced estrogenic action

Question 6

how does restricted caloric intake/starvation impact the menstrual cycle

Answer 6

1. reduced calories leads to reduced adipose
2. reduced adipose leads to reduced leptin
3. reduced leptin leads to reduced kisspeptin
4. reduced kisspeptin leads to decreased GnRH
   and i feel like you should probs know what happens next I DONT WANNA TYPE IT AGAIN

Question 7

hyperprolactinemia

Answer 7

elevated prolactin inhibits GnRH

Question 8

physiologic hyperprolactinemia

Answer 8

pregnancy

breast feeding

Question 9

which secondary sex characteristics are under E/P control

Answer 9

breasts

Question 10

which secondary sex characteristics are under androgen/DHEA control

Answer 10

pubic hair

Question 11

categories of causes of amenorrhea

Answer 11

outflow obstruction
POI
pituitary
hypothalamic
physiologic
other endocrine

Question 12

important cause of outflow obstruction leading to amenorrhea

Answer 12

androgen insensitivity syndrome

Question 13

important cause of pituitary stimulated amenorrhea

Answer 13

meds:
antidepressants (increase prolactin)
antipsychotics (increase prolactin)
opiates (decrease GnRH)
prolactinoma

Question 14

important endocrine causes of amenorrhea

Answer 14

adrenal disease
thyroid disease
adipose/body fat