Menarche, Pubarche, and Mentrual Disorders Flashcards by Sarah Gillen

4 cycles associated with female reproduction (i.e., sources of control)

Hypothalamic
Pituitary
Ovarian
Endometrial

How well did you know this?

Not at all

Perfectly

The ideal menstrual cycle is ____ days, with ovulation occurring day _____

The first day of bleeding is cycle day _____

The average length of bleeding is _____

Average blood loss is _____

28; 14

3-7

30cc

How well did you know this?

Not at all

Perfectly

Mean age of menarch = _____

Mean age of menopause = ____

13; 52

How well did you know this?

Not at all

Perfectly

Normal menstrual cycles in young females in terms of menarche, mean cycle interval, menstrual cycle interval, menstrual flow length, and menstrual product use

Menarch = 12.43 yrs

Mean cycle interval = 32.2 days first year

Menstrual cycle interval = 21-45 days

Menstrual flow length = 7 days or less

Menstrual product use = 3-6 pads or tampons/day

How well did you know this?

Not at all

Perfectly

During the luteal phase, the follicle is transformed into the corpus luteum. This phase is 12-14 days long, and the corpus luteum lasts _____ days

9-10

How well did you know this?

Not at all

Perfectly

Menses occurs due to withdrawal of _____ and _____. Spiral arteries ______, resulting in necrosis/ischemia of endometrium

Progesterone (P4), estrogen (E2); constrict

How well did you know this?

Not at all

Perfectly

During proliferative phase of endometrium, endometrial glands are deep within ____ layer

This phase is responsive to ______, which causes growth and thickening, elongation of spiral arteries, and glands appear straight

Basalis; estrogen

How well did you know this?

Not at all

Perfectly

The secretory phase of the endometrium involves _____ stimulation from corpus luteum; secretions increase from glandular cells and they have sawtooth appearance

Progesterone

How well did you know this?

Not at all

Perfectly

_____ is characterized by development of secondary sexual characteristics and reproductive ability

Puberty

How well did you know this?

Not at all

Perfectly

What factors affect onset of puberty?

Genetics
Geographic location
Nutritional status
Excessive exercise - Frisch theory
Psychologic factors

How well did you know this?

Not at all

Perfectly

T/F: age of menarch has increased through history

False, has decreased from age 17 in 1840, age 13 in 1979, and today age 12.4

How well did you know this?

Not at all

Perfectly

During the fetal/newborn period, there is complex integration of negative feedback mechanisms. At 20 weeks gestation, there is _____ rise, as well as _______ rise to encourage organ dev’t

FSH/LH; glucocorticoid

How well did you know this?

Not at all

Perfectly

Placental and maternal estrogen provide negative feedback for _______, this negative feedback is lost after delivery of the placenta

Gonadotropins

How well did you know this?

Not at all

Perfectly

The fetal adrenal gland produces _____, which regresses after delivery. This precursor is used by the placenta and other pathways

DHEA-S

How well did you know this?

Not at all

Perfectly

What axis is suppressed between the ages of 4-10 years old?

Hypothalamic-pituitary-ovarian axis

How well did you know this?

Not at all

Perfectly

The hypothalamic-pituitary system regulating gonadotropin release is termed the ______

Gonadostat

How well did you know this?

Not at all

Perfectly

Low levels of gonadotropins and sex steroids during this prepubertal period are the function of what 2 mechanisms?

Gonadostat - sensitive to the negative feedback of low circulating estradiol

Intrinsic CNS - inhibition of the hypothalamic gonadotropin-releasing hormone (GnRH) secretion

How well did you know this?

Not at all

Perfectly

Between the ages of 8-11, there is an increase in ______, _____, and ______

Adrenal androgen production increases, and there is differentiation by the ____ ____ of the adrenal cortex

DHEA; DHEA-S, and androstenedione

Zona reticularis

How well did you know this?

Not at all

Perfectly

The rise in adrenal androgens in late childhood leads to growth of _____ and _____

Axillary and pubic hair

How well did you know this?

Not at all

Perfectly

Around 11 years of age, there is gradual loss of sensitivity by the _______ to negative feedback of sex steroids. Intrinsic loss of CNS inhibition of hypothalamic ____release

Gonadostat; GnRH

How well did you know this?

Not at all

Perfectly

Sleep-associated increses in ____ secretion occur and gradually shift into adult type secretory patterns

GnRH

How well did you know this?

Not at all

Perfectly

GnRH increases at onset of puberty lead to what changes?

Promotion of ovarian follicular maturation and sex steroid production

Secondary sexual characteristics

How well did you know this?

Not at all

Perfectly

By mid to late puberty, the positive-feedback mechanism of _____ on LH release from AP gland is complete and ovulatory cycles are established

Estradiol

How well did you know this?

Not at all

Perfectly

Physiology of puberty summary

HPA axis suppressed ages 4-10

Age 8-11 — androgens increase, adrenal cortex differentiation occurs, adrenarche starts (DHEA, DHEA-S)

Age 11-12 — negative feedback intrinsic control lessens, GnRH increases, role of leptin, gonadotropins increase, ovarian follicular maturation

How well did you know this?

Not at all

Perfectly

______ is the first physical sign of puberty in females, which requires ______

Thelarche (breast development); estrogen

Pubarche/adrenarche (pubic hair/axillary hair development) requires ______

Androgens

Maximal growth or peak height velocity occurs 2 years earlier in _____; occurs about 1 year _____ onset of menses

Girls; before

Menarche requires ______ GnRH from the hypothalamus, FSH and LH from the _____, estrogen and progesterone from the ______, and a normal outflow tract

Pulsatile; AP; ovaries

Tanner staging based on breast tissue

Stage 1: preadolescent; elevation of papilla only Stage 2: breast bud stage; elevation of breast and papilla as small mound with enlargement of areolar region Stage 3: further enlargement of breast and areola without separation of their contours Stage 4: projection of areola and papilla to form a secondary mound above the level of the breast Stage 5: mature stage; projection of papilla only, resulting from recession of the areola to the general contour of the breast

Tanner staging based on pubic hair

Stage 1: preadolescent; absence of pubic hair Stage 2: sparse hair along labia, hair downy with slight pigment Stage 3: hair spreads sparsely over junction of pubis; dark and coarse Stage 4: adult type hair; no spread to medial thigh Stage 5: adult type hair with spread to medial thighs assuming inverted triangle pattern

Average duration of pubarche

4.5 years

The growth spurt that occurs with pubarche is mediated by what 3 hormones?

GH Insulin ILGF

Fusion of the long bones during pubarche is mediated by ____ production

Steroid

What is the difference in bone mass in males vs. females prior to vs. after puberty?

Prior to puberty: bone mass same in males/females After pubterty: females have more body fat and less skeletal bone mass

Menarche occurs 2-3 years after ________, roughly tanner stage _____ Menarche is rare before tanner stage ____

Thelarche; IV III

98% of females will have had menarche by age 15, if they do not, it is called ______

Primary amenorrhea

What is the purpose of the initial health visit to OB/GYN in females age 13-15?

PMH, PSH and FH Review of normal dev’t Educate on safe sex and STIs Screen for at-risk behavior Exam may be indicated Vaccinations and HPV info

What is the purpose of regular preventative health visit for OBGYN?

``` Annual exam Cervical cancer screening Mammography Contraceptives Reproductive choices Vaccines Review of health history ```

What are the 4 most common causes of menstrual irregularity?

Pregnancy Endocrine causes Acquired conditions Tumors

What are endocrine causes of menstrual irregularity?

``` Poorly controlled DM PCOS Cushing’s Thyroid dysfunction Premature ovarian failure Late onset congenital adrenal hyperplasia ```

Acquired conditions that cause menstrual irregularity

Stress-related hypothalamic dysfunction Medications Exercise-induced amenorrhea Eating disorders

Tumors that cause menstrual irregularity

Ovarian tumors Adrenal tumors Prolactinomas

What are important considerations when evaluating abnormal uterine bleeding?

Good menstrual hx (frequency, irregularity, duration, blood loss) Pelvic exam Rule out pregnancy!!!

No menstruation has occurred by the age of 13 without secondary sexual development or by age of 15 with secondary sexual development

Primary amenorrhea

Absence of menses for 6+ months

Secondary amenorrhea

Abnormally frequent menses at intervals <21 days

Polymenorrhea

Excessive and/or prolonged menses (>80mL and >7days) occurring at regular intervals

Menorrhagia

Irregular episodes of uterine bleeding

Metrorrhagia

Heavy and irregular uterine bleeding

Menometrorrhagia

Scant bleeding at ovulation for 1-2 days

Intermenstrual bleeding

Menstrual cycles at >35 day cycles

Oligomenorrhea

Mnemonic for the causes of dysfunctional uterine bleeding

PALM (structural) COEIN (functional) ``` P = polyp A = adenomyosis L = leiomyoma M = malignancy and hyperplasia ``` ``` C = coagulopathy O = ovulatory dysfunction E = endometrial I = iatrogenic N = not yet classified ```

Soft friable protrusion of endometrium into the endometrial cavity associated with menorrhagia, spontaneous, or post-menopausal bleeding

Endometrial polyps

What are ultrasound findings associated with endometrial polyps

Focal thickening of endometrial stripe Saline hysterosonography and hysteroscopy allows for better detection

T/F: endometrial polyps are usually benign

True; more concerning if symptomatic or postmenopausal

Extension of endometrial glands and stroma into uterine musculature (>2.5 mm beneath basalis layer), sometimes associated with endometriosis, and the associated islands of cells do not participate in secretory cycles

Adenomyosis

Symptoms of adenomyosis

May be asymptomatic Severe secondary dysmenorrhea and menorrhagia Associated with dyspareunia with deep penetration

What is leiomyoma?

Uterine fibroids — benign tumors derived from smooth muscle of myometrium

Most common neoplasm of the uterus

Leiomyoma

Symptoms of leiomyoma

Excessive uterine bleeding, pelvic pressure, pelvic pain, infertility Most are asymptomatic

What is the most common indication for a hysterectomy?

Leiomyoma

What are risk factors for developing uterine fibroids?

Increasing age during reproductive years African american women have 2-3x risk Nulliparity Family hx

______means precursor to malignancy, can be simple or complex with or without atypia

Hyperplasia

Type 1 vs. type 2 malignancy in OB cancers, which one is most common?

Type 1 = endometrial adenocarcinoma — MOST COMMON Type 2 = clear cell and papillary serous

Risk factors for malignancy

Obesity Smoking (risk for type 2) Unopposed estrogen Genetic factors

What is the most common presentation of endometrial malignancy?

Postmenopausal bleeding [or irregular bleeding with perimenopause]

Coagulopathies (AUB-C) are associated with heavy flow and ______ disease

Von willebrand

Ovulatory dysfunction (AUB-O) is associated with what changes in menses? What condition?

Unpredictable menses with variable flow associated with PCOS

Endometrial causes (AUB-E)

Infection (endometritis)

Iatrogenic causes (AUB-I)

IUD, IUS, exogenous hormones

Evaluation of DUB

H and P UPT Labs: CBC, TSH, prolactin, coagulation studies Imaging: TVUS, sonohystogram, MRI Biopsy: endometrial, D and C, hysteroscopy

Indications for in-office endometrial biopsy

AUB (in postmenopausal women with spotting/bleeding, in age45-menopause with intermenstrual bleeding or menorrhagia, in less than 45 yrs with unopposed estrogen exposure like obesity or PCOS or prolonged amenorrhea Cervical cytology results + glandular cells

Medications for AUB

NSAIDs to normalize prostaglandins Antifibrinolytic therapy like tranexamic acid during menses Coordinate endometrial sloughing with OCPs like MPA or COC Endometrial suppression with progestin daily, extended cycling with COC, LNG-IUS

Surgical therapy for AUB

``` Polypectomy Myomectomy Uterine ablation D and C Hysterectomy ```

Menarche, Pubarche, and Mentrual Disorders Flashcards

(74 cards)