Menarche, Puberty, Menstrual Disorders

Question 1

What does the follicular phase begin and end with?

Answer 1

• onset of menstruation and ends with preovulatory LH surge

Question 2

What does the luteal phase begin and end with?

Answer 2

• onset of preovulatory LH surge and ends with first day of menses

Question 3

What happens with the corpus luteum regresses, regarding FSH?

Answer 3

Decreasing levels of estrogen and progesterone initiate increase in FSH by negative feedback, stimulating follicle growth and estradiol secretion

Question 4

What is GnRH synthesized by, specifically?

Answer 4

The arcuate nucleus

Question 5

What does estradiol do in regards to GnRH?

Answer 5

Enhances release of GnRH and induces midcycle LH surge

Question 6

How much progesterone does the ovary secrete during follicle development? Prior to ovulation? When does it peak?

Answer 6

• very little
• lots more
• reaches max 5-7 days after ovulation then returns to baseline

Question 7

What are the two zones of the endometrium?

Answer 7

• the functionalis

- the basalis

Question 8

What happens in the functionalis? What does it contain?

Answer 8

• this is the part that undergoes cyclic changes during menstrual cycle and is sloughed off during menstruation
• contains spiral arteries

Question 9

What happens in the basalis? What does it contain?

Answer 9

• this layer remains unchanged during menstrual cycle, contains stem cells for renewal of functionalis layer
• contains basal arteries

Question 10

What happens during the menstrual phase? (5)

Answer 10

• disruption and disintegration of endometrial glands and stroma
• leukocyte infiltration
• red blood cell extravasation
• sloughing of functionalis layer
• compression of basalis layer

Question 11

When does menarche occur with regards to Thelarche and Tanner stages?

Answer 11

• 2-3 years after Thelarche

- at tanner stage IV, usually

Question 12

What is primary amenorrhea?

Answer 12

Absence of menarche by age 13 without secondary sexual development OR by the age of 15 with secondary sexual development

Question 13

What is secondary amenorrhea?

Answer 13

absence of menstruation for six months or longer

Question 14

What are the 4 categories for causes of menstrual irregularity?

Answer 14

• pregnancy
• endocrine causes
• acquired conditions
• tumors

Question 15

What is dysfunctional uterine bleeding (DUB)? (5)

Answer 15

Abnormal uterine bleeding that can’t be attributed to:

• medications
• blood dyscrasias
• systemic disease
• trauma
• organic conditions

Question 16

What is D.U.B. usually caused by?

Answer 16

Aberrations in the H-P-O axis resulting in anovulation

Question 17

What is polymenorrhea?

Answer 17

Abnormally frequent menses at intervals of less than 21 days

Question 18

What is menorrhagia? What specific qualifiers does it have?

Answer 18

• Excessive and/or prolonged menses occurring at regular intervals
• greater than 80ml of blood and greater than 7 days

Question 19

What is metrorrhagia?

Answer 19

Irregular episodes of uterine bleeding

Question 20

What is menometrorrhagia?

Answer 20

Heavy and irregular uterine bleeding

Question 21

What is intermenstrual bleeding?

Answer 21

Scant bleeding at ovulation for 1 or 2 days

Question 22

What is oligomenorrhea?

Answer 22

Menstrual cycles at greater than 35 day cycles

Question 23

What are the structural causes of AUB?

Answer 23

PALM

• Polyp
• Adenomyosis
• Leiomyoma
• Malignancy and Hyperplasia

Question 24

What are the Nonstructural causes of AUB?

Answer 24

COEIN

• Coagulopathy
• Ovulatory dysfunction
• Endometrial
• Iatrogenic
• Not yet classified

Question 25

What is adenomyosis? How deep specifically?

Answer 25

- Extension of the endometrial glands and stroma into the uterine musculature - greater than 2.5 mm below basalis layer It's basically endometriosis of the myometrium

Question 26

What are leiomyomas?

Answer 26

benign smooth muscle tumors

Question 27

What are leiomyomas also called?

Answer 27

fibroids

Question 28

What are risk factors for leiomyomas? (4)

Answer 28

- increasing age during reproductive years - african american women have increased risk - nulliparity - family history

Question 29

What is the pathogenesis of leiomyomas? (what is it caused by)

Answer 29

Estrogen stimulates the proliferation of smooth muscle tissue (so typically they don't grow before menarche or after menopause)

Question 30

What are symptoms of leiomyomas? (4)

Answer 30

Typically asymptomatic, but: - pelvic or lower back pain - frequency of urination - prolonged or heavy bleeding - increased incidence of infertility

Question 31

What is endometrial hyperplasia? What is it usually caused by?

Answer 31

- Overabundant growth of the endometrial lining | - unopposed estrogen

Question 32

What can cause endometrial hyperplasia? (4)

Answer 32

- PCOS - obesity - exogenous estrogens - tamoxifen (estrogen receptor antagonist)

Question 33

Why is endometrial hyperplasia significant?

Answer 33

It is a precursor to endometrial cancer

Question 34

What is the average duration of puberty?

Answer 34

4-5 years

Question 35

What is the order of the stages of normal pubertal development in females?

Answer 35

- thelarche - pubarche/adrenarche - maximal growth/peak height - menarche

Question 36

What hormone does thelarche require?

Answer 36

estrogen

Question 37

What happens in each Tanner stage of breast development?

Answer 37

- Stage 1 = papilla only elevated - Stage 2 = 'breast bud' stage, elevation of breast and papilla, enlargement of areola - Stage 3 = further enlargement of breast and areola - Stage 4 = areola and papilla form secondary mound over breast - Stage 5 = only papilla projects now

Question 38

What happens in each Tanner stage of pubic hair development?

Answer 38

- Stage 1 = preadolescent, no pubic hair - Stage 2 = sparse, downy hair w/little pigment - Stage 3 = hair spreads, becomes darker and coarser - Stage 4 = adult-type hair that hasn't spread to medial surface of thighs - Stage 5 = adult-type hair spread to medial thighs