Menstruation and PMS Flashcards
what is the order of pubertal landmarks?
thelarche (breast budding), pubarche (axillary and pubic hair growth), and menarch (first menses)
what is the hormone responsible for the onset of thelarche?
estradiol
what is the hormone responsibile for the onset of pubarche?
adrenal hormones
what is the hormone responsible for menarche?
estradiol
a female of 13 years or older without any breast developement is in deficiency of which hormone?
estrogen
what is the etiology behind puberty?
believed to begin with DISINHIBITION of the pulsatile gonadotropin releasing hormone (GnRH) secretion from the hypothalamus
at what tanner stage of development is the prepubertal child?
tanner stage 1
at what tanner stage of development is the developmental child?
stages 2-4
at what tanner stage of development is “adulthood” classified?
stage 5
what is the definition of precocious puberty?
appearance of secondary sex characteristics before 8 years of age
what is the most common etiology behind precocious puberty?
unknown
many follicles are stimulated by FSH but which egg is actually released?
the follicle that secretes more estrogen than androgen
in terms of the menstrual cycle what is the pathology behind endometrial sloughing?
withdrawal of progesterone
which hormone is responsible for endometrial proliferation?
estrogen
which hormone causes the oocyte to be released? (ovulation)
LH surge
which hormone is responsible for follicle maturation and estrogen secretion?
FSH
during the luteal phase, what is responsible for secreting progesterone? what is the result?
the corpus luteum which causes endometrial maturation and a drop in FSH and LH
what is the pathology behind the LH surge?
the dominant follicle releases the most estradiol so that its positive feedback causes an LH surge
what is the average length of menses?
4 to 7 days
what is average blood loss during mense?
30-50 mL
_____ released from the endometrium causes dysmeorrhea
prostaglandins
ovulation takes place approximately how many hours after LH surge? after LH peak?
24-36 hours; 12 hours
which phase is more variable in nature - follicular or luteal?
follicular (the luteal phase is usually around 11 days due to the length of time the corpus luteum is able to secret progesterone
what maintains the corpus lutuem after fertilization?
hCG, released by the embryo
what is the start of the follicular phase?
the first day of the menses
at the very beginning of menses (the start of the follicular phase) at what levels are the hormones?
they are all very low - and so w/out any negative feedback, GnRH from the hypothalamus causes FSAH release from the pit gland
FSH stimulates which cells in the ovary? what is the response?
stimulates maturation of granulosa cells; estrogen secretion
as the estradiol levels increase during the follicular phase, what is happening with LH and FSH levels?
estradiol inhibits FSH and LH due to negative feedback
which hormone acts on the theca cells to increase secretion of androgens?
LH
t or f: androgens are eventually converted to estradiol
TRUE
t or f: progesterone causes inhibition of FSH and LH
TRUE
symptoms during which phase of the menstrual cycle is classic for PMS?
luteal phase
what is the main difference between PMS and PMDD in terms of symptoms?
PMS does NOT impair daily activities
when do symptoms go away for PMS/PMDD?
once menses begins - w/in 4 days (this is also a good way to clinically rule out other causes …IOW if the pt has affective and somatic complaints that go away with menses) - pts are adviced to keep a prospective sx diary for two months
t or f: PMDD/PMS can be diagnosed after one cycle
FALSE; must be after two prospectively monitor cycles
what is the therapy with most evidence for effectiveness for PMS/PMDD?
SSRI and ovulation blocking agents
t or f: calcium with help to relive PMS/PMDD symptoms
TRUE
what medication can be given for SEVERE PMS?
GnRH agonists
