menstration

Question 1

What is the order of events in normal female puberty?

Answer 1

adrenarche, gonarche, thelarche, pubarche (appearance of pubic hair), growth spurt, menstration

Question 2

By what point are all oocytes formed and partially matured?

Answer 2

20 wks gestation

Question 3

If any signs of sexual development occur before age ___ in a girl, it is considered precocious.

Answer 3

8 yrs

Question 4

At what time of day are LH and FSH higher? Why?

Answer 4

higher at night, because GnRH is released in a pulsatile fashion at night

Question 5

What do LH and FSH levels do in menopause?

Answer 5

Increase- they are still trying to stimulate the ovaries, who aren’t responding in a way to give them feedback inhibition

Question 6

At what age are LH and FSH at their highest during the lifespan?

Answer 6

20-30 wks gestation

Question 7

Puberty before the age of ___ is considered precocious in boys and is most commonly caused by ____.

Answer 7

• 9

- adrenal hyperplasia

Question 8

What is the difference between heterosexual and isosexual precocious puberty?

Answer 8

• heterosexual puberty: virilization of girls or feminization of boys
• isosexual: premature sexual development appropriate for gender; may be complete (all sexual characteristics develop prematurely) or incomplete (only one sexual characteristic develops early)

Question 9

What are causes of heterosexual precocious puberty?

Answer 9

In girls, often the result of congenital adrenal hyperplasia, exposure to exogenous androgens, or androgen-secreting neoplasm

Question 10

What labs should be run for precocious puberty?

Answer 10

1. Give GnRH and measure LH and FSH. If LH and FSH are high and increase with GnRH, suspect pituitary gland activation. If LH and FSH are low and don’t respond to GnRH, suspect excess sex steroid production.
2. Measure estrogen and compare with LH and FSH levels. If estrogen is high and LH/FSH are low, suspect exogenous estrogen production (neoplasm0
3. Measure adrneal steroids- may be high in neoplasm or congenital adrenal hyperplasia.
4. Measure TSH. Inr. TSH with low T3 and T4 suggests precocious puberty in response to chronic hypothyroidism

Question 11

What are treatments for precocious puberty due to HPA pathology?

Answer 11

GnRH analogues

Question 12

What are complications of precocious puberty?

Answer 12

short stature (bones fuse early), social/emotional adjustment problems

Question 13

what are the 3 phases of the menstrual cycle?

Answer 13

1. follicular/proliferative phase- begins first day of menses
2. luteal/secretory phase- LH surge induces ovulation

Question 14

Describe the hormones that occur wit the follicular phase?

Answer 14

• FSH stimulates growth of the ovarian follicle (granulosa cells), which secrete estradiol. a dominent follicle forms.
• Estradiol induces endometrial proliferation and further increases FSH and LH secretion from positive feedback
• Progesterone is pretty low in this phase
• ends with an LH surge, which marks transition to the luteal/secretory phase

Question 15

What happens to body temp at ovulation?

Answer 15

it increases

Question 16

Describe the hormones/key events of the luteal/secretory phase

Answer 16

• begins with ovulation
• corpus luteum secretes estradiol and progesterone to maintain endometrium and induce development of ducts in the endometrium
• high estradiol decr. FSH and LH
• if egg is not fertilized, corpus luteum degrades, progesteronea nd estradiol decreases, and the endometrial lining is shed

Question 17

What happens if an egg is fertilized?

Answer 17

egg and endometrium secretes beta hCG to maintain corpus luteum
corpus luteum keeps making progesterone until 8-12 wks, when the developing placenta can take over

Question 18

What is the definition of premature menopause? What are the risk factors?

Answer 18

menopause before age 40; common in ppl with hx of tobacco use, radiation therapy, chemo, autoimmune disease, or abd/pelvic surgery

Question 19

What are the s/sx of perimenopause?

Answer 19

hot flashes, breast pain, menstrual irregularity, menorrhagia, fatigue, anxiety, irritability, dyspareunia, change in bowel/bladder
-keys are hot flashes, dyspareunia

Question 20

What is the role of FSH?

Answer 20

stimulates the development of the ovarian follicle (regulates ovarian granulosa cells to control estrogen synthesis)

Question 21

What hormone induces the LH surge?

Answer 21

estradiol; high levels inhibit FSH secretion

Question 22

What is the role of progesterone?

Answer 22

-stimulate endometrial gland development, inhibit uterine contraction, incr. thickness of the cervical mucus, incr. basal body temp, inhibit LH and FSH production to maintain pregnancy. falling levels –> menstruation

Question 23

What hormone does beta hCG act like?

Answer 23

acts like LH- maintains corpus luteum viability