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PMS: Menstruation FINAL
FINAL
99
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Kindergarten
08/20/2010

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Cards

Term
What is the average duration of the adult reproductive system? How many days?
Definition
23-35 days
Term
What is the "chain of menstruation?" (there could be a problem at any of these sites causing problems..)
Definition

Hypothalamic pituitary

Adrenal

Ovarian

Uterine outflow tract

Menstruation

Term

When does menarche typically occur?

 

When does perimenopause occur?

Definition

When does menarche typically occur? 12.4

 

When does perimenopause occur? 51.4

Term
What are some examples of factors that could interrupt one's menses?
Definition

·   Interrupted  by pregnancy, lactation, illness, birth control pills, gynecologic disorders, exogenous factors, any mechanism containing hormones

Term
When is it most common to see variability in cycle length and irregularity?
Definition
early or late reproductive ages
Term
What are the three phases of menstruation?
Definition

3 components

1.       Beginning: Menstruation and follicular phase

2.       Ovulation: release of egg

3.       Luteal phase: under influence of corpus luteum

Term

What phase does this describe:

 

begins on the day of the LH surge and ends with the onset of menses

Definition
Luteal phase
Term
how long does each phase last?
Definition
14 days
Term
Pt comes in and says 23 day cycle- what day do they ovulate?
Definition

Take number of days of cycle-14=when they ovulate

23-14=Day 9

Term

30 day cycle- when do you ovulate?

Definition

30-14= ovulate around day 16

Term

What are hormones?

 

Are all hormones the same?

Definition

·   Hormones are substances produced in a special tissue, where it is released into the bloodstream, and travels to distant responsive cells in which the hormone exerts its characteristic effects

·   Hormones can be viewed as chemical regulatory and signaling agents

All hormones are NOT the same

Term

What is

HYPOTHALAMIC PITUITARY-OVARIAN AXIS?

What is released by each area?

Definition

       Refers to the interactions between the hypothalamus, pituitary, and ovaries that regulate the reproductive cycle

Hypothalamic: GnRH

Pituitary: FSH and LH

Ovaries: Estrogen and progesterone

 

Term
What is unique about the hypothalmus?
Definition

hypothalamus is a pulse generator (like the heart; called the arcuate nucleus; this reaches pituitary via blood and releases FSH and LH; CANNOT MEASURE GnRH because in the middle of the brain, but we CAN measure LH

Term
Can you measure GnRH?
Definition

NOPE

 

have to measure LH and FSH to check the function of the hypothalamus

Term

Who does the hypothalamus "talk"directly to?

 

how do they talk (whats the means?)

Definition

ANT pituitary

 

via the hypo-thalamic-pituitary portal vascular system

Term
The ovaries are stubborn. What is the pulsatile pattern they prefer?
Definition

·   Ovarian function requires the pulsatile secretion of GnRH in a specific pattern ranging from 60 minutes to 4 hours

Term
Why can't you measure GnRH?
Definition

·   Because of the location of its release and very short life of only 2-4 minutes,  direct measurement of GnRH secretion is not possible, instead measurement of LH  pulses are used to indicate GnRH pulsatile secretion

Term
FSH responds to _____________
Definition
low estrogen
Term

low estrogen causes _________ feedback

 

steady estrogen causes __________ feedback

Definition

low estrogen causes positive feedback

 

steady estrogen causes negative feedback

Term
How do birth control pills work?
Definition

Steady state of estrogen; sending neg inhibition to brain

Term
Explain the two cell theory.
Definition

Follicle: basement membrane is a barrier, inside granulose, stroma has cells called theca cells; under right stimulus granulose cells produce estrogen; outer cells in stroma or theca produces androgens. Ovary doesn’t want androgens bc with enough androgens we stop ovulation; OVARY WANTS ESTROGEN! Lets do something so androgens can cross basement membrane and get into granulose and add chemicals and convert androgens to chemicals= called two cell theory of estrogen production in the follicular cell of ovary

Term
LH receptors are on what type of cells?
Definition
thecal cells
Term
LH causes ____ to cross basement membrane where it is converted to ______ then ______ and goes to blood
Definition

LH causes androgens to cross basement membrane where it converts to androstendione to estrogen and goes to blood

Term
What is FSH and LH? Who secretes them?
Definition

glycoproteins

 

secreted by ant pituitary

Term
What determines the rate and magnitude of FSH and LH secretion?
Definition

       Magnitude and rates of secretion are determined by the levels of ovarian hormones estrogen and progesterone and other factors such as inhibin and activin 

Term
What happens to lining of endometrium when there is in increase in estrogen?
Definition
proliferative stage:lining is growing
Term

What is the role of activin? Who does it work on?

 

What does it inhibit?

Definition

enhances production of FSH

And inhibits release of prolactin; increases FSH binding/ activates cycle and tries to get everything going; increases receptors, increases FSH; plays a role in changing two cell process

Term
What is the role of inhibin?
Definition

Inhibin: inhibits FSH and GnRH from the start; the more FSH, the more FSH~no effect on LH

 

Estrogen is going up and FSH is stimulating follicle; everything is going nice, estrogen is growing, why inhibin? Why inhibit FSH? Bc only want one egg! If not, if everyone was getting stimulated you would litters

Inhibin is the way to put body in check

 

Term

two cell theory:

 

   Immature follicle is encircled by a single layer of _______followed by a thin basement membrane that separates the follicle form the the surrounding stroma

   Stroma cells differentiate into _____

   Granulosa cells produce _______, including________ and _______

   Theca cells produce _______which serve as the precursors required for granulosa cell estrogen production.

   ________enter the granulosa cells by diffusion and are converted to estrogen.

 

Definition

   Immature follicle is encircled by a single layer of granulosa cells followed by a thin basement membrane that separates the follicle form the the surrounding stroma

   Stroma cells differentiate into theca cells

   Granulosa cells produce estrogens, including estrone and estradiol

   Theca cells produce androgens which serve as the precursors required for granulosa cell estrogen production.

   Androgens (androstenedione and testosterone) enter the granulosa cells by diffusion and are converted to estrogen.

Term

LH stimulates theca cells to produce __________

Definition
androgens
Term

What is this process called:

 

Increased androgen production leads to increased estrogen production

Definition
via aromatization
Term

Who makes activin?

 

what does it increase? what does it inhibit?

Definition

gonads and pituitary

 

increases FSh

 

inhibits prolactin

Term

True or False

 

Activin participates in androgen synthesis, enhancing LH action in the ovary.

Definition
True
Term

What does this describe?

 

 Inhibits FSH production and GnRH release from the hypothalamus

Definition
Term

True or false.

 

Inhibin inhibits both FSH and LH

Definition

FALSE

 

no effect on LH

Term
What occurs at LH surge?
Definition

ovulation

 

  Ovulation results in the dominant ovarian follicle releasing its oocyte and transitions to a progesterone-secreting ovarian cyst, the corpus luteum

Rising estrogen; estradiol (dominant estrogen); instead of having inhibitory action it turns to pos action-if it goes up quickly or above 400 picograms goes into stimulatory effect and tells brain to push forward so you get more estrogen AND get midcyle surge of LH- this causes follicle to pop! Activates prostaglandins CALLED OVULATION!

Term
people who take fertility pills- what are we giving them?
Definition
FSH
Term
What hormone starts to be made during ovulation?
Definition

progesterone

 

follicle changes names and becomes corpus luteum and starts making an additional hormone called progesterone (estrogen is still made)

Term

  LH surge _______ ovulation by 34-36 hours

Definition
precedes
Term
What causes the LH surge?
Definition
Increased estradiol secretion from the dominant follicle for a set time results in  positive feedback to the pituitary resulting  in the LH surge
Term
What causes body temp to go up?
Definition
progesterone
Term
What converts a follicle into corpus luteum?
Definition
LH
Term
What is luteinizatinon?
Definition

  Mid-cycle LH surge  stimulates these receptors and converts enzymatic machinery of these cells to produce progesterone, this process is called luteinization

Term
What type of effect does progesterone have on the pituitary secretion of FSh and LH?
Definition
Neg feedback
Term

  Corpus luteum also produces _________ in pattern that parallels progesterone production

Definition
estradiol
Term
What happens if conception does not occur durign luteal phase?
Definition

Life expectancy of corpus luteum is 11 days; reason why second half of cycle is about 14 days. If conception does not occur- corpus luteum breaks down bc progesterone drops sharply; as progesterone starts to fall, inhibin starts to go down too; so what happens? Lose negative feedback—so FSH which has been suppressed/menstruation has not begun, but FSH starts to rise; if conception does not occur during 10 days; as progesterone starts to fall, so take away inhibitory mechanism and get machine to work again; turn off inhibin and get activin going and turn on FSH to get ready for another cycle and pick another follicle.

Term
When is progesterone production begin?
Definition
24 hours before ovulation
Term
Withdrawl of progesterone during late luteal phase causes what?
Definition

releases FSH from negative feedback

  FSH begins to rise before menstruation

Term

How do you know if ovulatory or anvoulatory?

Definition

Period: Non clotting blood and contain endometrium tissue- sloughing epithelial layer of tissue 

PGs cause spasm/contracture of muscles and causes ischemia 

Cramping: as progesterone is dropping- PGs are released, endometrium getting ischemic this is prodromal cramping preceding menstruation 

Day 1 of period: estradiol starts to rise; estrogen In early follicular phase, reason bleeding stops bc estrogen has healing effect to bleeding

Term

menstruation:

 

how much blood loss?

 

describe blood-- contents

Definition
average loss of 20-60mL of dark non-clotted blood, containing blood and desquamated superficial endometrial tissues
Term
What produces contractions of the uterine vasculature and musculature, resulting in endometrial ischemia and uterine cramping?
Definition
Prostaglandins
Term

  Rising ________ levels in the early follicular phase induce endometrial healing leading to cessation of menstruation

Definition
estrogen
Term

At the end of the luteal phase,

 

what type of levels do you see of

serum estradiol, progesterone and LH?

Definition
LOW LEVELS
Term

What is the criteria for being the dominant follicle used during mensturation?

 

(3)

Definition
 only the follicle with the greatest number of granulosa cells, FSH receptors and estradiol production becomes the dominant follicle
Term
When does meiosis occur?
Definition
Ovulation/ during LH surge
Term
What causes human chorionic gonadotropin?
Definition

Pregnancy

 

  Fertilized oocyte becomes a zygote which secretes human chorionic gonadotropin

Term
What allows the corpus luteum to stick around for another 6-7 days?
Definition
human chorionic gonadotropin
Term
What hormone is needed to sustain early pregnancy?
Definition
progesterone
Term
When does placenta come into the picture during pregnancy?
Definition
week 6-7
Term

What can cause a miscarriage during weeks 6 or 7?

 

how can YOU help?

Definition

luteal phase defect

 

give pt progesterone to help

Term

What areas are influences by hormones?

 

5

Definition

endometrium

       endocervix

       breasts

       vagina

       hypothalamus

Term
What occurs to the endometrium during follcular phase?
Definition

  During menstruation the entire endometrium is expelled and only the basal layer remains

  During the follicular phase, estrogen stimulates endometrial cell growth

  Stroma thickens and cells elongate to form proliferative endometrium

  Endometrium reaches maximal thickness at time of ovulation-why? Ready for implantation

Term

What happens to the endometrium during luteal phase?

 

what becomes the predominant hormone?

Definition

  Predominant hormone shifts from estrogen to progesterone

  Endometrial changes occur daily

  Proliferative endometrium  changes to secretory endometrium

  Endometrial stroma become loose and edematous, white blood vessels entering the endometrium become thickened and twisted

  Endometrial glands which were straight and tubular during the proliferative phase become tortuous and contain secretory material within the lumen

Term

If woman doesn’t ovulate, she doesn’t make progesterone- what happens?

Definition

What happens to lining of uterus- lining will grow and outgrow support and will have acyclic non-predictable bleeding- could be spotting to hemorrhaging (like an iceberg that grows and loses its support so then sloughs off) what’s tx? Give progesterone

Term

Why is it important for cervix to produce mucous?

 

What hormone helps with this process?

Definition

Cervix: estrogen will make mucous clear, water, very imp! Helps catch sperm; activates sperm, helps with fertilization of egg;

Term

What hormone allows for pubertal breast development?

 

What hormone is responsible for reproductive changes?

Definition

What hormone allows for pubertal breast development?

 estrogen

 

What hormone is responsible for reproductive changes?

progesterone

Term
What causes breast tenderness and fullness in the luteal phase?
Definition
progesterone
Term
What hormone is responsible for lubrication and transudation during sexual stimulation?
Definition
estrogen
Term
What causes thermogenic effects?
Definition
progesterone
Term
endocrine process that involves the physical, emotional, and sexual transition from childhood to adulthood
Definition
puberty
Term

What is this called:

 

increased production of androgens in the adrenals, begins at age 6-8

Definition
adrenarche
Term

Adrenarche:

 

involves production of what?

Definition
Adrenarche involoves the increased production of dehydroepiandrosterone (DHEA), which can be converted to the more potent androgens testosterone and dihydrotestosterone
Term
How long does pubertal development take?
Definition
about 4 yrs
Term

What are some of the stages that take place in pubertal development?

 

What is important to remember about this process?

Definition

- accelerated growth

   - breast development (thelarche)

   - pubic hair development (pubarche)

   - maximum growth rate

   - menarche

   - ovulation

 

NEEDS  TO BE IN ORDERLY PREDICTABLE SEQUENCE

Term

Put these in the right order

 

Thelarch: breast development

Menarche: menstruation

Pubarche: pubic hair

 

Definition

Thelarch: breast development

Pubarche: pubic hair

Menarche: menstruation

Term
What does being obese and being very athletic do to puberty?
Definition

If obese: earlier menarche, early development: bc of peripheral conversion of androgen (androdenstione-part of adrenal secretions-converted to estrogen)

Athletic slightly delayed menarche bc less body fat

Term
Name four abnormalities of pubertal development.
Definition

       Precocious puberty

       Primary amenorrhea

       Delayed sexual maturity

       Incomplete sexual maturation

Term

What is this:

the onset of secondary sexual characteristics prior to age 6 in black girls and age 7 in white girls

Definition
precocious puberty
Term

What causes precocious puberty?

 

What do you measure?

Definition

   Precocious puberty is caused either by GnRH-dependent or GnRH independent sex hormone production

   Measure pituitary FSH and LH to distinguish between a hypothalamic-pituitary from a gonadal etiology

Term
What is the most common etiology of GnRH dependatn precocious puberty?
Definition
idiopathic
Term
What do you need to be concerned about in pt who has GnRH precocious puberty?
Definition
estrogen closing epiphysela paltes too quickly- can become dwarf
Term
name some causes of GnRH independent precocious puberty.
Definition
Can be caused by ovarian cysts or tumors, adrenal tumors, iatrogenic causes or McCune-Albright syndrome
Term

If a test revealed Elevated 17-hydroxyprogesterone

what are you thinking?

Definition

pathognomonic of 21-hydroxylase deficiency

Adrenal Causes of Precocious Puberty

Adrenal tumors-rare

Enzyme-secreting defects

   congenital adrenal hyperplasia (CAH)

   21-hydroxylase deficiency  is the most common form of CAH

   presents at birth with ambiguous genitalia

    adrenal glands unable to produce adequate amount of cortisol because of a partial block in the conversion of 17-hydroxyprogesterone to deoxycortisol

   results in shunting away from production of cortisol  towards the production of of androgens  (testosterone and estradiol) which results in precocious puberty

 

 

Term
What is Mcune Albright Syndrome?
Definition

   Snydrome characterized by premature menarche, often the first sign, multiple bone fractures, café-au-lait spots and precocious puberty

Thought to result from a mutation whereby the ovary can produce estrogen without FSH stimulation

Term
What should you consider in all children who present with precocious puberty?
Definition
iatrogenic precious puberty
Term
What is the treatment for precocious puberty treatment?
Definition
• Main goal is to arrest or diminish sexual maturation until a normal pubertal age
• Maximize adult height
• GnRH dependent precocious puberty is treated with GnRH agonist, with rapid results during the first year of treatment
• Goal of GnRH independent precocious puberty is to suppress gonadal steroidogenesis
Term
What is considered delyaed puberty?
Definition

   Puberty is considered delayed when secondary sex characteristics have not appeared by age 13,  there is no evidence of menarche by age 15-16, or when menses have not begun 5 years after thelarche

Term
What can cause delayed puberty?
Definition

Hypergonadotropic Hypogonadism (FSH >30mIU/mL)

       Gonadal dysgenesis (Turners syndrome)

 Hypogonadotropic Hypogonadism      

        (FSH & LH <10mIU/ml)

        Constitutional (physiologic) delay

       Kallmann syndrome

       Anorexia/Extreme exercise

       Pituitary tumors/ pituitary disorders

       Drug use

 Anatomic Causes

Mullerian agenesis

Term
Most common cause of delayed puberty with an elevated FSH
Definition
gonadal dysgenesis or Turner syndrome
Term

Pt presents with amenorrhea, short stature, webbed neck, shield chest with widely spaced nipples, increased carrying angle of the elbows.

 

What could it be?

Definition
hypergonadotropic hypogonadism
Term
What is the treatment for hypergonadotropic hypogonadism?
Definition

   Estrogen administration should be initiated at the normal time of initiation of puberty

   Growth hormone should be initiated early and aggressively, often before estrogen therapy to normalize adult height

   Low-dose estrogen therapy is started to initiate sexual maturation and is increased once breast budding begins

   If large dosages of estrogen are given initially epiphyseal closure may begin resulting in short stature adults

   Delay of estrogen therapy may result in teenage osteoporosis

Progesterone should not be added until Tanner stage IV, because premature progesterone administration may prevent complete development of the breast

Term
what can cause hypogonadotrophic hypogonadism?
Definition

Most common: physiologic/constitutional delay

 

Other causes are: Kallmann syndrome, anorexia, exercise, stress, pituitary tumors, pituitary disorders, hyperprolactemia and drug use

Term

       Arcuate nucleus does not secrete GnRH and the olfactory tracts are hypoplastic

       Women have little or no sense of smell and lack breast development

Prognosis for treatment and restoration of sexual maturation and reproduction is excellent with the use of exogenous hormones or pulsatile GnRH

Definition
Kallmann syndrome
Term
What causes hypothalmic amenorrhea?
Definition

   Weight loss

   Strenuous exercise (ballet, long-distance running)

   Anorexia nervosa or bulimia

   Stress

Craniopharyngioma-most common tumor associated with delayed puberty. Tumor develops in the pituitary stalk.

Term
What is the definitive therapy for imperforate hymen?
Definition
hymenotomy
Term

pt presents with pain in the area of the uterus and bulging, bluish appearing vagina.

 

What is it?

Definition

Primary Amenorrhea: Imperforate Hymen

   Simplest genital tract anomaly to treat

   Lower vagina and mid-portion of the vagina form from canalization of the genital plate

   Imperforate hymen results from incomplete canalization and hymen is closed

Term
What is the most common cause of primary amenorrhea in women with normal breast development?
Definition

Mullerian ducts develop and fuse in the female fetus to form the upper reproductive tract (fallopian tubes, uterus, and upper vagina-NOT VAGINA)

Mullerian agenesis or Mayer-Rokitansky-Kuster-Hauser syndrome is the most common cause of primary amenorrhea in women with normal breast development

Syndrome associated with congenital absence of the vagina, and often the uterus and fallopian tubes

Ovarian function is normal so all secondary sexual characteristics of puberty occur at appropriate time

Renal anomalies occur in 40%-50% of patients

Term

What does this describe?

 

Phenotypically- develop beautifully like women

Genetically they are XY: males

 

Definition
Mullerian agenesis
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