wh 1 menstruation, dysmenorrhea, abnormal uterine bleeding, & amenorrhea (part 1)

9-14 years, 8-13 years

when does puberty begin for boys? girls?

adrenarche

what is occurring at the same time of puberty?

increase in the secretion of adrenal hormones

what is adrenarche?

thelarche

what is the name of the first event of puberty for girls?

development of breasts

what is thelarche?

pubarche

what follows thelarche?

development of axillary and pubic hair

what is pubarche?

first menstrual period

what is menarche?

anovulatory

the initial periods of menarche are generally....

about 1 year later

in relation to menarche, when does regular ovulation begin?

what ages define precocious puberty in girls? boys?

-constitutional

-cerebral

-gonadotrophin-independent precocity

what are the three categories of causes of true precocious puberty?

-disorders involving posterior hypothalamus

-tumors

-infections

-developmental abnormalities

what types of cerebral causes result in true precocious puberty?

Precocious pseudopuberty

what is it called when there is early development of secondary sexual characteristics without gametogenesis?

-adrenal

-gonadal

-miscellaneous

what are the three causes of precocious pseudopuberty?

-Congenital Virilizing Adrenal Hyperplasia (without tx in males, following cortisone treatment in females)

-androgen-secreting tumors (in males)

-estrogen-secreting tumors (in females)

what are the adrenal causes of precocious pseudopuberty?

-interstitial cell tumors of testis

-estrogen-secreting tumors (in females)

what are the gonadal causes of precocious pseudopuberty?

absence of secondary sexual development by age 12 in girls or until failure of menarche within 3 years of onset of secondary sexual characteristics

what is defined as delayed puberty?

menstrual cycle

what are the regular periodic cyclic changes of the adult female reproductive system in preparation for fertilization and pregnancy called?

ovarian cycle, uterine cycle, and cyclic changes seen in cervix, vagina, and breasts

what is the menstrual cycle divided into?

shedding of uterine mucosa on cyclic basis

what is menstruation?

predominately arterial, 25% is venous blood

what is the source of blood in menstruation?

-debris

-prostaglandins

-fibrinolysin from endometrial tissue

what does menstrual blood contain?

28 days

how many days is the average cycle?

21-35 days

what is the normal variation for menstruation?

3-5 days (1-8 days normal variation)

how many days is typical for bleeding during menstruation?

30-80mL

during menstruation, what is normal for blood loss?

primordial follicles

what follicles are present from the time of birth?

immature ovum

what does each primordial follicle contain?

antrum

at the start of each ovarian cycle, several primordial follicles enlarge and a cavity forms around the ovum which is called what?

follicular fluid

what is the antrum filled with?

day 6

on what day does a primordial follicle start growing rapidly and become the dominant (graafian) follicle?

atretic follicles

during the ovarian cycle, the dominant follicle grows rapidly and the other follicles regress to form what?

primordial follicle matures into dominant follicle

what generally occurs during the follicular phase of the ovarian cycle?

graafian follicle

what is the mature ovarian follicle called?

theca interna

what part of the graafian follicle is the primary source for circulating estrogen?

estrogen (g)

what are the granulosa cells (graafian follicle) a source of?

day 14

on what day of the ovarian cycle does the distended follicle rupture and the ovum is extruded into the abdominal cavity?

uterine tubes

during ovulation, what is the ovum picked up by?

follicle ruptures at the time of ovulation and fills with blood

what is corpus hemorrhagicum?

Mittelschmerz

what is it called when a woman feels pain due to blood entering the abdominal cavity during ovulation?

corpus luteum

what remains as pregnancy occurs?

yellowish, lipid rich luteal cells

in the corpus luteum, what is blood replaced with?

estrogen and progesterone

what do luteal cells secrete?

day 24

if there is no pregnancy, on what day does the corpus luteum degenerate?

follicular phase and luteal phase

what are the two phases of the ovarian cycle?

fibrous tissue formed by degradation of the corpus luteum in absence of pregnancy

what is the corpus albicans?

> 2 million

how many ova are females born with?

~300,000

how many ova last until puberty?

400-500

about how many ova go through ovulation during lifespan?

proliferative and secretory phases

what are the two phases of the uterine cycle?

preovulatory or follicular phase

what is the proliferative phase aka?

estrogen secreting from developing ovarian follicles

what is the proliferative phase of the uterine cycle influenced by?

deep layer of endothelium

by the end of each menstrual period, all but what has sloughed?

days 5-16

during what days does the endometrium regenerate from the deep layer and increase rapidly in thickness?

proliferative phase

most period abnormalities happen during what phase of the uterine cycle?

days 15-28

what days of the cycle make up the secretory phase (luteal phase) of the uterine cycle?

secretory phase (luteal phase)

the length of what phase is constant 14 days from ovulation?

prepares the uterus for implantation of fertilized ovum

what is the purpose of the secretory phase of the uterine cycle?

increase in vascularization from estrogen and progesterone produced by the corpus luteum

what happens during the secretory phase of the uterine cycle?

restoration of the epithelium from preceding menstruation

what is the purpose of the proliferative phase of the uterine cycle?

makes it thinner and more alkaline, promotes survival and transport of sperm

what does the influence of estrogen do to the mucus and what does this do?

time of ovulation

when is mucus thinnest?

arborizing, fern-like pattern

describe how mucus dries when put on a slide at the time of ovulation

after ovulation and during pregnancy

when is the mucus thick and fail to form the fern-like pattern?

10 days prior to menstruation

when is breast swelling, tenderness, and pain experiences?

-distension of ducts

-hyperemia

-edema of the interstitial tissue of breasts

what is breast swelling, tenderness, and pain due to?

during menstruation

when does breast swelling, tenderness, and pain and associated sx regress?

-rise in basal body temp

-thin cervical mucus

-rise in urinary LH

what are some indicators of ovulation?

increase in progesterone (thermogenic)

what is the rise in temperature change at the time of ovulation probably due to?

spinnbarkeit

what is it called when mid-cycle drop can be stretched into a long thin thread (8-12cm)?

9 hours

ovulation normally occurs ___ after the peak of the LH surge at midcycle

72 hours

how long does the ovum live (probs fertilizable for less than half that time)?

120 hours

some sperm can survive in the female genital tract and produce fertilization for up to ___ prior to ovulation

48 hours prior to ovulation

when is a woman most fertile?

17B-estradiol

what is the most potent form of estrogen?

-17B-estradiol (most potent)

-estrone

-estriol (least potent)

what are the different types of naturally occuring estrogen?

corpus luteum (theca and granulosa cells) then placenta

what is estrogen secreted by?

after menopause

when is estrogen very low?

prior to ovulation (maturing follicle), during mid luteal phase (corpus luteum)

when does estrogen peak during the menstrual cycle?

-facilitates growth of ovarian follicles

-increases fallopian tube motility

-promotes endometrial regeneration and vascularization

-cervical mucus thinning

-increase uterine blood flow and musculature

what are five effects of estrogen on the female GU tract?

decrease FSH production

what is the effect of estrogen on endocrine organs?

-duct growth

-breast growth at puberty

-pigmentation of areolas, more so in pregnancy than puberty

what is the effect of estrogen on breasts?

corpus luteum and placenta

what is progesterone secreted by?

20-fold

during the luteal phase ovarian secretion of progesterone goes up...

-uterus

-breast

-brain

what are the target organs of progesterone?

lobules

what does progesterone stimulate in the breasts?

-stimulates endometrial growth

-inhibits uterine contractions (anti-estrogen effects)

-cervical mucous thickening

-proliferation of vaginal epithelium

what are the effects of progesterone on the uterus?

-inhibit LH secretion

-potentiate inhibitory effects of estrogen

-both preventing ovulation

what does large doses of progesterone do?

corpus luteum, prostate

what is relaxin produced by in females? males?

-relaxes pelvic joints

-softens/dilates the cervix

-decreases uterine contractions

what is the role of relaxin in pregnancy?

ovaries

what are inhibins and activins produced by?

inhibit FSH secretion

what do inhibins do?

stimulate FSH secretion

what do activins do?

action of the hormones secreted by the anterior pituitary gland

what is ovarian hormone secretion dependent on?

TSH and prolactin

what does TRH stimulate the release of?

FSH and LH (gonadotrophin)

what act in concert to regulate the secretion of the ovarian hormones?

early maturation of ovarian follicles

what is FSH responsible for?

LH

what stimulates the secretion of estrogen and progesterone from the corpus luteum?

corpus luteum

the burst of LH secretion triggers ovulation and the formation of...