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Women Module 1
Terms in this set (94)
Tanner stages of breast development
1. Preadolescent- small slightly elevated nipple
2. Breast Bud- small mound, areola enlarges
3. Adolescent- breast and areola enlarge, menses begins
4.Late adolescent- nipple and areola form secondary mound over breast
5. Adult- nipple protrudes, areola flush with breast shape
Tanner Stages Pubic Hair
-Begin at age 8
1. No pubic hair present
2. sparse, lightly pigmented
3. hair becomes more pigmented, coarse, curled, and more abundant
4. pubic hair abundant, but covers smaller area than in an adult
5. adult hair distribution
6. Hair grows up linea alba
Average age for menarche
12-13, range 9-17
Patient has no pubertal development by 13 or menses by 15, what do you do?
Work up of pubertal delay
Cycle length for the 1st year?
Cycles are least variable between ages?
Normal cycles are how many days?
32 days (range 20-60)
21-35 with no more than 7 days variability
A patient is describing her menstrual flow and she has greater than 3 days of light or very light spotting prior to the onset of heavy flow. Is this normal?
Patient is describing her menstrual flow and states that she has prolonged light, very light, or brown at tail end of flow. Is this normal?
Describe the HPGA cycle in the bio female:
a. the hypothalamus releases what hormone?
b. the anterior pituitary releases 2 hormones, what are they?
c. what hormone initiates ovarian follicles to begin to develop?
d. what 2 hormones are elevated to trigger ovulation?
a. GnRH, FSH releasing factor, LH releasing factor
b. FSH & LH
d. Estrogen & LH. "Increased estrogen levels during the follicular phase cause a surge of LH. This causes ovulation to occur 16-36 hours later."
What hormones do the ovaries release?
Progesterone, estrogen, testosterone, inhibin, activin, follistatin
How does cortisol level affect ovulation?
Hypercortisolism—> decrease GnRH—> decrease LH and FSH—>anovulation
How's does prolactin level affect ovulation?
Hyperprolactemia—> decrease GnRH—> decrease LH and FSH, increase in T, and decrease in E—>anovulation
How does hyperthyroidism affect ovulation?
Loss of pre-ovulatory LH surge causing irregular menses, anovulation, infertility
How does hypothyroidism affect ovulation?
Heavy breakthrough bleeding, spotting, and infertility
How does vitamin D deficiency affect ovulation?
It modulates production of P and E
Decrease and P and E—>increase in LH, FSH, and T—> ovulating dysfunction
What can hyperandrogenism lead to?
Congenital adrenal hyperplasia (CAH), PCOS, obesity, adrenal and ovarian adenomas
How does kisspeptin affect the HPG axis?
Decreased levels result in decrease GnRH
How does Leptin hormone (obesity hormone) affect the HPG axis?
Cause GnRH release—> increase LH, FSH, and E, prevents inhibition through negative feedback—> gonadatropins stay elevated—> preventing ovulation
A patient is extremely overweight and is experiencing continuous estrogenic mucus, oligo/amenorrhea, and breakthrough bleeding. What is most likely causing this?
A patient is underweight and lacking a period and struggling with fertility. What is most likely the cause?
How has hyperinsulinemia and insulin resistance affect the HPG axis?
Decrease in GnRH—>decrease LH, FSH, and SHBG, increase in free T and E—> continuous estrogenic mucus, amenorrhea, breakthrough bleeding, ovulatory dysfunction
phases of menstrual cycle
follicular phase, ovulation, luteal phase, menstruation
The first phase of the ovarian cycle, during which a follicle (an oocyte and its surroudning cells) enlarges and matures. This phase is under the control of FSH from the anterior pituitary, and typically lasts from day 1 to day 14 of the menstrual cycle. The follicle secretes estrogen during this time period.
The second stage of the general menstrual cycle, when the ovum is released. Surge in LH, start of decline in E.
The third phase of the ovarian cycle, during which a corpus luteum is formed from the remnants of the follicle that has ovulated its oocyte. The corpus luteum secretes PROGESTERONE and ESTROGEN during this time period, which typically lasts from day 15 to day 28 of the menstrual cycle. Formation of the corpul luteum is triggered by the same LH surge that triggers ovulation, however in the absence of LH (levels quickly decline after the surge) the corpus luteum begins to degenerate.
the phase of the menstrual cycle during which menstruation occurs
Low E and P levels
Phases of endometrial cycle
Menstrual phase of endometrial cycle?
Low estrogen and progesterone levels cause disruption of endometrial capillaries, prostaglandins initiate smooth muscle contraction and sloughing
Proliferative phase of endometrial cycle
Increasing E levels about 4-5 days after onset of menses, endometrium grows and thickens to prep for implantation, variable in time frame
The secretory phase of endometrial cycle?
Begins at ovulation, P produced but the corpus luteum, endometrium dilated, thick, cushiony and nutrient rich, constant time frame
phases of ovarian cycle
follicular phase, ovulation, luteal phase
follicular phase of ovarian cycle
Day one of menses to just before ovulation, when follicle mature, usually about 14 days is normal (follicle developing)
ovulatory phase of ovarian cycle
LH causes ruptured follicle to form CL "yellow body", produces mainly P, neg feedback to hypothalamus and AP to prevent further ovulation
When the follicle secretes estrogen, what does the vaginal mucus look like?
Clear, stretchy, lubricative cervical mucus
When the follicle bursts and releases the ovum in ovulation, what does the vaginal mucus look like?
Last day of clear, stretchy, moist cervical mucus
When the corpus luteum secretes progesterone, what does the vaginal mucus look like?
Thicker cervical mucus
When the corpus luteum atrophies and progesterone drops, it causes what?
zygote to blastocyst
Oocyte in uterine tube
4 cell stage (2 days)
Morula (3 days)
Early blastocyst (4 days)
Implanting blastocyte (6 days)
Protects cervix against penetrating sperm
Constant high levels of estrogen?
What do ovaries produce to affect the breasts?
Estrogen to stimulate growth of glands and ducts
Progesterone stimulates growth of milk producing cells
What does the anterior pituitary produce that affects the breasts?
Prolactin causes mammary gland development, milk production
Growth hormone causes mammary gland development
What does the posterior pituitary produce to affect the breasts?
Oxytocin that causes milk ejection in response to suckling
What accounts for the most preventable problems in pregnant women?
When to administer CRAFFT part b?
If a patient has had 2 or more miscarriages, what do you refer them to?
Genetic testing/ counseling
What meds to discontinue preconception?
Teratogenic meds: ACE inhibitors, Coumadin, paroxetine, statins, depakote (anti-epileptic)
What is asymptomatic in adults but causes blindness, hearing loss, epilepsy, and neurological delays in newborns?
Toxoplasmosis (parasitic-food borne and animal-human transmission)
What is asymptomatic in adults but devastating to fetus causing cerebral palsy, mental retardation, stillbirth, and hearing loss?
CMV (sexual contact, blood, urine, saliva)
Frequent exposure to young children puts a women at high risk for what?
Fifth disease (parvovirus b19)
Ideal BMI preconception?
For HTN, avoid ____ and _____ preconception and instead prescribe ____ and ____. Sometimes can use ____ but maybe less effective.
Order of pelvic exam?
External inspection and palpating
If BMI is 30 or greater or FH what screening would you preform preconception?
FBS or 2 hour OGTT with 75g glucose load, then FBS every 1-3 years
Folic acid supplementation with no health risk?
0.4-1.0 mg daily at least 2-3 months PTC and throughout pregnancy
Folic acid supplementation if woman has epilepsy, IDDM, BMI>35, FH NTD, Mexican born Hispanic, prior history of neural tube defect?
4.0 mg daily 2-3 months PTC until 12 weeks gestation then reduce to 0.4 mg
Vitamin A supplementation
Max 8000 IU/ day PTC and through your pregnancy. Higher doses may cause birth defects
No conception after 12 months of trying
Insecticides, pesticides, and organic solvents cause increase risk for?
NTD, decreased cognitive development, increase in childhood cancers
Max amount of tuna consumption to avoid mercury exposure?
3oz twice weekly
Canned food packed in epoxy (white plastic liners), plastic bottles stamped "7"
When to give Tdap vaccine during pregnancy?
NYHA class 2 or >, left heart obstruction, prior CV event, ED <40%
High risk for CV event in pregnancy
Chronic HTN goal of Bp during pregnancy?
Patient has had acne and is prescribed isotretinoin (accurate), what is important to educate the patient on?
No to conceive
A patient has ho psoriasis and is taking etretinate (soriatane) retinoid, what is important education for this patient?
Avoid getting pregnant for 1-2 years after
Hypothyroid management during pregnancy?
Possible increase dosage
Hyperthyroid during pregnancy?
Remission is possible
CrMS cycle charting
Charting estradiol and progesterone levels
This type of chart tracks FSH, estrogen, progesterone, follicles, and vaginal discharge
How long is a luteal phase?
If the luteal phase took place, what does that mean?
Billings Ovulation Method (BOM)
Involves the assessment of cervical mucus changes that occur during the menstrual cycle. The amount and character of cervical mucus change because of the influences of estrogen and progesterone.
Creighton model and NaPro technology
a form of natural family planning which involves identifying the fertile period during a woman's menstrual cycle
What may cause abnormal bleeding?
TH disease, cancer, prolactin levels
A short luteal phase signifies?
Cervical monitoring along with clear blue plan easy fertility monitor
Used to raise fertility awareness
monitor measures urinary metabolites of estrogen and LH
Clear blue easy
Tracking temp, mucus, and cervical position
How to decide if a patient should use contraceptives when breastfeeding
Technology to monitor women's health
Tracks LH and estrogen
Tracks LH with interpretation
Measures urine metabolite of progesterone- pregnanediol glucuronide (PdG)
Estrogen rise and fall
Marks beginning and end of window of fertility
Pregnandiolone- early PdG rise
Estradiol and follicular rupture
Cervical mucus- cervical mucus (beginning and end)
Progesterone rise marks what?
End of the fertile window
Estradiol rises and falls ____ hours before ovulation.
LH surge in blood ___ hours before ovulation.
Progesterone rises ___ hours before ovulation.
LH peaks _____ hours before ovulation.
Progesterone _____ after ovulation.
Cervical mucus peaks ___ days around ovulation.
Patient has a cycle less than 24 days or more than 36 days.
Patient has normal cycle length but short luteal phase or absence.
Length of follicular phase
Normal length of luteal phase?
11-17 days (by urinary E1G peak)
9-18 days (by mucus peak symptom)
What organs do you assess with abnormal cycles?
Ovaries, pancreas, hypothalamus
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