DIFFERENTIAL DIAGNOSIS OF COMMON GYNECOLOGICAL COMPLAINTS . . . CONT.
Non-Gynecological Causes thyroid disease (hyper-/hypo- thyroid) chronic liver disease von Willebrand disease leukemia idiopathic thrombocytopenic purpura hypersplenism rectal or urethral bleeding renal failure adrenal insufficiency and excess drugs: spironolactone, danazol, psychotropic agents metastatic cancer
STAGES OF PUBERTY
1. accelerated growth 2. thelarche (breast budding) 3. pubarche and adrenarche (growth of pubic and axillary hair) 4. maximal growth (peak height velocity) 5. menarche
Tanner Staging (see Pediatrics Notes)
Characteristics menarche at age 11-14 entire cycle 28 +/– 7 days, with bleeding for 1 - 6 days polymenorrhea if < 21 days oligomenorrhea if > 35 days 25-60 mL of blood loss per cycle
Day 12 Day 14 Ovulation
Day 28 New Cycle Begins
Day 1 to days 3-7: Menstruation, FSH and LH levels are rising.
Rising FSH stimulates growth of several ovarian follicles and maturation of an ovum.
FSH and rising LH stimulate the follicles to produce estrogen.
Estrogen causes proliferation of endometrium and further stimulates ripening of the ovum.
Estrogen triggers a LH surge which is responsible for ovulation.
After ovulation, progesterone produced by the corpus luteum stimulates secretory
changes in the endometrium.
Deterioration of the corpus luteum causes progesterone to decrease.
Decreasing progesterone and estrogen stimulate pituitary to produce FSH and LH.
Figure 2. Hormone Levels During Normal Menstrual Cycle
Proliferative/Follicular Phase first day of menses to ovulation variable in length low basal body temperature estrogenic endometrial priming ovarian follicular development
MCCQE 2000 Review Notes and Lecture Series