3. Puberty & Abnormalities In Menstrual Function Flashcards
Describe the changes that occur in puberty in the female
What is the normal age range
Breast bud (thalarche)
Pubic hair growth (Adrenarche)
Growth spurt (9cm/yr)
Onset menstrual cycle (menarche)
8-13 yrs
What controls the onset of puberty
Brain: under hormonal control
Maturation of control centres: cells secrete more GnRH
Pulsatile GnRH secretion = Steady rise in FSH & LH
Hypothalamic-pituitary-gonadal axis switched on (before, hypothalamus not responding)
What is the most important factor in the timing of puberty?
What are the normal parameters?
Body weight
Crucial weight = 47kg
What influences the following: Adrenarche (pubic & axillary hair) Growth spurt Thelarche (breast development) Male genital development
Androgens (in girls, from adrenal glands)
Growth hormone & steroids
Oestrogen
Testosterone
Describe precocious puberty
What are the possible causes
Development of signs of puberty before age 8 (girls) or 9 (boys)
Majority unknown cause, but can be due to:
Neurological causes: early stimulation of central maturation = GnRH secretion (e.g. From Meningitis, Pineal tumours)
Uncontrolled Gonadotrophin / steroid secretion (hormone secreting tumours)
Describe the changes that occur in pre-menopause
What is the normal age for this
Changes in menstrual cycle:
Follicular phase shortens (ovulation early/absent)
Less oestrogen secreted (less -ve feedback: LH & FSH rise)
Reduced fertility
> 40yrs
Describe the changes that occur in menopause
What is the normal age for this
Cessation of menstrual cycle:
Run out of follicles
Oestrogen levels fall (less -ve feedback: LH & FSH rise; FSH more - no Inhibin)
49-50
Describe the effects of menopause
Vascular:
Hot flushes
Oestrogen sensitive tissues: Uterus - regression endometrium, shrinkage myometrium Thinning of cervix Vaginal rugae lost Involution of some breast tissue Changes in skin Reduction in bladder tone
Bone:
Mass reduces: Increased re absorption relative to production
What are the advantages & disadvantages of hormone replacement therapy on post - menopausal women
Advantages:
Relieves symptoms of menopause
Orally/topically: ease of admin
Can limit osteoporosis
Disadvantages:
No longer 1st line recommended treatment of osteoporosis (bisphosphonates)
No longer advised for cardio-protection
Define the following: Ovulatory cycles Anovulatory cycles Oligomenorrhoea Dysmenorrhoea Menorrhagia Dysfunctional uterine bleeding (DUB) Cryptomemorrhoea
Normal menstrual cycles & dysmenorrhea/mastalgia (sore breasts)
No ovulation/ luteal phase
Infrequent periods occurring @ intervals 35 days - 6 months
Painful periods
heavy periods (vaginal bleeding that is not DUB)
Abnormal bleeding, no obvious organic cause
Periods occur but not visible due to obstruction in outflow tract
Define the following: Amenorrhoea Primary amenorrhoea Secondary amenorrhoea Hypothalamic/pituitary amenorrhoea Gonadal/end-organ amenorrhoea Outflow tract amenorrhoea
Absence of periods for @ least 6 months
Never had a period
Established menstruation ceased (>3m regular cycle, >9m irreg cycle)
Inadequate levels of FSH = inadequately stimulated ovaries, which then fail to produce enough oestrogen to stimulate endometrium of uterus
(Incl due to stess, eating disorder, hyperprolactinaemia)
Ovary Doesn’t respond to pituitary stimulation = low oestrogen = increased FSH
(Inc due to PCOS, androgen insensitivity, drug induced)
Hypothalamic-pituitary-ovarian axis functional, FSH normal
Primary (e.g. Vaginal atresia) or secondary (e.g. Intrauterine adhesions) outflow tract obstruction
What would you assess in someone with secondary amenorrhoea
History:
Menstruation, contraception, pregnancy, surgery, medication, weight change, chronic diseases / stress, family history
Physical exam:
BMI, hair distribution, thyroid, visual fields/ breast discharge (hyperprolactinaemia), abdomen masses/tenderness
Describe the changes that occur in the male at puberty
What is the normal age range
Genital development
Pubic hair growth (Adrenarche)
Spermatogenesis begins
Growth spurt (10cm/yr)
9-14 yrs
