5) Puberty and Menopause

Question 1

What is thelarche?

What ages does it occur at?

Answer 1

Development of breast (8-11)

Question 2

What is pubarche?

What ages does it occur at?

Answer 2

Development of axillary and pubic hair (11-12)

Question 3

What is menarche?

What ages does it occur at?

Answer 3

First menstrual period (<16, 95% between 11-15)

Question 4

What is adrenarche?

What ages does it occur at?

Answer 4

Onset of increase in androgen secretion (11-12)

Question 5

What is puberty?

Answer 5

When sexual maturation and growth are completed and result in ability to reproduce

Question 6

What changes occur during puberty?

Answer 6

Accelerated growth (spurt)
Maturation of primary sexual characteristics (gonad and genitals)
Appearance of secondary sexual characteristics
Menstruation and spermatogenesis begin

Question 7

What is the growth spurt dependent on?

Answer 7

Growth hormone and steroids

Question 8

Why are men usually larger?

Answer 8

Growth spurt is longer and growth is faster (10cm/yr)

Question 9

What stops the growth spurt?

Answer 9

Closure of epiphyseal growth plates

Question 10

What is the critical weight for girls to enter menarche?

Answer 10

47kg

Question 11

What evidence supports the critical weight theory?

Answer 11

Malnutrition associated with delayed menarche
Primary amenorrhoea in lean female athletes
Anorexia associated with missed periods

Question 12

What hormonal changes trigger the onset of puberty?

Answer 12

Activation of GnRH by arcuate area of brain (KISS neurones)

Increases LH and FSH = sexual steroid secretion

Question 13

What is the mechanism behind the growth spurt?

Answer 13

GH secretion from pituitary leading to increased TSH, metabolic rate, promotion of tissue growth and increased androgens (bone and muscle growth)

Question 14

How can pubertal development be classified?

Answer 14

Tanner Standard (5 stages) 
Growth velocity

Question 15

What is the sequence of development in girls?

Answer 15

Breast development -> pubic hair -> growth spurt -> menarche

Question 16

What is the sequence of development in boys?

Answer 16

Testicular volume > 4ml -> pubic hair -> spermatogenesis -> growth spurt

Question 17

What is precocious puberty?

Answer 17

Onset of puberty occurring younger than 2SD before average age
Girls < 8 Boys < 9

Question 18

What are some gondatropin dependent causes of precocious puberty?

Answer 18

Tumours: gliomas, pineal
CNS injury or trauma
Congenital
Gonadotropin secreting tumours

Question 19

What are some gondatropin independent causes of precocious puberty?

Answer 19

Congenital adrenal hyperplasia
Tumours: adrenal, HCG secreting liver, pineal, gonadal
Testotoxicosis
Exogenous oestrogen or androgen exposure

Question 20

What ages is puberty considered to be delayed?

Answer 20

Girls = 13 (15-16 in primary amenorrhoea)
Boys = 14

Question 21

What are the causes of delayed puberty?

Answer 21

Gonadal failure

Gonadal deficiency

Question 22

What is Turner’s syndrome? Describe some symptoms:

Answer 22

45, X

Short stature, gonadal dysgenesis, cardiac and skeletal malformation

Question 23

What are the ‘Seven Dwarves’ of menopause?

Answer 23

Itchy, twitchy, sweaty, sleepy, bloated, moody, forgetful

Question 24

Describe the pre-menopause stage:

Answer 24

From age 40
Follicular phase shortens, ovulation early or absent (reduced fertility)
Decreased oestrogen

Question 25

Describe the menopause stage:

Answer 25

Cessation of menstrual cycles
Ages 49-50
No more follicles or oestrogen

Question 26

What changes occur in the menopause?

Answer 26

Vascular changes = hot flushes 
Regression of uterus 
Thining of cervix
Involution of breast 
Pelvic floor lax (incontinence) 
Decreased bones mass

Question 27

What is hormone replacement therapy?

Answer 27

Giving oestrogen orally or topically

Relieves symptoms and improves wellbeing

Question 28

What are the disadvantages of HRT?

Answer 28

Risk of breast cancer and thromboembolism