5) Puberty and Menopause Flashcards
What is thelarche?
What ages does it occur at?
Development of breast (8-11)
What is pubarche?
What ages does it occur at?
Development of axillary and pubic hair (11-12)
What is menarche?
What ages does it occur at?
First menstrual period (<16, 95% between 11-15)
What is adrenarche?
What ages does it occur at?
Onset of increase in androgen secretion (11-12)
What is puberty?
When sexual maturation and growth are completed and result in ability to reproduce
What changes occur during puberty?
Accelerated growth (spurt) Maturation of primary sexual characteristics (gonad and genitals) Appearance of secondary sexual characteristics Menstruation and spermatogenesis begin
What is the growth spurt dependent on?
Growth hormone and steroids
Why are men usually larger?
Growth spurt is longer and growth is faster (10cm/yr)
What stops the growth spurt?
Closure of epiphyseal growth plates
What is the critical weight for girls to enter menarche?
47kg
What evidence supports the critical weight theory?
Malnutrition associated with delayed menarche
Primary amenorrhoea in lean female athletes
Anorexia associated with missed periods
What hormonal changes trigger the onset of puberty?
Activation of GnRH by arcuate area of brain (KISS neurones)
Increases LH and FSH = sexual steroid secretion
What is the mechanism behind the growth spurt?
GH secretion from pituitary leading to increased TSH, metabolic rate, promotion of tissue growth and increased androgens (bone and muscle growth)
How can pubertal development be classified?
Tanner Standard (5 stages) Growth velocity
What is the sequence of development in girls?
Breast development -> pubic hair -> growth spurt -> menarche
What is the sequence of development in boys?
Testicular volume > 4ml -> pubic hair -> spermatogenesis -> growth spurt
What is precocious puberty?
Onset of puberty occurring younger than 2SD before average age
Girls < 8 Boys < 9
What are some gondatropin dependent causes of precocious puberty?
Tumours: gliomas, pineal
CNS injury or trauma
Congenital
Gonadotropin secreting tumours
What are some gondatropin independent causes of precocious puberty?
Congenital adrenal hyperplasia
Tumours: adrenal, HCG secreting liver, pineal, gonadal
Testotoxicosis
Exogenous oestrogen or androgen exposure
What ages is puberty considered to be delayed?
Girls = 13 (15-16 in primary amenorrhoea) Boys = 14
What are the causes of delayed puberty?
Gonadal failure
Gonadal deficiency
What is Turner’s syndrome? Describe some symptoms:
45, X
Short stature, gonadal dysgenesis, cardiac and skeletal malformation
What are the ‘Seven Dwarves’ of menopause?
Itchy, twitchy, sweaty, sleepy, bloated, moody, forgetful
Describe the pre-menopause stage:
From age 40
Follicular phase shortens, ovulation early or absent (reduced fertility)
Decreased oestrogen
Describe the menopause stage:
Cessation of menstrual cycles
Ages 49-50
No more follicles or oestrogen
What changes occur in the menopause?
Vascular changes = hot flushes Regression of uterus Thining of cervix Involution of breast Pelvic floor lax (incontinence) Decreased bones mass
What is hormone replacement therapy?
Giving oestrogen orally or topically
Relieves symptoms and improves wellbeing
What are the disadvantages of HRT?
Risk of breast cancer and thromboembolism
