Adolescence and Female Puberty Flashcards
What is the first sign of puberty in females?
Breast and papilla buds begin (thelarche)
- usually in SMR 2 (11.5-13 yrs)
there is 5% of females that develop pubarche first, but the majority is thelarche
- *also can show physiologic leukorrhea at the same time (clear vaginal discharge)**
- signals onset of menarche within 6 months
When does menses usually begin
Usually within 3yrs after thelarche (3-4 SMR)
- ages 12.5 is average
- age range = 9-15 yrs
Timing is almost always determined by genetics
- can also be influenced by obesity, chronic illness, nutritional status and physical/psychosocial environment
Early menarche is usually anovulatory and have irregular cycles (range from 21-45 days with 3-7 days of menstration)
When does growth spurt start for females
peak height velocity is usually at SMR 2/3, roughly 6 months before menarche is to begin
PHV = 8-9cm/yr
Growth spurt begins dismally and comes centrally
Normal menses
21-35 days between 1 period -> next period
- during first 3 years are superior irregular though
- if periods are being skipped need to work this up
Normal menses actually lasts <7 days usually
Normal menstration should be 6 or fewer soaked pads or tampons per day
Average age of menarche = 12.5 yrs
- slightly older for non-Hispanic whites
- slightly younger in blacks and Hispanics
Factors that affect onset of menarche
Weight exercise level, chronic medical conditions
there is a close concordance of age of menarche between mother and daughter
Severe dysmenorrhea or prolonged menstrual bleeding with menses
Needs more aggressive management and potential referral to gynecology
What are the history requirements for patients with menstrual irregularities
Timing of pubertal milestones
- especially pubic, axillary hair growth and breast development
- detailed patient menstrual history
- age of menarche
- overall menstrual pattern of mother and sisters
- family history of gynecologic problems
Complete ROS (below are really important)
- headaches, vision changes
- galactorrhea
- diet changes
- exercise and sports participation
3 types of abnormal uterine bleeding
AUB-O = Ovulatory dysfunction
AUB-C = coagulopathy
AUB-N = not classified
When should you do a Pelvic exam on an adolescent female
Only when they have delayed menses (>16 yrs old) and if they are sexual active with symptoms of an infection
Primary vs secondary amenorrhea in adolescence
Primary = no menstration within 3yrs of the onset of puberty
Secondary = no menstration for the length of 3 previous cycles in a postmenarche patient
When to evaluate for puberty delay
Lacks any signs of puberty by age 13
In sexual active patients with symptoms of pathology with 1 or 2 missed cycles
In patients whose breast development started between 8-9 yrs old
- usually observe for 3 yrs first and then go from there
Causes of primary and secondary amenorrhea
Pregnancy
Functional hypothalamic causes (stress, weight loss, malnutrition, etc)
Female athlete triad
Eating disorders
Premature ovarian insufficiency
Hypothalamic or pituitary damages
Thyroid disease (both can cause by hypo is more likely)
Prolactinoma
Systemic diseases (sickle cell, CF, celiac, IBD, congenital heart disease)
Hyperandrogenism (POCS and adrenal hyperplasia/tumor)
Drugs and medications (atypical antipsychotics and hormones are most common)
Tuner syndrome
Anatomic abnormalities
- imperforate hymen
- transverse vaginal septum
- mullarian abnormalities
Constitutional delay
Labs to get for amenorrhea
hCG pregnancy test
Serum levels of prolactin
TSH levels
FSH levels
Treatment of menstral abnormalities
Usually need to refer out or work together with other professions to actually get the disorder under control
- depends on the issue
Amenorrhea/PCOS treatment in children
OCPs (combo of estrogen and progesterone)
Lifestyle modifications = obesity and insulin resistance treatment
Patient with abnormal glucose tolerance (2 hr OGTT shows higher than 150) = metformin
Spironolactone for hirsutism if present
