Puberty and Menopause

Question 1

Define Puberty

Answer 1

Process by which the immature individual will acquire the physical and behavioural attributes that allow sexual reproduction

Question 2

Age of puberty onset in females

Answer 2

8 - 13

Question 3

Age of puberty onset in males

Answer 3

9 - 14

Question 4

Define Adrenarche

Answer 4

An early sexual maturation stage…
contribution of the adrenal gland to puberty
increased synthesis and secretions of adrenal androgens

Linked to the increase in pubic and axillary hair growth

Question 5

List the secondary sexual characteristics in males

Answer 5

inc. laryngeal size
deepening voice
inc. bone mass
inc. mass and strength of muscle
thickened skin
more and thicker body hair

Question 6

Generally describe the changes that occur during puberty

Answer 6

Accelerated somatic growth
Maturation of priumary cexual characteristics
Appearance of secondary sexual characteristics
Menstruation and Spermatogenesis begin

Question 7

List the secondary sexual characteristics in females

Answer 7

Enlargement of breasts
Growth of pubic hair
Enlargement of both labia
Keratinisation of vaginal mucosa
Uterine enlargement

Question 8

Define Thelarche

Answer 8

Onset of breast development in females

Question 9

Define menarche

Answer 9

Onset of menstrual cycle

Question 10

Outline the stages of menarche

Answer 10

Comes with 3 stages of HPO axis maturation:

1. Increased FSH and LH secretions from the anterior pituitary gland
2. Ovarian recognition of FSH and LH and the response to produce ovarian steroids as a result
3. Establishment of +ve feedback mechanism of the hypothalamus and pituitary by Oestrogen

Question 11

Explain the correlation of % body fat to Menarche

Answer 11

Fat produces Leptin, which inhibits NPY (neuro-peptide Y)
NPY inhibits GnRH
High Leptin releases GnRH from prepubertal inhibition

Question 12

Definition of precoccious puberty

Answer 12

Puberty occurring younger than 2 S.D below average age

Question 13

List some causes of precoccious puberty

Answer 13

Congenital Adrenal hyperplasia
Tumours: pinneal, hypothalamic hamartoma, gonadal tumours
Testotoxicosis

Question 14

Define delayed puberty

Answer 14

Initial physical changes of puberty not present by…

13 yrs in females (or primary amenorrhea at 16 yrs)
14 yrs in males

Question 15

Causes of delayed puberty

Answer 15

Gonadal failure:

• Turner syndrome
• post chemo/radiotherapy

Gonadal deficiency:

• Hypothalamic/pituitary lesions
• FSH/LH receptor mutations

Question 16

Give a brief description of Turner syndrome

Answer 16

45, X

Signs:

• short stature
• gonadal dysgenesis
• skeletal abnormalities

Therapy: GH, sex hormones substitutions
…must be recognised early for effective therapy

Question 17

Changes in pre-menopause

Answer 17

Follicular phase shortens with ovulation early or absent
Less Oestrogen, increased LH and FSH
Reduced fertility

Question 18

Define menopause

Answer 18

Physiological changes in the female that signify an end to reproductive life…ultimately caused by ovarian failure

‘Oestrogen withdrawal syndrome’

12 months with no menstruation

Question 19

The average age that a woman experiences menopause

Answer 19

49 - 50

Question 20

Explain what a ‘hot flash’ is and how it can be relieved

Answer 20

Symptom of menopause: transient rise in skin temp. and subsequent sweating

Oestrogen treatment

Question 21

List some changes to Oestrogen sensitive tissues that occur in menopause

Answer 21

Uterus:

• regression of endometrium
• shrinkage of myometrium

Involution of breast tissue

Thinning of cervix

Vaginal atrophy (loss of rugae)

Reduction in bladder tone

Reduced bone density

Question 22

Explain how menopause accelerates a reduction in bone density

Answer 22

Reduced Oestrogen - increases osteoclast activity

Oestrogen antagonises PTH