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Reproductive > Puberty and menstrual abnormalities > Flashcards

Puberty and menstrual abnormalities Flashcards

1
Q

Describe the sequence of physiological and anatomical changes which occur in the male during puberty

A

Changes in the Male at Puberty (Begins 9-14 Years)

o	Genital development begins (5 stages)
o	Pubic hair growth (Adrenarche) (5 stages)
o	Spermatogenesis begins
o	Growth spurt (10cm/year)
o	Genitalia adult
o	Pubic hair adult
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2
Q

Describe the sequence of physiological and anatomical changes which occur in the female during puberty

A

Changes in the Female at Puberty (Begins 8-13 Years)

o	Breast bud (Thelarche) – the first sign that puberty has begun. 
o	Pubic hair growth (Adrenarche)
o	Growth spurt (9cm/year)
o	Onset of menstrual cycles (Menarche)
o	Pubic hair adult
o	Breasts adult
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3
Q

Describe the mechanisms underlying the physiological changes seen in puberty

A

Puberty is under hormonal control; the start of puberty is associated with a steady rise in FSH and LH secretion. The brain initiates puberty, under environmental influences such as BMI

o Pulsatile GnRH secretion leads to rise in FSH and LH
o Rise in GnRH could be reduction in sensitivity to

–‘ve feedback by steroids, or (more likely) due to ‘maturation’ of central mechanisms

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4
Q

What influence does body weight have on puberty?

A

o Body weight is the most important factor in the timing of puberty
o Critical weight is 47kg for menarche
 If body weight falls significantly below this the reproductive cycle ceases (may be signalled to the brain by leptins)
o Growth spurt start weight is 30kg for girls and 55kg for boys
o In western countries puberty is now much earlier
 Children much bigger
 Average age of menarche was seventeen 200 years ago compared with thirteen now.

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5
Q

What is and what initiates adrenarche

A
  • the development of pubic and axillary hair
  • depends on androgens in both sexes
  • from adrenal glands in girls, testis in males
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6
Q

Outline the growth spurt seen in puberty for males and females

A
  • Occurs in both sexes, but is earlier and shorter in girls
  • Men are larger as growth spurt is longer and slightly faster
  • Depends on Growth Hormone and Steroids in both sexes
  • Ended in both sexes by epiphyseal fusion
  • Oestrogen closes epiphyses earlier in girls. Oestrogen is needed to initiate the growth spurt, but once levels reach a certain point it causes the epiphyses to fuse.
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7
Q

What is and what initiates thelarche?

A
  • breast development

* dependant on oestrogen

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8
Q

What initiates and controls male genital development?

A

Testosterone

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9
Q

What is precocious puberty and what initiates it?

A

Most parts of the reproductive system can work before the normal age of puberty, but don’t because hormone levels are too low. This is a result of low GnRH secretion.

The development of the signs of puberty before the age of 8 in Girls or 9 in Boys is known as precocious puberty. The cause of the majority of precocious puberties is unknown, but they can be due to:

  • Neurological: Pineal tumours, meningitis
  • Hormonal: gonadotrophin or steroid secreting tumours
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10
Q

Describe the hormonal changes which lead to the onset of the menopause

A
  • the climacteric or menopause
  • changes in menstrual cycle due to shortening of follicular stage with absent or early ovulation
  • less oestrogen secreted so LH and FSH rise
  • FSH rises more due to loss of inhibin
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11
Q

Draw out the feedback pathway for sex hormones in females

A

check against workbook.

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12
Q

Draw out the feedback pathway for sex hormones in males

A

check against workbook

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13
Q

Outline key characteristics of the menopause

A
  • cessation of menstrual cycles
  • typical age 49-50 but variation occurs
  • loss of follicles
  • oestrogen levels fall dramatically (HRT)
  • less negative feedback so FSH and LH rise dramatically
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14
Q

What are the vascular effects of the menopause?

A
  • hot flushes affect around 80% of women
  • transient rise in skin temperature and flushes
  • relieved by oestrogen replacement normally
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15
Q

What are the changes seen in tissues as a result of a fall in oestrogen?

A
  • regression of endometrium
  • shrinkage of myometrium
  • uterus shrinks
  • thinning of cervix
  • loss of vaginal rugae
  • involution of some breast tissue
  • potential skin changes
  • reduction in bladder tone
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16
Q

What effect does the menopause have on bone?

A
  • bone mass reduces by 2.5% per year for several years
  • increased bone reabsorption as oestrogen supports osteoblast differentiation
  • osteoporosis is a significant risk
17
Q

List the advantages and disadvantages of HRT

A
  • relieves symptoms of the menopause
  • can be taken topically by patch or gel
  • can offer protection against osteoporosis
  • no protection offered against cardiovascular disease
18
Q

Describe common menstrual problems

A
  • Amenorrhoea; absence of periods for >6 months. can be broken down into primary (never had a period) and secondary (cessation due to malnutrition etc)
  • Oligomenorrhoea; infrequent periods occurring at intervals anywhere from 35 days to 6 months
  • Dysmenorrhoea; painful periods
  • menorrhagia; heavy and prolonged periods
  • cryptomenorrhoea; periods occur but are not seen due to outflow tract obstruction
  • DUB: dysfunctional uterine bleeding, NOS
19
Q

Outline the causes of primary and secondary amenorrhoea

A
  • hypothalamic, pituitary, ovarian or outflow tract aetiology

–> hypothalamic: primary - Kallman syndrome, inability to produce GnRH. Secondary - reduced GnRH due to exercise, stress,eating disorders etc.

–> Secondary pituitary amenorrhoea: hypopituitarism

–> ovarian (end organ) due to Turners syndrome, receptor dysfunction, CAH etc. Secondary amenorrhoea caused by pregnancy, menopause, PCOS, drugs

–> Outflow tract: primary - vaginal atresia, imperforate hymen, mullarian agenesis etc. Secondary: adhesions, i.e. Asherman syndrome

20
Q

How would you evaluate amenorrhoea?

A 
o     Menstrual history
o	Contraception
o	Pregnancy
o	Surgery
o	Medication
o	Weight change
o	Chronic diseases, stress, diet
o	Family history
	Age at menopause, thyroid dysfunction, diabetes, cancer
o	Physical examination
	BMI – Weight change
	Hair distribution – PCOS
	Thyroid
	Visual fields / Breast discharge – Hyperprolactinaemia 
	Abdomen-masses? Tenderness?

Reproductive (9 decks)

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