Repro: Puberty And Menopause

Question 1

What is thelarche, puberache, menarche and adrenarche?

Answer 1

Thelarche: development of breast
Puberache: development of axillary and pubic hair
Menarche: the first menstrual period
Adrenarche: the ones of an increase secretion of androgens

Question 2

What are the different phases of puberty?

Answer 2

Accelerated growth - growth moves from linear to accelerated growth

Maturation of primary sexual characteristics

Appearance of secondary sexual characteristics

Onset of menstruation and spermatogenesis

Question 3

What are the hormonal changes causing the onset of puberty?

Answer 3

Onset of puberty caused by steady rise in LH and FSH that occurs between 9 and 12 years

The amplitude of LH pulses increases, especially during sleep

Question 4

What is the critical weight in girls for the onset of puberty?

Answer 4

47kg - if there is significant weight loss then the reproductive ceases

Question 5

What is the difference between primary and secondary amenorrhea?

Answer 5

Primary amenorrhea is the failure of onset of menses by age 16 - failure of onset of any secondary sexual characteristics by age 13 should be considered as primary amenorrhea.

Secondary amenorrhea is cessation of menses after menarche. Oligomenorrhea is menses occurring more than 35 days apart.

Question 6

What are the effects of increased GH secretion?

Answer 6

Increases TSH and therefore metabolic rate. Promotes tissue growth
Increase androgens causes rentention of minerals to support bone growth

All leads to a growth spurt

Question 7

What are the first phenotypic changes of puberty?

Answer 7

Breast development and testicular enlargement

Question 8

What secondary sex characteristics are induced by oestrogen and androgens?

Answer 8

Oestrogen: growth of pelvis, deposit of subcutaneous fat, maturation of internal and external reprod organs

Androgens: growth of pubic hair, growth of bone, secretion from sebaceous glands

Question 9

How can pubertal development be staged?

Answer 9

Using the tanner standard - measures testicular volume, breast size and hair

Question 10

What is the normal age range for start of puberty in girls and boys?

Answer 10

Girls is 9-13 (average 11)

Boys is 10-14 (average 12)

Question 11

What is the duration of puberty is girls and boys?

Answer 11

Girls 1.1-2.4 years

Boys 1.8-3.2 years

Question 12

At what age is puberty considered precocious?

Answer 12

Onset of puberty occurring younger than 2 standard deviations before the average age

So in girls <8 (much more common)
Boys <10

Question 13

What are the causes of precocious puberty?

Answer 13

• majority unknown

Gonadotrophin-dependent:

• tumours eg gliomas pineal tumours
• CNS trauma or injury
• hydrocephalus

Gonadatrophin independent: 
- congenital adrenal hyperplasia 
- HCG secreting tumours in liver
- testotoxicosis
- exogenous oestrogen or androgen exposure 
EXPLAIN WHY

Question 14

What is delayed puberty?

Answer 14

The initial changes of puberty are not present by age 13 in girls or age 14 in boys

Or the rate of pubertal development is abnormal eg time between first signs of puberty and menarche/complete genital growth in boys is more than 5 years

Question 15

What are some causes of delayed puberty?

Answer 15

Gonadal failure:

• turners syndrome
• post chemo/radiotherapy
• autoimmune syndromes

Gonadal deficiency:

• congenital hypogonadotrophic hypogonadism
• lesions in the hypothalamus or pituitary
• rare gene mutations sting FSH/LH or their receptors

Question 16

What are the 7 symptoms of menopause? (The dwarves!!)

Answer 16

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

Question 17

What is the pre-menopause?

Answer 17

Typically occurs from age 40
The follicular phase shortens and ovulation is early or absent.
Oestrogen decreases and FSH and LH increase

There is reduced fertility

Question 18

What is the menopause?

Answer 18

Cessation of menstrual cycles for 12 months - occurs around 49-50yrs

Oestrogen levels fall dramatically - FSH and LH rise (FSH more so due to loss of inhibin)

Question 19

What are some effects of the menopause?

Answer 19

• vascular changes resulting in hot flushes
• regression of endometrium
• cervix thin
• vaginal rugae lost which can lead to vaginal dryness
• loss of pelvic tone so can get incontinence
• bone mass reduces because oestrogen normally inhibits osteoclasts activity

Question 20

Why is hormone replacement therapy used?

What are the risks?

Answer 20

HRT is oestrogen given orally or topically.
It relieves symptoms of the menopause and can limit osteoporosis.

However HRT increases the risk of Breast cancer.
Ovarian cancer.
Womb cancer.
Blood clots.
Heart disease and strokes.

Question 21

What is the first sign of puberty in boys and girls?

Answer 21

Boys: increased testicular volume

Girls : breast development

Question 22

How can you assess if menstrual blood loss is great enough to have adverse effects?

Answer 22

Usually symptoms begin when blood loss >80ml per cycle

This is usually when women become anaemic - so do blood test