Session 3 Flashcards
Describe the sequence of physiological and anatomical changes that occur in the male at puberty
9-14yrs
Genital development begins
Pubic hair growth (adrenarche)
Spermatogenesis begins
Growth spurt - increased rate of growth, longer duration than girls
Pubic and axillary hair depends on androgens from testes and adrenals
Breast development limited due to conversion of oestrogen –> testosterone
Testosterone more potent stimulus thereform increased growth and longer
Describe the mechanism underlying such changes at puberty
Initiated by brain - maturation of central mechanisms, reduction in sensitivity to negative feedback by steroids
Hormonal - steady rise in FSH and LH
Body weight - 47kg
Adrenarche (pubic and axillary hair) - androgens
Growth spurt - growth hormone, steroids, growth spurt start weight (girls = 30kg, boys = 55kg). Oxygen fuses epiphyses once it reaches a certain point
Thelarche (breast development) - oestrogen
Male genitals - testosterone
Describe the condition precocious puberty and what it may be caused by
The development of the signs of puberty before 8 in girls and 9 in boys
It may be due:
Pineal tumours, meningitis - early stimulation of central maturation, early GnRH secretion
Hormone secreting tumours - uncontrolled gonadotrophin or steroid secretion
Describe the hormonal changes which lead to the features of the menopause aka ‘the climacteric’
Changes in cycle, ovulation early or absent, low oestrogen, high LH/FSH
No more follicles to develop –> very low oestrogen –> no inhibin –> increased FSH/LH
Effects - ‘hot flushes’, regression of endometrium, shrinkage of myometrium, thinning of cervix , vaginal rugae lost, involution of some breast tissue, reduced bone mass (–> osteoporosis)
List the advantages and disadvantages of hormone replacement therapy in post-menopausal women
++ - relieves symptoms of menopause, can limit osteoporosis
– - no cardio protection, increase in endometrial cancer
Define the term primary amenorrhoea and give some examples of causes
Absence of menses by age 14 with absence of secondary sexual characteristics
Hypothalmic/pituitary - hypogonadotrophic, low FSH
Ovarian - gonadal dysgenesis, androgen insensitivity syndrome, receptor abnormalities for FSH/LH, congenital adrenal hyperplasia, premature menopause
Outflow tract - Mullerian agenesis, vaginal atresia, imperforate hymen
Define the term secondary amenorrhoea and give some examples of causes
An established menstruation has ceased for 3 months (if regular) or 9 months (if irregular)
Hypothalmic/pituitary - exercise, stress, eating disorders/weight loss, hyperprolactinaemia, hypo/hyperthyroidism
Ovarian - pregnancy, anovulation, premature menopause, PCOS, drug induced
Outflow - intrauterine adhesions
Describe how, in principle, menstrual dysfunctions may be assessed and managed
Evaluation - menstrual history, contraception, surgery, medication, family history, physical exam
Management - COCP, tranexamic acid, NSAIDs
Define the terms menorrhagia, dysfunctional uterine bleeding (DUB), oligomenorrhoea, anovulatory cycle, dysmenorrhoea, cryptomenorrhoea
Menorrhagia - heavy periods, excessive (>80ml), prolonged (>7 days) uterine bleeding
DUB - abnormal bleeding with no obvious organic cause
Oligomenorrhoea - infrequent periods (35 days - 6 months)
Anovulatory cycle - no ovulation/luteal phase, oligo/amenorrhoea +/- menorrhagia
Dysmenorrhoea - painful periods
Cryptomenorrhoea - periods occur but not visible due to obstruction in outflow tract
Describe the sequence of physiological and anatomical changes that occur in the female at puberty
Puberty - 8-13yrs Breast bud (thelarche) Public hair growth (adrenarche) Growth spurt Onset of menstrual cycle (menarche) around the middle of puberty - critical weight 47kg Pubic and axillary hair depends on androgens (from adrenals) Breast development depends on oestrogens Oestrogen closes epiphyses
