Session 3 Flashcards
What term is used to describe development of the breasts?
Thelarche
What term is used to describe development of axillary and pubic hair?
Puberache
What term is used to describe the first menstrual period?
Menarche
What term is used to describe the onset of an increase in the secretion of androgens?
Adrenarche
Puberty is initiated by a rise in secretion of which hormone?
GnRH
Which hormone is responsible for the early epiphyses closure in girls?
Oestrogen
In the Western world, what is considered to be the average age of menarche in girls?
<13 years
What weight is said to be critical in girls in order for them to undergo a reproductive cycle?
47kg
What are the first phenotypic changes observed in puberty?
Breast development/testicular enlargement
How can pubertal development be staged?
Tanner standard
On average, at what age does puberty occur in females?
9-13 years
On average, at what age does puberty occur in males?
10-14 years
How is precocious puberty defined?
Onset of puberty occurring younger than two standard deviations before the average age
Girls <8 years (5-10 times more common in girls)
Boys <9 years
Give examples of causes of gonadotropin-dependent precocious puberty.
Tumours (gliomas, astrocytomas, hamartomas, pineal tumours, hCG-secreting germ cell tumours)
CNS trauma or injury
Hydrocephalus
Arachnoid cysts
How is gonadotropin-independent precocious puberty more accurately defined?
Precocious pseudopuberty
It is the appearance of secondary sexual characteristics due to increased production of sex hormones (i.e. occurs independently of the HPG axis)
Give examples of causes of gonadotropin-independent precocious puberty.
Congenital adrenal hyperplasia
hCG-secreting tumours in the liver
Testotoxicosis (familial male precocious puberty)
Exogenous oestrogen or androgen exposure
How is delayed puberty defined?
Initial physical changes of puberty are not present by age 13 in girls, age 14 in boys OR
Primary amenorrhoea at age 16 in girls OR
The interval between the first signs of puberty and the completion of puberty is >5 years
Give example of causes of delayed puberty.
Gonadal failure (hypergonadotropic hypogonadism):
Turner’s syndrome
Chemo/radiotherapy
Polyglandular autoimmune syndromes
Gonadal deficiency:
Congenital hypogonadotropic hypogonadism
Hypothalamic/pituitary lesions
What changes occur in the female during the pre-menopause?
Shortened follicular phase of the menstrual cycle
Ovulation early or absent
Reduced fertility
What changes occur in the female during the menopause?
Cessation of menstrual cycles
No more follicles to develop
Oestrogen levels fall dramatically
FSH and LH levels rise
What effects are seen in females as a result of the menopause?
Vascular changes (transient rises in skin temperature)
Regression of endometrium and shrinkage of myometrium
Thinning of cervix
Loss of vaginal rugae (leading to dryness)
Involution of some breast tissue
Changes in skin
Loss of pelvic tone (leading to urinary incontinence)
Loss of bone mass (oestrogen no longer inhibits osteoclasts leading to osteoporosis)
What name is given to a particularly heavy menstrual bleeding?
Menorrhagia
Give examples of causes of menorrhagia.
Abnormal clotting Fibroids IUCD (intrauterine contraceptive device) Cancer Progesterone contraception
What is a uterine fibroid?
A benign growth in the uterine cavity (can sometimes grow large enough to mimic a pregnancy)
Name five different types of uterine fibroids.
Intracavity Submucosal Intramural Subserosal Pedunculated
What is DUB?
Dysfunctional uterine bleeding - heavy bleeding with no recognisable pelvic pathology, pregnancy or general bleeding disorders
When is irregular bleeding likely to occur?
During the first three months of starting hormonal contraception
After missing doses of contraceptive pills
After vomiting/diarrhoea whilst on COCP
Whilst taking certain medications (or St John’s Wort) whilst using hormonal contraception
Give examples of hormonal contraception.
Combined oral contraceptive pill (COCP) Progesterone-only contraceptive pill Contraceptive (transdermal) patch Contraceptive implant/injection Intrauterine contraceptive device (IUCD)
