Repro 3.1 Puberty and Menopause Flashcards Preview

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Flashcards in Repro 3.1 Puberty and Menopause Deck (44):

When are primary sexual characteristics established?

Before birth


When do male and female reproductive systems become active?



When do male hormone levels change?

First few months of life


At what age do girls and boys reach puberty?

Girls - 8-13
Boys - 9-14


From where are sex steroids secreted?

Adrenal glands and gonads


Why do boys grow taller?

Growth spurt starts later so they have grown more before it starts and grow at a faster rate during the growth spurt and it is also slightly longer (10cm/year as opposed to 9cm/year in girls)


What terminates the growth spurt?

Epiphyseal fusion - adult height virtually set


What controls the development of secondary sexual characteristics in girls?

Gonadal oestrogens influence breast development and female genital development
Androgens from adrenals control the development of pubic and axillary hair


What controls the development of secondary sexual characteristics in boys?

Testicular androgens control the development of genitalia and body hair and deepening of the voice


What is the name for the onset of a girls first menstrual bleed?


NB. This does not indicate the onset of full fertility


What is the equivalent event for boys to menarche in girls?

Nocturnal erection and first ejaculation (more difficult o monitor)

NB. This does not indicate the onset of full fertility


Describe the hormonal changes in a girl until menarche.

Plasma levels of FSH and LH rise gradually from about 7 years of age to reach adult levels at of soon after menarche.
Plasma oestrogen levels rise steadily until at the beginning of menstrual cycles regular cyclical rises and falls are associated with the ovarian cycle
Weak androgens are secreted from adrenal glands


Describe the hormonal changes in boys from birth to adult level.

FSH and LH rise later than girls to reach adult levels around 16 years of age. This is associated with a steady rise in testosterone levels
Weak androgens are secreted from adrenal glands


What changes in the body signal the onset of puberty?

The brain initiates pulsatile GnRH secretion. This does not seem to depend on any signal from the gonads


What are the 2 theories explaining the onset of puberty?

Decreasing hypothalamic sensitivity to feedback -> Increased GnRH secretion
Hypothalamic mechanisms mature and steadily secrete more GnRH under other influences


Why has the onset of puberty become steadily earlier in the last 150 years in western society?

The main determining factor for onset of puberty is weight. Increased average body mass has decreased the age at which the onset of puberty occurs


Approximately what is the body weight at menarche?



What is the approximate weight of the growth spurt in girls?



What is the critical weight for boys for the onset of the growth spurt?



How is the hypothalamus aware of the appropriate weight for onset of puberty is achieved?

Leptin, a fat derived hormone may indicate to the hypothalamus the attainment of the body weight


What are some causes of precocious puberty?

-Meningitis/trauma (inflammation)
-tumours of the brain or spinal cord

-Tumours of the gonads
-Exposure to external sources of oestrogen and progesterone


In order, what are the stages of puberty in girls?

1) Breast bud appears (thelarche)
2) Pubic hair growth begins (adenarche)
3) Growth spurt
4) Onset of menstruation (menarche)
5) Adult pubic hair
6) Adult breasts


In oder, what are the stages of puberty in a boy?

1) Genital development begins
2) Pubic hair growth (adenarche)
3) Spermatogenesis begins
4) Growth spurt
5) Genitalia of adult
6) Pubic hair of adult


Define precocious puberty.

Physical signs of sexual maturation before 8 years or menarche before 10 years old.


What is true precocious puberty?

Precocious puberty caused by premature secretion of gonadotrophins. Usually idiopathic but can be caused by CNS lesions.


What is the effect of precocious puberty on height?

Shorter - growth spurt begins and terminates earlier. Oestrogen closes epiphyseal growth plates


How would you assess a boys stage in puberty?

Genital size
Body hair
Bone age
Medical history


Define delayed puberty

Lack of sexual maturation by age 15 - majority constitutional delay (benign)


What proportion of 14 year old boys would be expected to not yet be exhibiting signs of puberty?

3-5% - visibly begins aged 9-14


What is bone age and what might it indicate in delayed puberty?

Age suggested by bone - density, presence of epiphyseal growth plates etc.
Young bone age may indicate delayed puberty
Normal bone age may indicate there is a problem causing the delayed puberty


When does the growth spurt occur in boys?

12 months after genital development


How is the cause of delayed puberty in boys diagnosed?

Blood tests:
Low testosterone indicates hypogonadism
Low FSH indicates hypothalamic/pituitary problem


How might you treat precocious puberty?

Treat underlying cause:
Drugs to inhibit pituitary gonadotrophin secretion eg medroxyprogesterone or LHRH analogues
Drugs to block androgen action e.g. cryproterone


What disorders of the adrenal gland might cause precocious puberty?

Congenital adrenal hyperplasia -> hyperfunction
Cushings syndrome from adrenocortical tumour


What is the menopause?

End of reproductive life


On average, at what age does menopause usually occur?



What causes menopause?

Depletion of follicles in the ovaries so gonadotropins are no longer able to stimulate follicular development - interaction between the hypothalamus, pituitary and gonads that usually maintains the reproductive cycle is broken


What physiological changes occur with the onset of the menopause?

vasomotor changes - hot flushes (approx 80%)
Regression of endo and myometrium
Thinning of cervix
Vaginal rugae lost
Involution of some breast tissue
Skin changes
Bladder changes
Decreased bone mass 2.5% pre year -> osteoporosis
Mood changes


What changes occur in the menstrual cycle in pre-menopausal women?

More erratic menstrual cycle
Shortened follicular shortened - ovulation early or absent
Less oestrogen secreted
LH and FSH levels rise, FSH more (inhibin)
Reduced fertility but not absent


What changes in the menstrual cycle and relevant hormones occur in menopausal women?

Cessation of menstrual cycles
No more follicles to develop as the stock is used up
Oestrogen levels fall dramatically
FSH and LH levels rise (FSH more)
GnRH risesWh


What is HRT?

Hormone replacement therapy
Relieves symptoms of the menopause
Can improve well-being
Oestrogen given orally or topically by patch of gel
Can limit osteoporosis but no longer recommended for first line treatment
No effect on cardio changes


When does the end of the male reproductive life occur?

Spermatogenesis continues throughout life but incidence of loss of libido, impotence and inability to reach orgasm increase with age
Testosterone levels may decrease but without rise in LH (or FSH) suggesting a change in feedback control mechanism


What are possible disadvantages of HRT?

Clots - thromboembolism
Endometrial or breast cancer


Why are oestrogen only preparations not given to women who have had a hysterectomy?

Still have uterus which oestrogen therapy will increase its proliferation as it is oestrogen sensitive, increasing risk of endometrial cancer