https://nabeelbeeran.blogspot.com/ Puberty & Menopause

1. Physiology of Puberty And
Menopause
Dr. Nabeel Beeran MBBS, MD
Department of Physiology
09/08/2019
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2. Specific Learning Objectives
At the end of the class you should be able to:
• Define puberty and understand the physiology of
puberty in boys and girls.
• Describe the stages of puberty (Tanner’s staging)
• Describe the mechanism of onset of puberty and
physiological changes occurring in boys and girls.
• Explain the disorders of puberty.
• Know the mechanism, features and management of
menopause.
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3. Puberty and adolescence
• Transition from the non-reproductive state to
the state of reproductive functions that allows
procreation.
• Onset:
• Sudden spurt of physical growth
• Appearance of secondary sexual characters
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4. Tanner’s staging
Stages of
puberty
Female Male
Characteristics Characteristics
Stage 1 Preadolescent age Preadolescent age
Stage 2 Thelarche: Appearance of breast
buds
Estrogren secretion increases
Genital development begins
Testosteronre secretion increases
Stage 3 Axillary and pubic hair appears
Enlargement of breast
Axillary and pubic hair appears
Enlargement of penis
Spermarchy
Stage 4 Menarche
Breast areola begins to elevate &
project
Further growth of testis, penis
and genitalia
Stage 5 Adult genitalia
Secondary sex characters
Adult genitalia
Secondary sex characters
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5. Female Male
A) STRUCTURAL CHANGES
• Body
configuration
Narrow shoulders,
broad hips.
Thighs converge
Arms diverge
Shoulders are broader
than pelvis
• Skin Smooth and light Thick, dark & oily.
• Hair growth
Body hair
Face
Scalp
Pubic
Fine & scanty
---------------
Frontal hairline rounded
Concave
Rough & dark
Moustaches & beard
Indented at the sides
Convex
• Muscularity Soft (+) Bulky (+++)
•Subcutaneous
fat
Characteristic curves &
contour to the body
--------------------
• Genitalia Adult type Adult type 5

6. Female Male
B) FUNCTIONAL CHANGES
• Voice No change Loud, low pitched,
deepens and breaks.
• BMR Lower 10-15% higher than
females
• RBC and Hb conc. Lower Higher
• Menstrual cycle Begins Absent
C) PSYCHOLOGICAL Emotional, shy,
introvert and gets
attracted toward
males
Aggressive, extrovert
and interested in
opposite sex.
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7. Onset of puberty
Role of hypothalamus:
• From birth to preadolescent age:
• At the time of puberty.
• Awakening of hypothalamus.
• Role of leptin:
Evidences:
Anorexia nervosa.
Mice with low levels of leptin, Immature mice.
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9. Hormonal changes during puberty
• Gonadotropins
• Gonadal hormones
• Adrenal androgens
• Growth hormone
• Thyroid hormone
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10. Disorders of puberty
Precocious puberty:
• True precocious puberty
Causes:
Idiopathic
Conditions disrupt feedback inhibition of GnRH
release
Hypothalamic precocity
• Pseudoprecocious puberty
Congenital virilising hyperplasia
Androgen/ estrogen secreting tumours
Gonadal tumors .
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11. Delayed puberty:
Causes:
• Failure of hypothalamus/ pituitary to secrete
gonadotropins
• Primary gonadal failure.
• Chromosomal abnormality (XO pattern)
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12. Menopause
• What is menopause?
• Cause?
• Features and management:
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Source: https://www.independent.ie/life/health-wellbeing/health-features/the-menopause-everything-you-need-to-know-about-the-
change-35837358.html

14. Summary
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15. References
• Guyton and Hall Textbook of Medical Physiology ,
• GK Pal Comprehensive textbook of Medical
Physiology. Volume 1
• Textbook of Medical Physiology (2nd edition)- Indu
Khurana
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16. Thank you
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