Puberty

PUBERTY IN GIRLS FOR UNDERGRADUATE

1. PUBERTY… DR SALINI MANDAL B.G. ASST PROFESSOR DEPT OF OBG FMHMC

2. DEFINITION Puberty in girls is the period which links childhood to adulthood.

3. Profound BIOLOGICAL , MORPHOLOGICAL and PSYCHOLOGICAL changes which lead to full maturity and eventually fertility.

4. MORPHOLOGICAL CHANGES Breast Pubic and Axillary hair Height Menstruation Completed between the age of 10 to 16 years

5. MENARCHE First menstruation in life 10 – 16 years  peak time 13 years First period is usually anovular Ovulation may be irregular during variable periods following menarche and may take 2 years for regular ovulation to occur.

6. GROWTH Increase in the height due to the hormones ( GH, estrogen , insulin like growth factor)

7. GENITAL ORGAN CHANGES

8. OVARIES Elongated shape becomes bulky and oval Ovarian bulk is due to follicular enlargement at various stages of development and proliferation of stromal cells

9. UTERUS Uterine body : cervix ratio = 1:2 (at birth) = 2:1 (after menarche)

10. VAGINA, VULVA Thin layers of epithelium  stratified epithilium of many layers Cells are rich in glycogen due to oestrogen VULVA – more reactive to steroidal hormones

11. Mons pubis and labia minora - increase in size Breast – due to oestrogen  proliferation of duct systems and deposition of fat. Becomes prominent and round

12. Precocious Puberty

13. Section 1 What is Precocious Puberty?

14. Definition The term precocious puberty is reserved for girls who exhibit any secondary sex characteristics before the age of 8 or menstruate before the age of 10

15. Causes For the majority of children, no underlying medical problem and no identifiable reason for the early puberty. 2 Types of Precocious Puberty Central / Complete / True Peripheral / Precocious pseudopuberty Incomplete

16. Central Most common form of precocious puberty Puberty process starts too soon, but the pattern and timing of the steps in the process are normal Constitutional, intracranial lesions

17. Central Tumor in brain or spinal cord Brain defect present at birth Hyperthyroidism

18. Peripheral Less common Excess oestrogen or androgen Caused by the release of estrogen into the body because of problems with the ovaries, adrenal glands or pituitary gland

19. Aetio - pathology Constitutional – premature activation of HPO axis  bone maturity accelerated  leading to premature closure of the epiphysis. Intracranial lesions – tumour (hypothalamus)  early release of gonadotrophins from pituitary Premature thelarche – isolated development of breast tissue before the age of 8.

20. Premature puberche – isolated development of axillary and or pubic hair prior to the age of 8. (excess androgen production due to adrenal hyperplasia) Premature menarche – isolated event of cyclic vaginal bleeding without any other signs of secondary sexual development. (unusual endocrine sensitivity of the endometrium)

21. DIAGNOSIS TRUE PRECOCIOUS CONSTITUTIONAL – H/O early menarche in mother and sisters. Puberty changes in order. No cause can be detected PREMATURE THELARCHE – somatic growth not accelerated. Bone age not advanced. Nipple development absent. Vaginal smear – negative oestrogen effect

22. PREMATURE PUBERCHE – no ovarian enlargement. Adrenal tumour may be the cause. PREMATURE MENARCHE – if no foreign body or injury and if bleeding is cyclic- then diagnosis confirmed

23. PROGNOSIS Apart from the short stature due to accelerated bone maturity, they have got a normal menstrual pattern in future. The fertility rate is also expected to be normal.