1. Physiological Changes During Puberty & Menopause
Dr. Amel Eassawi
Dr. Shaikh Mujeeb Ahmed

2. Objectives Define puberty.
List the factors that affect time of onset of puberty in females and males.
Describe the hormonal changes that take place during puberty in females and males.
Outline the functions of pituitary and gonadal hormones during puberty.
Define Menopause and Andropause.
Distinguish the hormonal changes that takes place during menopause.

3. Puberty
Puberty is defined as the stage of physical maturation in which an individual becomes physiologically capable of sexual reproduction.

4. Endocrine Regulation of Reproduction
Hypothalamus releases GnRH into hypothalamo-hypophyseal portal vessels.
Anterior pituitary secretes:
LH (luteinizing hormone).
FSH (follicle-stimulating hormone).
Primary effects of LH and FSH on gonads:
Stimulation of spermatogenesis and oogenesis.
Stimulation of gonadal hormone secretion.
Maintenance of gonadal structure.

5. Endocrine Regulation of Reproduction

6. Onset of Puberty Wide variation in the onset of puberty:
Males vs. females.
Ethnic and racial groups.
Individual difference(genetic factor).
On average It usually begins between the ages of Males years and females 8-14 ( two years earlier in females than males )
Female pubertal changes usually begin with breast budding followed by pubic hair & menarche.
Male pubertal changes usually begin with testicular enlargement followed by pubic hair and penile growth.

7. ONSET OF PUBERTY
While control of the onset of puberty is not clear, two factors are believed to contribute:
An intrinsic brain timing mechanism
(Agonadal subjects demonstrate increase gonadotropins in the pubertal time periods with both males and females).
Changes in hypothalamic sensitivity to gonadal steroid feedback regulation.
This mechanism has been called the “Hypothalamic gonadostat “ theory.

8. Onset of Puberty 1. Increase gonadotropins in the pubertal time:
FSH and LH secretion is high in newborn, but falls to low levels in few weeks.
At puberty secretion of GnRH,FSH,& LH increases and become pulsatile.
Pulsatile pattern of hypothalamo pituitary axis is required for normal reproductive functions.

9. Onset of Puberty
2. Changes in hypothalamic sensitivity to gonadal steroid feedback regulation. During childhood , the hypothalamus is extremely sensitive to the negative feedback exerted by the small quantities of estradiol & testosterone produced by the child's ovaries or testes. As puberty approaches , the sensitivity of the hypothalamus is decreased and subsequently , it increase the pulsatile GnRH secretion initially at night . The anterior pituitary responds by progressive secretion of FSH and LH associated with increased secretion of growth hormone .

10. Circadian Rhythm of LH Secretion from Prepuberty to Adulthood
A major nighttime surge of LH is characteristic of puberty in girls and boys
Smaller nocturnal surges of LH continue through the adult years

11. Puberty in Female
The ovaries respond to the increase Gonadotrophin secretion by follicular development & estrogen secretion.
Estrogen causes development of the genital organs and the appearance of the secondary sexual characters .
With increased estrogen secretion, menarche occurs.

12. Puberty in Females The sequence of events in girls are as follows:
THELARCHE: The development of breast
2. PUBARCHE: The development of axillary and pubic hairs.
3. MENARCHE: The first menstrual period.

13. Puberty in Females Charactrstic of Puberty in Females:
Folliculogenesis proceeds
Ovulation for first time
Increase of Estradiol and progesterone
Secondary sexual characteristics:
Broadening of hips.
Subcutaneous fat( buttocks, breast, thighs).
Growth of external genitalia.
Pubic hair.
Increased sebaceous gland secretions (adrenal androgens).

14. Puberty in Males
The testis respond to the increase Gonadotropin secretion by increase in testicular size and increase testosterone secretion. Testosterone causes development of the genital organs and the appearance of the secondary sexual characters.

15. Puberty in Males Puberty Changes in Males: Spermatogenesis initiates
Increased androgen secretion
Growth of accessory sex structures
Prostate
External genitalia
Male secondary sex characteristics
Facial and body hair
Growth of larynx( deepening of voice)

16. Factors Influencing the Time of Puberty
Genetic Factors
Although the interaction of multiple genes on the timing of puberty is recognized, little is known of the specific gene loci involved.
Environmental Factors
Socioeconomic status
Nutritional status
Health status
Geography
Altitude
Early onset of puberty is associated with improved socioeconomic status, nutrition and health.
Delayed puberty is associated with chronic disease and malnutrition.

17. Factors Influencing the Time of Puberty
The mechanism underlying the pulsatile GnRH secretion remain unclear
The Theories Proposed are:
Melatonin secretion by pineal gland.
2. Leptin secretion by adipose tissue.

18. Factors Influencing the Time of Puberty
Role of Melatonin Melatonin is secreted by pineal gland . Secretion decreases by exposure to light and increses during exposure to dark. It is suggested that , there is observed decrease in rate of melatonin secretion at puberty (particularly at night).

19. Factors Influencing the Time of Puberty
Role of Leptin
A satiety producing hormone.
Secreted by adipose tissue.
May play role in hypothalamic maturation at puberty ( delayed onset of puberty in lean or caloric deprived girls).
Leptin secreted by adipocytes appears to exert a permissive effect on the timing of puberty and is not considered a metabolic trigger for the event
This effect occurs both directly through receptors on the neurons secreting GnRH and indirectly through neural network influences

20. Menopause Cessation of woman’s menstrual cycle
(Absence of menstrual cycle for at least 12 consecutive months)
Usually occurs between ages of 45 and 55.

21. Menopause
Preceded by period of progressive ovarian failure characterized by:
Increasingly irregular cycles.
Declining estrogen levels.
Loss of estrogen primarily affects skeleton and cardiovascular system.
Period of transition from sexual maturity to cessation of reproductive capability is called the climacteric or perimenopause.

22. Menopause Characteristic of Menopause: Cessation of menstrual cycle
Loss of ovarian function
Infertility
Drop in ovarian steroids (estrogen and progesterone)
Rise in gonadotropin hormones
Decrease in ovarian inhibin production

23. Menopause Symptoms of Menopause: Hot flushes. Mood swings.
Vaginal dryness.
Depression.
Incontinence.
Change in sex drive.
Risk of cardiovascular diseases and osteoporosis increases.

24. Menopause What Causes Menopause:
Midlife hypothalamic changes may trigger onset of menopause.
limited supply of ovarian follicles present at birth. Once this reservoir is depleted ovarian cycle and menstrual cycle ceases

25. Menopause Hormone Replacement Therapy in Menopause:
Estrogen is taken on a daily basis while progesterone is taken less regularly.
Helps alleviate symptoms such as hot flashes, vaginal dryness and mood swings.
Slows the progress of osteoporosis; decreased rate of fractures.

26. Andropause Male reproductive aging.
Very gradual compared to menopause.
Gradual decrease in sperm production and in testosterone production.
May occur after 45 to 50 years.
Results from degenerative changes in small testicular blood vessels.

27. References Human physiology, Lauralee Sherwood, seventh edition.
Text book physiology by Guyton &Hall,11th edition.
Text book of physiology by Linda .s Contanzo, third edition.
Physiology by Berne and Levy, sixth edition.