1. PUBERTY &
MENOPAUSE
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2. PUBERTY
Def.: Period at which endocrine & reproductive functions of gonads have first developed.
Age of puberty:
In girls: (8-13 years) & in boys: (9-14 years).
CONTROL OF ONSET OF PUBERTY:
A maturation of CNS and hypothalamus involving gradual establishment of pulsatile GnRH release from hypothalamic neurons.

3. THEORIES OF PUBERTY
1- Change in Feed-back sensitivity of Hypothalamus & anterior pituitary :
- In female children: a very low level of estrogens has a very sensitive –ve Feed-back on hypothalamic GnRH  stop follicular development.
- In pre-puberty: the sensitivity of –ve Feed-back decreases, so, secretion of FSH starts follicular development   estrogen secretion and development of secondary sex characters.
- At puberty: normal Feed-back is reached. At midcycle,  estrogen  LH surge and ovulation occurs.

4. 2- Release of neurotransmitters at Hypothalamus:
 Dopamine & noradrenaline release   synthesis & release of GnRH by hypothalamus.
Enkephalin & beta endorphin act as synaptic transmitters in brain   gonadotropin level in circulation.
3-  Adrenal androgen secretion (Adrenarché):
It occurs at age 10 years due to increase enzyme system in adrenal cortex or due to secretion of adrenal-androgen stimulating hormone from ant. Pituitary.

5. 4- Removal of inhibitory effect of pineal gland hormones as melatonin on ant. pituitary & gonads: by its calcification at puberty.
5- leptin is the link between weight and onset of puberty

7. PHYSICAL CHANGES IN PUBERTY
1) Growth promotion:
Due to ↑ growth hormone, sex steroids and insulin & thyroxin.
The end of growth occurs when epiphysis fuses with bone shaft.
2) Maturation of secondary sex organs & characters:
*In females:
Thelarché: development of breasts (sex steroids).
Pubarché: development of axillary & pubic hairs (androgen).
Menarché: 1st menstrual cycle (anovulatory for 1ys).
Feminine distribution of fat with wider pelvis.
*In males:
Growth of ext. genitalia, body & facial hair with deeper voice.

9. Tanner stages
The physical changes that occur during puberty are usually marked by distinct stages of development.
The stages are known as Tanner stages, named after Professor James Tanner, the child development expert who first identified them.
The Tanner stages give average ages of development, although there can be significant variation among children and teenagers.

11. Psychological & behavioural changes
Puberty can often be a particularly difficult time.
You're forced to cope with changes in your body and possible side effects, such as acne or body odour, just at the time when you feel self-conscious about your body.
Puberty can also be an exciting time, as you develop new emotions and feelings.
Psychological and emotional effects such as: unexplained mood swings, low self-esteem, aggression & depression. These feelings can be a normal part of growing up and going through puberty. But if they're having a serious impact on your life, you may wish to talk to a psychiatrist.

12. ABNORMAL PUBERTY 1- Precocious pseudo-puberty:
(A) Early puberty:
1- Precocious pseudo-puberty:
Early development of 2ry sex characters without gametogenesis.
Due to ↑ production of sex hormones from adrenal or gonadal tumor.
2- Precocious true-puberty:
Hypothalamic disease  early secretion of GnRH or due to tumor of pineal body without inhibition of GnRH.

13. (B) Delayed puberty:
After 17 years in female and 20 years in male.
(C) Absent puberty:
Due to panhypopituitarism or hypothyroidism.
1 ry amenorrhea in female & Eunchiodism in male.

14. MENOPAUSE
Def.:
Loss of fertility and stoppage of sex cycles and menstruation in females at ages years.
Causes:
 Number of primordial follicles.
Unresponsiveness of ovaries to Gonadotropins.
 Blood levels of ovarian hormones as estrogen and progesterone &
 Gonadotropins secretion.
 Androgen output from ovary and adrenal cortex.

15. MENOPAUSE Effects: Regression of secondary sex characters.
Atrophy of secondary sex organs.
Psychic problems: anxiety, fatigue & depression.
Hot flushes: Sensation of warmth spreading from trunk to face due to vasomotor disturbances.
Osteoporosis & muscle wasting.

16. 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.

17. ANDROPAUSE Male reproductive aging.
Very gradual compared to menopause.
Gradual decrease in sperm production and in testosterone production.
May occur as early as age 45 to 50 and more dramatically after the age of 70 in some men.
Results from degenerative changes in small testicular blood vessels.

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