LU 10 Puberty, Menarche, Menopause

What is puberty ?

• the process of sexual maturation in which an individual becomes physiologically capable of sexual reproduction

• maturation of primary sexual characteristics (reproductive organs)

• develop secondary sexual characteristics (eg : pubic hair growth, voice changes)

What are the factors influencing puberty ?

• health status

• genetic factors

• nutritional status

• environmental factors

What are the first sign of puberty ?

• girls : breast development followed by pubic hair & menarche

• boys : testicular enlargement followed by pubic hair and penile growth

What is Tanner stages ?

• staging is based on pubic hair and breast in females, pubic hair and genitalia in males

• T1 : pre-pubertal

• T2 : appearance of first signs of puberty

• T3 : more pubertal changes

• T4 : further changes near to adult

• T5 : full puberty

What are the changes in male during puberty ?

• enlargement of penis and testes

• grow facial and body hair, pubic hair

• muscle growth, broad shoulder

• voice change becoming deeper

• body odour & acne

What are the sequence of evens in girls during puberty ?

• Thelarche : development of breast

• Pubarche : development of axillary and pubic hairs

• Menarche : first menstrual period

What are the changes in female during puberty ?

• breast development, may feel tender and sensitive

• clitoris grow a little, inner lips of vulva become more prominent

• develop body hair and pubic hair

• uterus increase in length and thickness

• body shape become rounded and curved figure

• body odor and acne

What are the psychological changes in puberty ?

• begin to separate from parents and identify with peers

• confrontational with parents

• mood swings, sensitive

• risk taking behavior

• interest in other gender

What are the common disorders of puberty ?

• precocious puberty (early development of secondary sex characteristics, more common in females)

• delayed puberty (later than the age of 14 years old)

• delayed menarche (not started by the age of 16 years old)

What are the management of abnormal puberty ?

• treat underlying cause

• psychological support (counselling & education)

• promote puberty (hormone supplement : low dose testosterone, ethinyloestradiol)

What are the care of adolescent ?

• explain the normal changes in his/ her body

• encourage him/ he to maintain healthy lifestyle

• risk taking behavior prevention & education

• encourage them to express themselves and talked to loved ones about their uncomfortable experiences

• provide psychological support and give respect

What is menarche ?

• the first menstrual cycle

• signals the possibility fertility

• average age : 12.5 years old

What is the normal menstruation ?

• first day of heavy menstrual flow is day 1

• normal cycle : 28 days (21-35 days)

• 14 days luteal phase

• duration of flow 3-7 days

• normal menstrual loss 35-40mls (<80mls)

What is primary and secondary amenorrhea ?

• primary amenorrhea : menses have not begun within 2 years after onset of breast development or by age 16 years old

• secondary amenorrhea : absence of menstruation for at least 3 cycles after regular cycles have been established or for 6 months

What are the abnormal menstruation ?

• amenorrhea (complete absence of menstrual bleeding)

• prolonged menses (bleeding > 8 days)

• menorrhagia (blood loss >80mls per cycle)

• intermenstrual bleeding

What is menopause ?

• permanent cessation of menstruation for at least 12 consecutive months without any other pathology

• due to decrease in estrogen and progesterone by ovaries

• usually 45-55 years old

What are the symptoms of menopause ?

• menopausal syndrome :

• hot flushes

• mood swings

• vaginal dryness

• depression

• incontinence

• weight gain

What are the effect of menopause ?

• risk for vaginal infections

• mood swings

• sleep disturbance

• fatigue

• hair loss

• skin changes

What are the management of menopausal syndrome ?

• hormone replace therapy (HRT)

• weight bearing exercises and calcium rich diet

• healthy lifestyle

• meditation

What is hormone replacement therapy ?

• combine regime of estrogen and progestogen in women with uterus

• for women with no uterus, only estrogen

• routes of administration: oral, transdermal , intravaginal & subcutaneous

• not for use more than 5 years

• premature menopause are advice to continue HRT until natural age of menopause (around 51 years old)

What are the benefits of hormone replacement therapy ?

• prevents osteoporosis

• relief of menopausal symptoms

What are the contraindications of HRT ?

• have a history of breast, ovarian, uterine cancer

• have a history of blood clots

• have untreated high blood pressure

• have liver disease

What are the risks of hormone therapy ?

• endometrial cancer

• breast cancer

• ovarian cancer

• stroke/ heart attack

• venous thromboembolic disease

What are the nursing advices for menopausal woman ?

• explain and reassure her that this is a temporary but normal body response to menopause

• provide guidance and support

• adopt a positive coping stress mechanism in life

• regular exercise to strengthen heart and lower blood pressure

• advice her to take steps to reduce anxiety and stress (eg : meditation)

• advice her to go for yearly medical check up