Scribd
Upload
34 views31 pages

Physiology of Puberty and Menstruation

Uploaded by

rakshitverma319
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
34 views31 pages

Physiology of Puberty and Menstruation

Uploaded by

rakshitverma319
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 31

PHYSIOLOGY OF

PUBERTY AND
MENSTRUATION
DR HEENA SINGHADIA
PHYSIOLOGY OF PUBERTY
• ADOLESCENCE is the timing during which endocrinal changes of puberty , sexual
development and growth occur.
• PUBERTY time of sexual maturation.
• GONADARCHE activation of hypothalamic-pituitary-gonadal axis.
• MENARCHE onset of menstruation.
• THELARCHE onset of breast development.
• ADRENARCHE activation of production of androgens by the adrenal cortex.
• PUBARCHE appearance of pubic hair.
ENDOCRIOLOGY OF PUBERTY
• Pulsatile secretion of GnRH begins soon after birth , resulting in rise in gonadotropin levels, this
continues to the level till 24-36 months of age
• After that level falls and remain low till puberty.

• NEURO-ENDOCRINE SWITCH: during puberty , GnRH receptor in puberty upgraded , which


response to GnRH increase and increase amplitude and frequency of GnRH .
• This is modulated by neurotransmitters.

• Neurotransmitters play role that modulate puberty:


1. Gamma amino butyric acid 6. Leptin
2. Neuropeptide – Y 7.Gherin
3. Neurokinin – B 8. Insulin
9.pro-opiomelanocortin
4. Glutamate
5. Kiss peptide
THELARCHE:
• The steroid hormones act on the breast and cause development of it .
• It is 1st obvious sign of puberty

MENARCHE:
• Under the influence of oestrogen, the uterus and cervix also grow and reach the
adult proportion 2:1.
• The endometrium differentiates into basal and functional layers and characteristic
changes under the influence of gonadal hormones.
• Onset of menstruation flows is known as menarche.
• The early menstrual cycles are anovulatory and irregular.
• With establishment of positive and negative feedback by steroid hormones and
inhibin.
ADRENARCH:
• Zona reticularis of adrenal produce ANDROSTENEDION and DHEAS by age of 6
years, levels are increase in puberty.
• Sudden increase in androgen levels are due to unknown cause , it is believe that it
is due to increase levels of pro-opiomelanocortin and leptins
• With increase level of adrenal androgen there is increase in growth of pubic hair
and axillary hair is known as PUBARCH.

GROWTH SPURT:
• It occurs about 2 years earlier in girls than in boys.
• 20% of the adult height is due to growth spurt.
• Growth spurt begins before the sexual changes of puberty but the peak growth
velocity is reached about 6 months before menarche.
• The secretion of GH peaks at puberty and declines thereafter.
• GH stimulates IGF 1 by liver stimulate the growth spurt.
• GH synthesis is also by ghrelin , leptin and nutrition factors .
• Towards the end of pubertal process , oestrogen leads to epiphyseal fusion in
long bones and cessation of linear growth.

CHRONOLOGICAL ORDER OF EVENTS IN PUBERTY:


1. Linear growth increase by 9-10 years (growth spurt)
2. Pubic and axillary growth (adrenarche)
3. Menarche by age of 11-12 years
OTHER CHANGES IN PUBERTY:
a. Body weight and composition:
• BMI increase in puberty.
• Increase in lean body mass and fat mass.
• Excessive weight gain occurred depending on nutritional status of inndiviual.

b. Bone growth:
• Linear body growth is essential for increase in height.
• Bone mineralization peaks a few months after peak height velocity.
• Increase in requirement of calcium and vitamin D
PHYSIOLOGY OF MENSTRUATION
OVARIAN CYCLE
OVARIAN
CYCLE

FOLLICULAR LUTEAL
OVULATION
PHASE PHASE
FOLLICULAR PHASE
1.PRIMODIAL FOLLICLE :
• Single layer of flattened granulosa cell

2.PRIMARY FOLLICLE:
• Cuboidal granulosa cells
• Increase in number of granulosa cells
• Pseudo stratification
• Formation of zona pellucida
3. SECONDARY FOLLICLE :
• Preantral follicle
• Increase in number of follicular cells
• Stromal differentiation into theca cells
• Formation into theca externa and theca interna

4. TERTIARY FOLLICLE:
• Antral follicle
• Collection of fluid into follicle
• Rapid increase in follicular size [10-20mm]
4. PREOVULATORY FOLLICLE :
• Increase in fluid .
• Increase in size of follicle >20mm.
• Formation of cumulus oophorous.
• Formation of corona radiata.
OVULATION:
• Triggered by LH surge
• LH surge causes :
 Completion of first meiotic division
 Extrusions of 1st polar body
 Inflammatory reaction of follicle
 Release of prostaglandins and cytokinin.
 May be midcycle pain k/a mittelschmerz pain.
 Proliferation of follicular wall
 Ovulation
 Pickup of oocyte by fimbriae
LUTEAL PHASE:
• Once the ovulation occurs , the graffian follicle collapse and the granulosa and
theca cell becomes yellow due to deposition of lipid and luteal pigmentation.
• This process is known as LUTEINIZATION.
• Remaining part of graffian follicle turned into corpus luteum.
• Corpus luteum secretes estrogen , inhibin A and large amount of progesterone.
• Neovascularization of corpus luteum ensures secretion of hormones into system
• High level of progesterone is characteristic of luteal phase, prepare endometrium
nidation.
• Size of corpus luteum by day 21: 2 cm
• If pregnancy occurs , progesterone from the corpus luteum give support to
pregnancy for 3 months of pregnancy after which placental tissue form from
which hormones secrete and give support to pregnancy.
• If pregnancy not occurred , the blood supply to corpus luteum , decrease which
form it fibrotic and form CORPUS ALBICAN.
Endometrial
cycle

Proliferative secretory menstruation


PROLIFERATIVE PHASE:
• day 1 to ovulation to ovulation (day 14)
• Effect of estrogen
• Endometrial changes
 Glands : elongation and dilatation
 Lining cells: columnar and pseudostratified
 Thickness : increase from 1 to 12 mm
SECRETORY PHASE:
• 15-28 days
• Effect of progesterone
• Glands : secretion
• Stroma : oedema , leucocytic infiltration
• Elongated and coiled arteries
MENSTRUATION:
• With demises of corpus luteum , level of estrogen and progesterone fall
• Local production of PGF2 alpha causing vasospasm of spiral artery, endometrial
ischemia and tissue destruction
• Lysosome release which cause tissue destruction
• Endometrium breaks down and functional layer is shed and expelled by
myometrial contraction .
• Vaso constriction and myometrial contraction are regulated by PG F2 alpha , E2 ,
I2 and TXA2.
• Vasodilators are PGE2 and I2
• Proper balance between PGs cause normal menstruation.
• Endometrial degradation , hemorrhage , uterine contraction and vasoconstriction
are regulated by cytokines , GF, platelet plugs fibrinolytic , MMP , endothelin and
other substance.
THANK YOU

You might also like