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Date Posted: 01:57:07 07/27/09 Mon
Author: khalil aslam
Subject: health

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Puberty and the menopause
Puberty
The onset of menstruation (the menarche) should be regarded as the culmination of a transitional stage in a girl's development. The term puberty refers not only to the complete functioning of the hormonal cycle for the flfst time but also to the gradual changes in the secondary sexual characteristics which precede the menarche.
In girls the earliest sign of puberty is enlargement of the breast buds, which most frequently occurs at the age of 11 years, with a range from 9 to 13 years. Pubic hair usually appears a year later, and at this time there is a spurt of growth, so that for a time girls may be taller than boys of comparable age, but after that females grow less rapidly than males because of earlier epiphyseal closure. The mean age of the menarche is 13 years, with a range from lIto 15 years.
Deposition of subcutaneous fat provides the rounded female contour. The mons pubis and labia majora increase in size, with the appearance of pubic and axillary hair. The infantile uterus enlarges, and the bony pelvis acquires female characteristics. Adolescent interest in boys may be accom- panied by shyness and fluctuating moods, but how far this is the result of educational and social stress rather than endocrine changes is hard to tell.
The age of onset of menstruation may be modified by heredity, nutrition or environment, and appears to be falling in Britain. Sexual maturity often occurs earlier in tropical countries, but this is a racial characteristic and not an effect of the climate.
During childhood rhythmic discharges of GnRH occur but with low amplitude. At puberty the amplitude of the discharges increases, so that FSH and LH are produced and in turn the level of oesfrogens rises. The secretion of oestrogens begins about 3 years before the menarche. Early cycles may be anovular, with no formation of corpora lutea and therefore no production of progesterone.
Precocious menstruation The onset of menstruation has been recorded even before the age of 4 years, and the case of Lima Medina who became pregnant at the age of 5 is well attested.
The majority of cases of precocious puberty are of the primary or 'constitutional' type. No other abnormality is found, and in other respects the child develops normally, except that breast development and the growth
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