By Trevor Dutt, Margareteret Matthews, Walter Scott
First released in 1999. Routledge is an imprint of Taylor & Francis, an informa corporation.
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The age at which puberty occurs is influenced by a number of factors, particularly that of body weight. Under-nourished girls are more likely to have a delayed menarche. The age of menarche has decreased in this century, probably because of the improvement in general health and nutrition. The precise physiological processes that initiate puberty are unknown. Steroid hormones produced from the adrenal gland may be involved, particularly in the growth of the secondary sexual hair or telarche. A body weight of 48 kg or more is required to menstruate which explains why anorexic girls do not have menstrual bleeds.
All these symptoms will generally resolve but one quarter of women will continue to experience them in varying degrees for more than five years. The second group of problems are also due to the lack of oestrogen but do not necessarily cause symptoms; nevertheless, they are vastly more important in terms of the general health of an increasingly ageing population. The major factors are cardiovascular disease and osteoporosis (de-mineralisation of the bones). Their importance lies in the fact that they are responsible for a good deal of the ill health and death in the post-menopausal population.
Menorrhagia is a very common presenting symptom in every general gynaecological clinic and is often investigated by an initial D & C. In about one-third of all cases, there will be a reduction in the menstrual loss but this is likely to be transient. In those cases where heavy periods are due to some anatomical factor, such as uterine fibromyomata, no improvement can be expected and the purpose of the D & C is to exclude other pathology before planning the definitive management. The possible causes of post-menopausal vaginal bleeding (PMB) are discussed in Chapter 5, but the most significant of these and the one that must be excluded in every case is a carcinoma of the endometrium.