Modules 1: adolescence and puberty teaching

At 13 years

By what age should puberty typically begin in females?

*Growth of pubic hair* ~Due to androgen stimulation ~Begins 6 months after thelarche (usually) ~Peak height attained

Define andrenarche

*Breast development* ~Average age 10 -11 yo ~Normally occurs between 8-13yo ~Affected by race and ethnicity ~AA girls will develop breasts b/t 8-9yrs ~15% of white girls will develop breasts b/t 8-9yo

Define thelarche

~increased cerebral maturation ~neuro pathways are developed and dependent on epigenetics: genetics/hormonal influence and experience ~education/role models and experience influence brain development ~impulse control is developed with maturation of the prefrontal cortex

Describe neurodevelopment puberty

~develop sense of identity and autonomy prior to adulthood ~peers become more important than parents

Describe psychosocial development of puberty

~tanner 1= no glandular tissue ~tanner 2= breast buds ~tanner 3= breast elevated beyond areola ~tanner 4= secondary mounds (increase in size + elevation) ~tanner 5= final adult size

Describe the 5 Tanner breast stages

~tanner I= no hair ~tanner 2= small amt hair ~tanner 3= curly/coarse hair ~tanner 4= adult-like hair that spares thighs ~tanner 5= hair on thighs

Describe the 5 Tanner pubic hair stages

~NSAIDS if no allergy to aspirin or severe asthma ~exercise ~heating pad on your abdomen or lower back

How do we advise to ease cramps?

~beginning in puberty, every month, your body will prepare for a possible pregnancy. ~hormones signal the ovaries to release an egg each month. ~the egg moves into one of the fallopian tubes. ~at the same time, the lining of the uterus begins to grow and thicken. ~if the egg is not fertilized by a man's sperm, pregnancy does not occur. The lining breaks down and flows out of the body through the vagina. ~this is called menstruation, the menstrual period, or just your "period."

How do we teach an adolescent about what is menstruation?

~creates social anxieties and self-esteem issues regarding body image ~rate of biological change is often mismatched with psychological maturity

How does the accumulation of adipose tissue affect adolescent girls?

Tanner 2

A girl has a small amount of pubic hair, and only breast buds. What Tanner stage is she in?

Tanner stages

Tanner stages

~adult height and weight is attained: low estrogen levels stimulate long bone growth ~peak height is attained approximately 2 years after breast budding and 1 yr prior to menarche ~rate and amount of accumulation of adipose tissue increases

What are some physical changes of puberty

~poor nutrition or eating disorders ~involvement in sports/athletic ~genetics ~medical conditions

What are the possible reasons puberty hasn't been reached by age 13, or has not had menses by age 15?

~depression ~conduct problems ~substance abuse

What can early or late pubertal onset place girls at risk for?

~grow taller and gain weight. ~hips may get wider. ~breasts grow. ~grow hair under your arms and around the vulva ~body odor changes ~may get acne or pimples. ~get your first menstrual period

What do hormonal changes cause physically in puberty?

~periods usually last between 2 days and 7 days ~periods normally come every 21-45 days ~periods often are not regular at first. You may miss a period. You may have two periods in 1 month. This is normal. ~it can take about 6 years after a first period for their body to get on a regular cycle ~a missed period could be a sign of pregnancy if sexually active

What do we teach an adolescent about how long menstrual periods last?

~at least every 4-8 hours ~may be more often during the first days of a period which may be heavier

What do we teach an adolescent about how often to change a pad or tampon?

~assess for normal variation (may be genetic variance) ~assess if due to excess androgen or estrogen deficiency

What if andrenarche occurs *prior* to thelarche (out of sequence)

11-14yrs

What is the age range for early adolescence?

18-21yrs

What is the age range for late adolescence?

15-17yrs

What is the age range for mid adolescence?

~15 years old and have not had a period. ~periods were regular each month and then they stopped being regular ~period comes more often than every 21 days or less often than every 45 days ~periods come 90 days apart - even if that happens only once ~periods last more than 7 days. ~periods are so heavy that they have to change pads or tampons more than once every 1-2 hours ~bad cramps that keep you from doing your regular activities and they are not helped by pain relievers.

What would you teach an adolescent about when to see her practitioner for concerns?

Most girls in the United States start between the ages of 12 years and 14 years, but some start earlier or later.

When does menstruation begin?

~girls should have their first gynecologic visit between the ages of 13 years and 15 years ~he first visit may be just a talk about what to expect at future visits anticipatory guidance about how to stay healthy ~teens can ask questions about their body

When should a girl begin seeing a women's health practitioner?

Tanner 4

Which Tanner stage usually occurs 1-2 years after the first period?

Tanner 3

Which Tanner stage usually occurs around the first period?