Puberty in girls: changes in the body. Premature puberty in girls

For the vast majority of girls, puberty begins at 8-13 years of age (on average 10.5 years).

Stages of puberty in girls

During the pre-pubertal period, the level of gonadotropins and gonadal steroids is low. At the same time, under the influence of ACTH, the secretion of adrenal androgens begins to increase in girls from 6-7 years of age, i.e. several years before the activation of the hypothalamic-pituitary-gonadal system in puberty. This phenomenon is called adrenarche. The growth spurt observed before puberty and sometimes the appearance of axillary and pubic hair are associated with the action of adrenal androgens. The secretion of hormones from the adrenal cortex gradually increases until late puberty. Pubic hair growth is caused by androgens from the ovaries and adrenal glands, and hair growth is assessed separately from the degree of development of other signs of puberty.

Hair in the armpits appears at approximately 13 years of age, and at the same time the apocrine sweat glands, which are localized in the armpits, genitals and mammary glands, begin to function. Acne and acne occur in girls at the age of 13 as a result of increased secretion of steroids from the gonads.

The first sign of the onset of puberty in girls is the acceleration of growth, which precedes the pubertal growth spurt. The onset of puberty is usually associated with such an easily observable symptom as enlarged mammary glands. The shape and size of the mammary glands are also determined by genetic factors and nutrition, but characteristic stages of gland development are observed in all girls without exception. The diameter of the nipple practically does not change in the 1st-3rd stages of mammary gland development (amounting to 3-4 mm), but increases significantly in subsequent stages, reaching 7.4 mm in stage 4 and up to 10 mm in stage 5 as a result of increased estrogen secretion during menarche.

Under the influence of estrogens, the fundus/cervix ratio increases. The latter takes on a pear-shaped shape, while lengthening from 3 cm in the prepubertal period to 5 cm. The ovaries increase in volume from 1 ml in prepuberty to 2-10 ml. The length of the vagina increases from 8 cm at the beginning of puberty to 11 cm at menarche.

Pubertal growth acceleration occurs under multilateral endocrine control, in which the leading role is given to growth hormone and sex hormones, in the absence of which the pubertal growth spurt decreases or does not occur at all. By enhancing the secretion of growth hormone, sex hormones indirectly stimulate the synthesis of IGF-1 and, in addition, directly activate the formation of IGF-1 in cartilage. Sex hormones stimulate the maturation of chondrocytes and osteoblasts, which leads to the closure of the epiphyseal growth zones. On average, girls grow 25 cm during puberty, and the later puberty begins, the higher their final height is (due to the longer period of puberty).

From the beginning of puberty, the growth rate of the legs is faster than the growth rate of the body, but during the growth spurt these rates level out. The distal parts of the limbs (feet and hands) begin to grow before the proximal parts begin to grow, so a rapid increase in shoe size is the first harbinger of the pubertal growth spurt.

From mid-puberty, estrogens can stimulate the secretion of gonadotropins. The frequency of GnRH secretion peaks increases to normal values, which predominantly increases the secretion of LH compared to FSH. This stimulates the synthesis of estrogen by the ovaries and leads to a midline surge in LH secretion, which causes ovulation. However, in the first menstrual cycles, despite the median release of gonadotropins, ovulation does not always develop: up to 90% of menstrual cycles in the first year after menarche are anovulatory, and 4-5 years after menarche, up to 20% of cycles still remain anovulatory. The onset of menarche correlates closely with skeletal age 13 years.

It would seem that just recently the daughter was a sweet angel, obedient and funny, and suddenly something happened to her - inexplicable whims, sudden changes in mood, and occasionally hysterics. You should not be afraid of such changes, because the girl is growing, and sooner or later she will enter puberty. What signs accompany such “growing up”, what can be considered early puberty and how should parents react to it? We will try to answer these questions in the presented material.

Signs of puberty in girls, or what happens in the body

The period of puberty in girls lasts 2 years and ends with puberty - this time falls on the first menstruation. Doctors still cannot name the timing of puberty that fits the norm - it is believed that this period is variable: it can begin at 9 years old and at 11 or 13. If signs of puberty in a girl are present at the age of 7 years, or are absent, When a child is already 15 years old, this is a cause for concern. All other years that occurred during the state under consideration are considered normal. We will write about early puberty later, but let’s make a reservation right away - the girl’s parents should not make any independent decisions about this. Only a doctor will be able to establish the true cause of early puberty and prescribe drug therapy, which, incidentally, also applies to late puberty.

Note:During their observations, doctors discovered the following: the earlier a girl’s puberty began, the faster it will end. That is, if a girl at the age of 9 has already shown signs of puberty, then in a year and a half you can expect her first menstruation, but if these signs are noted at the age of 14, then two to two and a half years may pass before her first menstruation.

Signs of normal puberty in girls:

Separately, it is worth mentioning the most important sign of puberty – menstruation. A girl’s first menstruation, as a rule, appears at the age of 13, but this age is very arbitrary! There are many cases where the first bleeding occurred at the age of 11 and this was not a pathology. Let’s make a reservation right away - the menstrual cycle will “form” and stabilize over about 12 months, during this period the bleeding will be irregular, it may be absent for 1-2 months, and this “behavior” of the girl’s body is quite normal. As soon as a girl’s first menstruation begins, her growth slows down sharply and after that, in total, the child will add another 5 cm in height.

Parents should pay special attention to preparing the girl for her first menstruation, and, naturally, the mother should take care of this. No matter what age your child starts getting their period, it can be very frightening. Yes, children are now accelerators. Yes, they sometimes know more than adults. And yet, experts emphasize the importance of conversations between a girl and her mother on the topic of puberty, first menstruation - not a single book, not a single friend, not a single video from the Internet will convey the necessary information to a girl. And then, such a trusting relationship with your mother, who will be able to listen and talk even about “intimate” topics, will become the key to close relationships in the future.

Psychological problems during puberty in girls

The above-described signs of the condition in question are quite capable of surprising not only the parents (“when did she manage to grow up”), but also the girl herself. And during this period, it is important not to leave her alone with her questions, fears and doubts.

Firstly, you will need to tell the girl why such changes are happening to her body and organism. If this happened earlier than with her friends, then it is worth emphasizing the significance of such an event as puberty, and clearly indicating that there are no deviations in development, all this is natural.

Secondly, it is worth carefully observing a girl whose puberty occurred in later years - she will feel too uncomfortable in the company of her peers and doubt her inferiority. And here you need to become a psychologist, explain to the girl that puberty occurs at different ages, you can even embellish the reality and tell that the mother herself experienced this period at the age of 14-15.

Thirdly, you need to talk in detail about menstruation. But you need to immediately stipulate that these topics are too personal, “intimate” and you shouldn’t tell your friends that your period has already begun. Yes, this means that “the girl has matured,” but this does not at all mean that she has become an adult, so the mother will need to have conversations and teach her daughter all the subtleties of behavior among her friends.

Note:A girl's perception of change during puberty directly depends on how close her relationship is with her mother. Therefore, try to “establish contact” from childhood - this will make it easier to have conversations on “intimate” topics, and in the future a trusting relationship will develop between two close people.

Early puberty in girls

Premature puberty in girls has its own signs:

• changes in the mammary glands began quickly and before the age of 9 years;
• female-type hair growth is observed at the age of up to 9 years;
• the girl's growth stops;
• the appearance of menstruation before the age of seven.

Particular attention should be paid to the fact that the appearance of menstrual bleeding in a girl during premature puberty does not mean at all that she has become a woman - such bleeding is also called non-ovulation/menstrual-like, that is, the egg from the girl’s ovary does not release into the uterine cavity for fertilization.

Such premature puberty in girls is a deviation from the norm and has several forms.

Classification of precocious puberty in girls

Gynecologists and endocrinologists distinguish several forms of the condition in question:

Causes of early puberty in girls

The following factors can lead to this condition:

• hereditary predisposition - early puberty is passed on in the family from generation to generation, but does not affect the reproductive abilities of the female body;
• problems in the functioning of the hypothalamus and/or pituitary gland, which leads to excess production of hormones;
• various neoplasms of a benign or malignant nature in the ovaries.

Very often, girls with precocious puberty are born to women who smoked/drank alcohol and drugs during pregnancy, or have a history of endocrine diseases.

How to treat

Only after a complete diagnosis and a series of specific examinations will the doctor be able to tell what therapy should be used to correct the girl’s sexual development. It is quite possible that you will only need to choose a diet and normalize the child’s psycho-emotional background. But often, hormonal drugs are used to normalize the condition; such medications should only be prescribed by specialists.

Surgical treatment is prescribed only if the girl has been diagnosed with a tumor of the adrenal glands, ovaries or hypothalamus - the tumor is simply removed and the processes of puberty proceed within normal limits.

As for the late puberty of a girl, we will most likely be talking about hormonal problems and/or malformations of the genital organs. Usually the problem can be solved with hormonal drugs, but they can only be prescribed by doctors.

Tsygankova Yana Aleksandrovna, medical observer, therapist of the highest qualification category

A 6.5 year old child has started to growhair on the labia. Ultrasound of the pelvic organs, adrenal glands and thyroidglands are normal. What should be done, what examination should I undergo?

Answered by Berezovskaya E.P.

All disorders of sexual development in girls can be divided into two qualitative groups: premature sexual development (PPD) and delayed sexual development. It was believed that precocious development of girls can be discussed with the appearance of secondary sexual characteristics (the growth of mammary glands and the appearance of pubic hair) before the age of 8 years, but there is increasing evidence that these signs can also be observed in girls aged 6-7 years.

PPR can be divided into two categories: gonadotropin-dependent PPR (true and false, central, cerebral) and gonadotropin-independent PPR. The first category is associated with premature activation of the hypothalamic-pituitary-gonadotropin system, which leads to impaired production of gonadotropins. A false type of PPR is observed with congenital adrenal hyperplasia, tumors that produce gonadotropins, especially hCG, tumors of the adrenal glands, ovaries, syndromeMcCune-Albrigh, et al. Precocious sexual development can be hereditary (autosomal dominant pathway of gene transmission) - this is a constitutional form of PPR, or gonadotropin-independent. PPR can also be divided into complete and incomplete forms.

In girls with precocious puberty, you can observe:

• accelerated growth and weight gain

• advanced bone age by more than 2 years

• breast enlargement up to 7-8 years

• appearance of pubic hair before 7-8 years of age

• bloody vaginal discharge

• enlarged uterus

• in some cases, regular menstruation appears. Possible pregnancy and childbirth at the age of 5-10 years

• neurological symptoms: headache, fatigue, visual impairment.

If a disorder of sexual development is suspected, the girl should be examined by a pediatric gynecologist. It is very important to interview parents about how the pregnancy progressed, collect information about the parents’ hereditary and acquired diseases, and analyze the child’s growth and development charts. Laboratory examination includes measuring the level of a number of hormones (LH, FSH, hCG, estradiol, TSH, T 4, etc.), insulin, glucose, etc. X-ray of the pituitary gland, bone skeleton, MRI, ultrasound, determination of karyotype significantly help in making the correct diagnosis .

How do you know if puberty has already begun in your body? When does it start and what are its symptoms? What to expect from your first period? In this article you will find out the answers to all your questions.

Signs of puberty

One of the first signs of puberty is a sudden change in height. If earlier you gained an average of 2 centimeters per year, then during puberty you can grow by 10 cm in a year! At the same time, girls grow much faster than their peers boys. This difference in height evens out at the age of 17-18 years. Just when girls end puberty.

Then the proportions of your body begin to change: the length of the limbs increases compared to the length of the body. Because of this, there is a change in body proportions, which can visually make you awkward. Don't worry, this happens to everyone.

The growth of your body triggers the appearance of one of the most unpleasant signs of puberty - acne. This happens because the skin is greatly stretched due to the enlargement of bones during growth. To avoid cracks, the body activates the sebaceous glands. As a result of their work, hair and skin become oilier. Thus, excess activity of the sebaceous glands leads to acne.

Then secondary female sexual characteristics begin to form in your body. First of all, your breasts get bigger. At the same time, hair begins to appear in the groin and armpit areas.

The amount of hair on your arms and legs will gradually begin to increase, and they will become darker.

The culmination of puberty in girls is the first menstruation. It is also called by the beautiful word menarche.

The changes in your appearance will not end there! The figure will begin to acquire rounded shapes, which are characteristic of the female body.

In addition to external changes, your body undergoes hormonal changes. The activation of the sebaceous glands begins, which, as you already know, leads to the appearance of acne.

When does puberty begin?

Puberty can begin at 7 years old, or maybe only at 13. But the usual time for it is 10 years old. This process may take 1.5–4 years. Typically, the first period occurs two to three years after a girl begins to develop breasts. You must understand that puberty for each girl is a very individual process! Some girls are almost fully formed by the age of 12 or 13, while others enter this process much later.

The sooner you start puberty, the sooner it will end. That is, if at the age of 9 you already have signs of puberty, then after a year and a half you can wait for your first menstruation, and if these signs are noted at the age of 12-13, then two to two and a half years may pass before your first menstruation.

Phases of Puberty

Puberty is divided into two phases:

Presexual phase (occurs at the age of 8-9 years and lasts about 5 years); This phase begins when secondary sexual characteristics appear, active development of the body and rapid growth occur. The presexual phase ends with the appearance of the first menstruation.

Puberty phase (starts at 13-14 and lasts until 18 years). After the first menstruation, growth slows down. This phase ends with the completion of sexual development, when your body is completely ready to conceive and bear a child.

Factors influencing the onset of puberty

Heredity: Ask your mother or other relative when she first started menstruating. Most likely, you should expect them at the same age.

Nationality: Girls of different nationalities may experience puberty at different times. This is due to genetically stored information.

Weight: If you're thin, your period may start a little later than your overweight friend. And your normal menstrual cycle may vary too.

Psycho-emotional environment: if the conditions in your family are unfavorable and you are under constant stress, there may be a failure in the nervous regulation of maturation processes and menstruation will come later.

Having chronic illnesses: If you are in poor health and have chronic illnesses, maturation may start later and take longer than others.

First menstruation

A few days before your first period, you may experience new and slightly uncomfortable sensations that are associated with premenstrual syndrome. Yes, yes, this is the same PMS. Its main symptoms are:

Increased appetite

Pain in the abdomen and lower back

Breast enlargement

Mood swings

Tearfulness

Irritability.

Apathy and weakness

As a rule, the first periods are light. In general, it could be a few spots on your underwear that you won’t immediately notice. But don't be surprised if you have a lot of discharge right away. Here you can’t guess who will be lucky. But, in any case, it is the discharge of blood that is the main sign of the first menstruation.

Learn how to use a period calendar.

On average, menstruation lasts 5 days. But a period of 3 to 8 days is absolutely normal. So if your period only lasts 3 days, that's completely normal. Moreover, you can be envied. If your period does not stop for more than 8 days, be sure to consult with gynecologist .

If you're worried that your period might start at any moment, carry a pad in your purse just in case. Even if this happens to you during class, you will be ready. And this is very calming. If your period takes you by surprise, don't be shy about asking another girl for a pad. This is absolutely normal, female solidarity.

Don't forget that puberty is a very individual process. It goes differently for everyone. So don’t worry if your girlfriends have already started their periods and you’re still waiting. For complete peace of mind, you can consult a gynecologist.

There is nothing good in situations where a child is significantly delayed in development. But premature maturation cannot be considered something natural and normal, since it can cause a considerable number of unpleasant consequences.

Let's look at this topic in more detail and find out why pathology can occur, what symptoms it is accompanied by, how it is diagnosed and whether there are effective ways to get rid of the problem. Special attention will be paid to the psychological aspect: the feelings of a child who is developing faster than his peers.

Puberty and its norms

It’s worth starting with the fact that puberty is considered to be a set of processes of physiological and hormonal changes in the body, as a result of which a person becomes ready for reproduction (reaches puberty).

In boys, this occurs between 10 and 20 years of age. Girls mature a little earlier - their puberty occurs between the ages of 8 and 17. These indicators are considered to be the norm.

But there are situations during which the child begins premature puberty. And in this case, it is worth paying attention to the problem in a timely manner and taking all necessary measures.

What is considered to be premature ripening?

Premature is the process during which a child’s maturation begins before the age of eight in girls or ten years in boys. Its main feature is the early appearance of secondary sexual characteristics, although the general symptoms include much more phenomena. We'll look at the main ones a little later.

Anomaly classification

What types of precocious puberty can be divided into? Classification may depend on many factors.

Based on the cause of its occurrence, it can be:

• true (the appearance is associated with premature activation of the hypothalamus or pituitary gland);
• false (the appearance is associated with excessive secretion of sex hormones by the ovaries or adrenal glands, as well as other factors).

In addition, there is isosexual and heterosexual precocious puberty.

The isosexual type is characterized by:

• mental retardation;
• various ;
• emotional instability;
• cerebral hypertension.

The heterosexual type of anomaly can be triggered by malfunctions of the adrenal glands.

Causes of pathology

It is worth dwelling on the question of why premature puberty begins. The causes are usually divided into two groups: central and peripheral.

The central ones include:

• previous infectious diseases associated with the brain (meningitis, encephalitis);
• radiation, trauma or tumor of the spinal cord or brain;
• abnormal production (congenital hyperplasia);
• a disease that provokes hormonal imbalances and also affects bones and skin pigmentation;
• ischemia;
• insufficient production of thyroid hormones (hypothyroidism);
• the presence of congenital brain pathology.

Peripheral causes of such a phenomenon as premature puberty in a girl or boy are associated with excessive release of testosterone and estrogen into the blood. This occurs as a result of dysfunction of the adrenal glands, ovaries or pituitary gland.

Despite the fact that there are many factors that provoke premature puberty, doctors often cannot determine the exact cause of its occurrence. The only thing that is known for sure is that the anomaly is a hormonal disorder, so you should immediately seek help from specialists.

General symptoms of the disease

The signs of prematurity and girls will vary. Common symptoms in children of either sex:

• acceleration of growth;
• headache;
• bulimia (gluttony);
• weight gain;
• changes in body odor;
• growth of pubic and axillary hair;
• fast fatiguability.

In addition, a high probability of acne in a child cannot be ruled out.

Symptoms of the disease in girls

Premature puberty in girls is accompanied by:

• establishing menstrual function.

Thus, in girls under 10 years of age, their first menstruation begins, the mammary glands enlarge, and hair appears under the arms and on the pubis. In this case, all the signs may be present at the same time, or part of them.

Symptoms of the disease in boys

Premature puberty in boys is accompanied by:

• early development of secondary sexual characteristics;
• acceleration of differentiation of skeletal bones;
• early stopping of the growth process and, as a result, the formation of short stature.

It often happens that in young men the size of the testicles and penis increases prematurely, so that already in childhood they reach an “adult” size.

Every third boy experiences premature hair growth above the lip.

What is the danger of the disease?

Precocious puberty syndrome is a dangerous phenomenon for the body that carries with it unpleasant consequences.

First of all, growth disorders can be noted. At the beginning of adolescence, children grow very quickly and become much taller than their peers. But soon this process stops and in the end they may end up lower than their peers.

For girls, the pathology is dangerous due to the occurrence of polycystic ovary syndrome and hormonal disorders in the future. This threatens irregular menstruation, increased androgen levels, the appearance of cysts and the impossibility of the unimpeded release of the egg.

Diagnosis of the disease

Which doctor should I contact if I suspect that my child may have the developmental pathology we are considering? He deals with similar issues. During diagnosis, he will study the medical history, give directions for some tests, and based on their results, he will be able to determine the presence of a problem.

A physiological examination of the child is mandatory. Its purpose is to identify signs of premature maturation: acne, enlargement of the mammary glands in girls and the penis, as well as testicles in boys, the appearance of pubic and armpit hair, rapid growth, the presence of the first menstruation, and so on.

Additionally, an X-ray examination of the patient’s wrists and palms is performed. This process will allow the doctor to determine the age of the bones and get an answer to an important question: are they developing within normal limits or at an accelerated pace?

The methods described above allow us to establish a preliminary (initial) diagnosis. Next, it is necessary to specify the disease and identify the cause of its occurrence. To do this, the child is given an injection of gonadotropin-releasing hormone and blood is taken for tests. With the peripheral type of anomaly, the levels of follicle-stimulating and luteinizing hormones will be within normal age limits. If premature puberty is of the central type, the amount of the above hormones will be increased. In this case, there is a need for another examination - an MRI of the brain. This will help identify possible anomalies. Additionally, examination of the thyroid gland is necessary to exclude possible hypothyroidism. In some situations, an ultrasound examination of the pelvic organs may also be necessary, the purpose of which is to identify tumors or ovarian cysts.

Treatment of precocious puberty

The choice of the necessary treatment method depends primarily on the cause of the disease.

If the problem was caused by the presence of a tumor, therapy is aimed at eliminating it. In this case, surgical intervention is provided that will help get rid of the “culprit” of hormonal imbalance.

In situations where the exact cause of the problem has not been identified, the child may be prescribed medication. This may be a gonadotropin-releasing hormone antagonist, such as leuprolide, which will help stop the human pituitary gonadotropin (HPG) growth axis and slow down subsequent development. The drug is injected into the body monthly, and treatment continues until the age of normal puberty is reached. At the end of the course of treatment, the child’s development continues according to established standards.

At this point, special attention should be paid to your diet. During premature puberty, children usually experience a significant increase in appetite, or, to be more precise, practically. Therefore, it is worth limiting the number of meals and avoid overeating. Otherwise, another problem will be added to the problem - obesity. In addition, you should avoid products containing testosterone and estrogen (sex hormones), since their levels in the body are already significantly increased.

Another important point that parents need to know is the existence of precocious maturation, which begins and occurs only partially. For example, a girl’s breasts may swell, and a boy’s testicles may swell, but soon this process will stop or will not be accompanied by other signs of the disease. In this case, no special measures need to be taken, because full puberty will begin on time.

Adaptation of a child to the process of premature puberty

It is worth paying special attention not only to the symptoms and methods of treating the disease, but also to the child’s feelings at the time of the onset of premature puberty. The fact is that in such a situation he understands that he is significantly different from his peers. This is primarily due to the early appearance of secondary sexual characteristics.

The current situation can cause emotional trauma, low self-esteem and even depression. Here a lot depends on the attentiveness of the parents. It is important to remember: if a child is not able to independently deal with his experiences, he needs qualified help from a specialist (psychotherapist).