ADOLESCENT GYNAECOLOGY

Normal and Abnormal Puberty in Girls

What is puberty?

Puberty is the process where children mature physically and sexually into adults with reproductive capacity.

What are the normal changes associated with puberty in girls?

Girls normally start to go through puberty anywhere from 8 to 13 years of age. This can vary depending on genetic and environmental factors. Primary developmental changes occur in the ovaries and genitals. The ovaries start producing eggs and the menstrual cycle commences. Secondary changes include breast development, pubic and axillary hair growth and accelerated increase in weight and height. The changes occur due to the secretion of hormones from the central nervous system. These changes happen gradually, in predictable stages. It takes approximately 2 years from the onset of breast development to menarche (the first menstrual period). Your doctor evaluates the timing and the sequence of events to determine if any abnormality is present.

What is abnormal puberty in girls?

When puberty occurs too early, too late or not at all, it is considered abnormal. It is also considered abnormal when the changes do not occur in the proper sequence.

What is delayed puberty in girls?

If there are no puberty-related changes by age 13, a girl should be evaluated for possible abnormalities. Delayed puberty could be due to genetic factors, chronic illness, malnutrition, excessive exercise, structural deficiencies, tumours, radiation, chemotherapy, etc. Your doctor will perform a thorough investigation to identify the cause for delay.

What are the other signs of abnormal puberty affecting girls?

When a girl experiences puberty before the age of 8 it is considered early. This could be due to early release of hormones from the brain causing the ovaries to mature. The underlying reason could be surgery, infection, hydrocephalus or a tumour, but often it is unknown. In certain conditions, excessive hormones are produced from other parts of the body such as the adrenal glands. A tumour present in the adrenal glands or ovaries could result in excessive testosterone production causing male pattern puberty changes. Other changes include early development of breasts, early growth of pubic and axillary hair and excessive body odour. Your doctor will perform a thorough evaluation to look for underlying causes. In case of early pubertal events, your doctor may wait to see if the rest of your child’s puberty progresses normally. Therapy or surgery may be recommended in certain cases.