Puberty in girls is the transitory period when girls come out of childhood and step into adolescence. For the sexual acquisitions of this period, teenage education is very important.
Although there is not a definite time span, usually girls begin puberty, earlier than boys between the ages of 9-13. Therefore, in this period of life, girls are ahead of boys by a few years and seem more mature.
The process of development and maturing in puberty occurs in a hierarchical order. In puberty, first of all breasts start to develop and this is called the “thelarche”. Then, in the genital areas, pubic hair starts to grow and it is called the “pubarch”. Last of all, menstruation (period) starts and this process is called the “menarche”.
Development of the Breasts (Thelarche)
For most of the girls, puberty begins with the development of the breasts. Development of the breasts can be detected by the formation of a small and delicate puff on one or both of the nipples. This puff will gradually grow in a few years.
In the beginning, one breast can be asymmetrical or larger than the other and this situation may last up to the point when the breasts take their final shape.
(In the below picture, stages of breast development in puberty are demonstrated.)
Forming of Pubic Hair (Pubarch)
Along with puberty, soft hair growth on the armpits and on the genital zones will be recognized (pubarch).
(In the above picture, stages of genital hair growth in puberty are schematized)
Together with hair growth on the genital areas, hair growth on the armpits and the legs will also be reckoned.
Many women get rid of these hairs with different methods (epilation). In reality, epilation has no medical reason but done only for cosmetic aims.
Rarely, in certain puberty transitions, at the ages of 8-9, before breast developments, there may be hair growth. In this case, tumors secreting male hormones from the adrenals should be considered. After examinations by the scanning methods such as ultrasound or MR, if no such case is detected, then this kind of a situation might be considered normal.
Bodily Changes In a teenage girl, in time, hips widen and the waist shrinks. The body will accumulate fat in the belly, the hips and the legs. This way, lines peculiar to the female form come about.
In this period, arms, legs and feet will grow faster compared to the other parts of the body. Until the other parts catch up with the growth of the legs and the arms, people can psychologically feel themselves shapeless and clumsy.
Skin Changes The skin, with puberty, becomes more sweaty and oily. In this period, together with the increase of the sweat glands, sweating also increases.
Again, in relation with the skin’s becoming oily, pimples (acne) will emerge on the face. These puberty pimples are called “acnes” and as they are related to the increase of hormones in the puberty period, they are considered normal.
In all teenagers, there is going to be acnes eventually. Yet, sometimes acnes can be very acute and may require treatment.
Psychological Problems In puberty many physical and hormonal changes are experienced. These changes bring together with them certain psychological problems to the teenagers.
Most frequently encountered psychological problems are: depression (inwardness) anxiety (inner worries), feeling ugly, extreme petulance and inadaptability.
Parents should take close care of their children, who are going through this natural process and support them. For psychogenic problems, sometimes professional help must be taken.
The First Period (Menarche)
The first period (menstruation), in its medical name the menarche, is accepted as the sign for the girls to pass to the reproduction age in their puberty process.
Most of the girls experience their first periods between the ages of 9 and 16.
Synonyms used for menstrual bleeding are “menstruation”, “catamenia”, “menses” and “period”. However the first menstrual bleeding, as it is told before, is called the “menarche”.
The age of the menarche depends on the genetic structure of the girl, geographic region, nourishment and social and cultural settings. For example in regions closer to the equator, where sun shine is more effective, the menarche occurs early, whereas in North European countries it happens at later ages.
Again, with girls who are nourished well and perhaps a little over weight, the menarche happens earlier.
The menarche, the start of the menses, is a very important stage in the pubertal development of the girl and follows a certain route in its development process.
In the pubertal development stages, which connote the initiation into adolescence, first of all height increase and breast developments are seen. The following stage is the growth of hair on the armpits and on the genital areas. After these the first period (menarche) is occurs. With the first period, the person is accepted as initiated into adolescence.
In girls, who have just passed on to adolescence, the first periods can be irregular. The time span between the menses can be very long or very short. The menstrual irregularities may continue up to the age of 16 due to the fact that the ovulation process is not at its full, these cases are considered normal and usually there is not a need for a treatment.
During adolescence, long and frequent menses may cause anemia in women and in this case short term medicine treatments can be applied. In irregular menses other than these, there is not a need for hormone treatments.
Early or Late Puberty Some girls may begin puberty earlier and some later than their peers in age. The ones who begin their puberty early are called “early adolescent” and the ones who begin late “late adolescent”.
Early Puberty (Precocious Puberty) If menstruation occurs earlier than age 9, it is identified as “early menarche” (early puberty). A hormonal disorder may cause the early menstruation that causes early puberty. Therefore doctor control is necessary. Even if no reason can be found causing this condition, as this condition may result in short height, it must definitely be treated, because for a teenager who starts to see her period regularly, her height growth will slow down.
Early puberty can be easily diagnosed by, determining person’s bone age, certain blood and hormone tests and stemming from person’s clinic symptoms. In cases where it is diagnosed, its treatment is a must.
Early puberty can be prevented or delayed by certain hormonal treatments. These kinds of hormonal treatments are very effective in the height growth of the person.
Otherwise, when the menses become regular, height growth would stop and people would stay short. Most of the girls, who have tall parents but themselves are short, are the ones that had begun puberty in the early ages and had lived the transitions of puberty in a fast way.
Late Puberty The case of having the first period after age 16 is identified as the “late menarche” (Late Puberty). In such cases, breast development, growth of hair and height growth functions that are known as the “secondary sex characters” are important in the girl.
Although reaching the age of 14, if the girl has not developed any secondary sex characters such as, pubic hair and breasts, there might be a growth problem with her hormone production.
If only secondary sex characters have developed, then it is okay to wait up until age 16 without intervening.
How does menstrual bleeding happen?
Menses, which is the normal menstrual bleeding, despite common thought, happens after a series of very complicated processes. Simplifying the process a good deal, let’s explain it:
In the ovaries of the girls, who are in their adolescence periods, female fertilization cells that are called “ovums” mature.
If the ovum meets with the male fertilization cell (sperm) that reaches the internal genital organs of the woman through sexual intercourse, fertilization (conjoining) occurs. Meanwhile, as preparation to the baby, in the inner surface of the uterus, a thick lining that also contains blood cells forms. The fertilized embryo settles in this “home” located in the uterus (start of pregnancy).
If the ovum does not meet with the sperm then the preparation becomes unnecessary and this tissue sheds from the vagina in the form of menstrual bleeding.
The menstruation period is characterized by this similar bleeding happening every month. The start of the menstruation in a girl is interpreted as that she is now ready to become pregnant.
The menstruation period usually lasts for 2 to 8 days and sometimes afterwards may continue for a few more days in the form of a colorless bleeding.
During a normal menstruation period, you do not have to refrain from your normal activities such as, swimming, horse riding or doing gymnastics. On the contrary, doing exercises may help to lessen the cramps and the other troubles occurring due to menstruation.
Many girls, after having their first periods, may think that the following menses will be right on time, but this is rarely the case.
For the first year (maybe for a longer time) periods do not match the calendar and sometimes there may be menses that occur between short periods of time such as 3 weeks or sometimes longer periods of time such as 6 to 8 weeks. After a while, the cycle will get into order and most of the girls will have their menstrual bleedings in every 3 to 5 weeks. Yet, it may take a few years for the periods to be fully regulated.
Even after the cycle gets into order, in conditions such as, sickness, stress, heavy exercise and malnutrition, the periods may falter. Naturally, besides all these reasons, it should be considered that a pregnancy may be causing the delay.
Normally, during menstruation, only 50 to 100 ml (average 80) blood are lost.
With some people, the menstruation bleedings may be heavier and more painful than others. In such a case, a doctor may be consulted.
During the menstruation period or before and after, the following complaints may be encountered:
► Cramps (In the waist and the groins)
► Gas accumulation in the belly
► Sensitivity and swellings in/on the breasts
► Abrupt mood swings such as, feeling bad and anxiety
If problems such as, depression, sensitivity and swellings in/on the breast, inflation in the belly, edemas, tension, petulance, eating disorders (increase or decrease in appetite, indulgence into the desserts) occur before menses and end after it finishes and cause changes in the normal life quality of the person, then this condition is called “Premenstrual syndrome” (syndrome of tension before menstruation). We advise you to consult a doctor for its treatment.
When is a gynecological examination necessary?
► If there is an abrupt change in the menstruation period without a known reason
► In periods that last for 3 to 5 days, but are quite painful and clots are seen.
► In heavy bleedings that last more than 8 or 10 days.
► Having in-between bleedings outside the normal periods
► In acute abdomen aches that last more than two days in the period after the menstruation starts
► In symptoms such as, fatigue, palpitation, paleness and dyspnea due to anemia
► Suspecting a pregnancy