Premature puberty: causes, symptoms, treatment. Transformation of a girl into a girl: sexual development of a girl - writes a gynecologist

In medical terms, precocious puberty is puberty that occurs too early in life. In most cases, this process is normal in all respects, except that it occurs at too early an age, representing a special case of normal development. In a small number of children, early development is caused by diseases such as a tumor or brain injury. Even when no disease is present, unusually early puberty may have side effects on social behavior and psychological development, may reduce growth potential, and may increase some health risks throughout life. Central precocious puberty can be treated by suppressing pituitary hormones that stimulate the production of sex hormones. The concept is used with several slightly different meanings, which usually depend on the context. In its broadest sense, often used in a simplified form as the concept of "early puberty", precocious puberty is sometimes referred to as any physical effect of sex hormones that occurs earlier than normal age, especially when it is perceived as a medical problem. More stringent definitions of “precocious puberty” may refer only to central puberty that begins earlier than a statistically established age based on population percentile (e.g., 2.5 standard deviations below population data), based on expert recommendations for ages at which the best chance of detecting an abnormality is also based on opinions regarding the age at which precocious puberty may have side effects. The general definition used in medicine refers to girls under 8 years of age and boys under 9 years of age.

Types and reasons

Pubertas praecox is a Latin term used by doctors in the 19th century. Early pubic hair, chest hair, or genital development may be caused by early maturation or other reasons.

Central

If the cause lies in the hypothalamus or pituitary gland, then this cause is perceived as central. Other names for this type are complete or precocious puberty. The causes of central precocious puberty can be:

damage to the brain's inhibitory system (due to infection, trauma, or radiation);

hypothalamic hamartoma produces pulsatile gonadotropin-releasing hormone (GnRH);

Langerhans cell histiocytosis;

Martin-Albright syndrome.

Central precocious puberty can be caused by intracranial neoplasms, infections (usually central nervous system tuberculosis, especially in developing countries), trauma, hydrocephalus, and Angelman syndrome. Precocious puberty is associated with the advancement of bone aging, which leads to early fusion of the epiphyses, which in turn leads to decreased final height and possible short stature. Precocious puberty may interfere with a child's fertility; the youngest mother is Lina, who gave birth at 5 years, 7 months and 21 days. "Central precocious puberty (CPPP) has been identified in some patients with suprasellar arachnoid cyst (SAC) and femoral head epiphysiolysis (FE), which occurs in patients with CPPP due to rapid growth and changes in increased hormone secretion". If the cause has not been identified, then the disease is considered idiopathic or constitutional.

Peripheral

Secondary sexual development caused by sex steroids from other abnormal sources is called peripheral precocious puberty or premature pseudopuberty. It usually presents as a severe form of the disease in children. Symptoms are usually complications caused by adrenal insufficiency (due to 21-hydroxylase or 17-hydroxylase deficiency, usually the former), which includes, but is not limited to, hypertension, hypotension, electrolyte abnormalities, intermediate external genitalia, and signs of virilization in women. Blood tests usually show high androgen levels with low cortisol levels. Causes may include: Endogenous sources

gonadal tumors (eg, arrhenoblastoma);

adrenal tumors;

germ cell tumors;

congenital hyperplasia of the adrenal cortex;

Martin-Albright syndrome.

Exogenous hormones

Exogenous hormones caused by external conditions;

As a treatment for another condition.

Isosexual and heterosexual

Typically, patients with precocious puberty develop phenotypically corresponding secondary features. This is called isosexual maturation. Sometimes the patient's processes may progress in the opposite direction. For example, a man may begin to develop breasts and exhibit other feminine characteristics, while a woman may experience a deepening of her voice and growth of facial hair. This is called heterosexual maturation. It is an extremely rare phenomenon in comparison with isosexual maturation, usually developing only in the case of unusual circumstances. As an example, children with a very rare genetic disorder called familial hyperestrogenism have extremely high levels of circulating estrogen, which leads to precocious puberty. Both men and women become hyperfeminized due to the syndrome, and therefore earlier maturation is classified as heterosexual in men.

Research

Many causes of precocious puberty are unclear, although it should be noted that girls whose diets are high in fat and who are not physically active or obese are more likely to experience early puberty. “Plus girls who are at least 10 kilograms of excess body weight have an 80% chance of developing breasts before age nine and menstruating before age 12 – the Western average age for menstruation is 12.7 years.” " Exposure to chemicals that mimic (known as xenoestrogens) may be a possible cause of early puberty in girls. Bisphenol A, a xenoestrogen found in hard plastics, has been shown to affect puberty. “Factors other than excess body weight, however, may be genetic and/or environmental factors; they need to be studied in order to explain the greater prevalence of precocious puberty in girls of the Black race than in Caucasian girls.” While more girls are entering puberty at an earlier age, new research shows that some boys are experiencing a later onset of puberty. “The increased prevalence of obese and overweight children in the United States may be responsible for delayed puberty in boys; this was reported by researchers from the University of Michigan Health System." High levels of beta-hCG in serum and cerebrospinal fluid were detected in a 9-year-old boy who was diagnosed with a pineal gland tumor. The tumor is called a pineal human chorionic gonadotropin-secreting tumor. Radiation therapy and chemotherapy helped reduce tumor size and normalize beta-hCG levels. In a study using neonatal melatonin in rats, results suggested that elevated melatonin levels may be responsible for some cases of precocious puberty. Familial cases of idiopathic precocious puberty (IPPS) have been identified, leading scientists to believe that there are specific genetic modulators of IPPS. Mutations in genes such as LIN28, LEP and LEPS, which encode leptin and the leptin receptor, are associated with precocious puberty. An association between LIN28 and the timing of puberty was identified through in vivo experiments, where mice overexpressing LIN28 ectopically showed a prolonged period of prepubertal growth as well as a significant delay in the onset of puberty. Mutations in the white protein fraction (KISS1) and its receptor KISS1R (also known as GPR54), involved in GnRH secretion and the onset of puberty, are also considered to cause STIs. However, there are inconsistencies in research, and some researchers have not found any connection between mutations in the LIN28, KISS1/KISSR genes and the causes of IPPS.

Clinical and social relevance

Sometimes a medical evaluation is necessary to identify children with serious disorders who are experiencing precocious puberty that is medically normal. Early onset of puberty may:

cause early maturation of bone tissue, reducing further human growth;

indicate the presence of a tumor or other serious problems;

cause increased sexual interest on the part of adults in a child, especially a woman.

Early puberty is thought to place girls at increased risk of non-pedophilic sexual abuse, as the child has already developed secondary sexual characteristics; however, this causal relationship is not convincing. Early puberty puts girls at high risk of ridicule or bullying, mental health problems, and short stature in adulthood. It is recommended to help children control their weight to delay puberty. Early puberty puts girls at increased risk of developing breast cancer. Girls who begin menstruating by the age of 8 grow breasts, pubic hair, and axillary hair; these changes usually occur at age 13 or older. Black women are especially prone to early puberty. There are debated theories regarding this trend, but the exact reasons have not been identified. Although boys face fewer problems than girls with precocious puberty, it is not always a positive thing; Early puberty in boys may be accompanied by increased aggressiveness due to a surge in hormones. Because they appear older than their peers, mature boys may face increased social pressure to conform to adult norms; society may view them as more emotionally developed, despite the fact that their cognitive and social development may lag behind their external development. Research has shown that boys who experience early puberty are more sexually active and more likely to engage in risky behavior.

Diagnostic criteria

Research has shown that breast development in girls and pubic hair growth in boys and girls begins earlier than in past generations. As a result, "precocious pubertal development" in children, particularly girls aged 9 and 10, is no longer considered abnormal, although this fact can be frustrating for parents and can also be harmful to children as they mature physically without maturing. at the same time mentally. At the moment, the age that can accurately separate normal and abnormal sexual development in children has not been established, but the following indicators can help minimize the risk of missing a medical problem:

Breast development in boys before pubic hair or testicular enlargement appears;

Growth of pubic hair or enlargement of the genitals (gonadarche) in boys under 9.5 years of age;

Pubic hair growth (pubarche) before age 8 or breast development (thelarche) in girls before age 7;

Menstruation (menarche) in girls under 10 years of age.

Treatment

One possible treatment option is the use of anastrozole. Histrelin acetate (supprelin LA), triptorelin or leuprolide, and GnRH agonists may also be used. Short-term use of GnRH agonists stimulates the pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH). However, when used regularly, GnRH agonists may cause decreased FSH and LH release. Long-term use is associated with an increased risk of osteoporosis. After stopping the use of GnRH agonists, pubertal changes resume within 3-12 months.

:Tags

List of used literature:

David Gardner, Dolores Shoback. Basic And Clinical Endocrinology. McGraw-Hill Medical; 2011. 9th Edition. Pg. 550

Dickerman, R. D.; Stevens, Q. E.; Steide, J. A.; Schneider, S. J. (2004). "Precocious puberty associated with a pineal cyst: is it disinhibition of the hypothalamic-pituitary axis?". Neuro endocrinology letters 25(3):173–175. PMID 15349080. edit

Kumar, Manoj; Mukhopadhyay, Satinath; Dutta, Deep (2015-01-15). "Challenges and controversies in diagnosis and management of gonadotropin dependent precocious puberty: An Indian perspective." Indian Journal of Endocrinology and Metabolism 19(2):228–235. doi:10.4103/2230-8210.149316. Retrieved January 16, 2015.

Why are many of your daughter’s age already interested in the opposite sex, wear “adult” underwear, are concerned about their appearance, but your girl still plays with dolls? The reason lies in the puberty of girls, the timing of which is purely individual.

Irritability, touchiness, frequent mood swings, isolation are temporary difficulties that every teenage girl has to go through. Some parents believe that girls' puberty and adolescence occur simultaneously, around the age of 11-13 years. In fact, a girl begins to turn into a girl starting from the age of 8-9. By the age of 17, a girl’s puberty stage is usually completed.

Puberty of girls. How does this manifest itself?

“You have a girl,” the midwife delivering the baby said joyfully. It is thanks to the primary sexual characteristics - external as well as internal genital organs - that the gender of the child can be determined. Subsequently, the manifestation of secondary sexual characteristics, which directly depend on the predominance of certain hormones, indicates the onset of puberty in the girl.

Puberty in girls: rapid growth.

A sure sign of the initial stage of puberty in a girl is rapid growth. To the surprise of parents, a daughter can gain up to 10 cm in height in a year, surpassing her peers, whose sexual development begins several years later.

Due to the rapid and disproportionate growth of bones and lagging muscles in development, the girl’s figure has angular outlines, her arms and legs appear thin and long, and her face appears elongated. Nerve endings and blood vessels lag behind the growth of bones, as a result of which the teenage girl is clumsy like a “bull in a china shop.”

In addition to intensive skeletal growth, puberty in girls is characterized by increased activity of the sebaceous glands. In this situation, the sebaceous glands perform a protective function, preventing damage, stretching and drying out of the skin. Since the sebaceous glands are “involved” in work throughout the body, the hair on the head and facial skin become oilier, causing the girl a lot of inconvenience. In the absence of proper skin care, acne appears - a faithful companion of teenagers.

IMPORTANT! External changes that occur during a girl’s sexual development can cause shyness, mistrust, and complexes. During this period, it is important to explain to a teenage girl the significance of her transformation. Ignoring the fact that your daughter is growing up is stupid, especially when she needs parental support.

Puberty of girls: enlargement of the mammary glands.

At puberty in a girl, the beginning of the development of the mammary glands, or “thelarche” in other words, occurs in parallel with the acceleration of growth. Breast enlargement in a young girl begins with the areola and nipple area, after which the entire gland begins to develop. Breast growth continues until the age of 16. The final size of the breast is determined only after breastfeeding ends.

The presence of several dark hairs on a girl’s chest is considered normal. The presence of a large amount of hair on the mammary glands is a sign of hormonal disorders and requires contacting a gynecologist-endocrinologist.

IMPORTANT! The color of the peripapillary area (halos) and nipple varies from light pink to rich brown, and depends solely on the level of pigment - melanin. The color of the nipple does not in any way affect the sensitivity or function of the mammary gland.

Puberty of girls: pubarche.

At the age of 10-11 years, the first coarse hairs appear in the pubic area. In girls, hair in this area grows in the shape of an inverted triangle, without creeping onto the inner surface of the thigh. With an excess of male sex hormones, hair grows not only on the pubis, but also on the hips and lower abdomen, which is the reason for consultation with a gynecologist-endocrinologist. Pubic hair growth during puberty in girls is called pubarche.

Puberty of girls: first menstruation (menarche).

An integral part of a girl's puberty is the first menstruation, which occurs on average at the age of 11-15 years. For Eastern and African peoples, menarche at the age of 10-12 years is also considered the norm. Within a year after the first menstruation, the ovulatory cycle is restored, becoming regular.

Important conditions for the onset of the first menstruation are normal body weight (at least 50 kg), as well as a sufficient mass of adipose tissue (35% or more), which is a depot of estrogens - female sex hormones.

IMPORTANT! The appearance of the first menstruation before the age of 11 indicates a girl’s premature sexual development. Late first menstruation (after 16 years) is a sign of delayed sexual development.

Rounded hips, enlarged mammary glands, pubic hair, fat deposits in the abdomen, waist and buttocks, the onset of the first menstruation - all this indicates the beginning of the female body’s preparation for bearing a fetus. Do not forget that the first menstruation is not an indicator of puberty, but only indicates the possibility of pregnancy.

The influence of obesity on the sexual development of adolescent girls.

Puberty in girls has its own characteristics, in particular those related to fat metabolism in the body. Puberty in girls is characterized by a slowdown in the growth of muscle tissue and the deposition of muscle tissue in these areas as compensation. For example, if the abdominal muscles of girls are as developed as those of boys, bearing a child will become impossible, since the tension of the abdominal muscles will prevent the growth of the uterus.

Puberty in girls is often accompanied by an increase in appetite, which leads to weight gain. A sedentary lifestyle, the predominance of carbohydrate foods in the diet, and overeating can lead to the development of nutritional obesity, which, in turn, disrupts hormonal levels.

According to research conducted by experts from the United States, obesity is one of the main causes of premature puberty in girls. Obesity promotes the production of female reproductive organs, which accelerate the process of puberty in girls. With regard to the problem of excess weight among boys, the situation is exactly the opposite. Obesity slows down the sexual and physical development of boys, disrupting the production of androgens - male sex hormones.

Towards the end of the girl's puberty, puberty begins, which is characterized by sexual activity due to increased sexual desire. Dramatic changes in a girl’s body should prompt her parents to hold an appropriate conversation about the beginning of sexual activity. By imposing a ban on the topic of intimate relationships, you can achieve only one thing - mistrust on the part of a teenage girl. It’s better to talk to your daughter about an exciting topic, warning her about the possible adverse consequences of early sexual relations. Sooner or later, what parents are so afraid of will happen, and it is better if the young girl is armed with the necessary knowledge about protection from unwanted pregnancy and sexually transmitted diseases.

The process of puberty is influenced by many factors. Early and increased hair growth in girls is not the norm and indicates serious disorders of the endocrine system.

What hormone affects hair growth?

During development in adolescents, the appearance of secondary sexual characteristics is observed: pubic hair growth in girls, development of hair in the armpits, development of mammary glands, and the presence of menstruation. In boys, pubic hair growth, prominence of the thyroid cartilage and changes in voice timbre. Hair growth in the armpits of boys is also noticeable.

The sex hormone testosterone stimulates hair growth. The formation of hair growth in boys is controlled by androgens produced in the testicles. Hair growth in girls is controlled by androgens produced by the adrenal glands and ovaries.

In girls, the role of androgens is not so great. The influence of androgens on a girl’s body manifests itself in pathological conditions - with excessive production of androgens. Increased levels of hormones cause excess hair growth. Low levels of the hormone lead to a prolongation of puberty and, accordingly, delayed hair growth in adolescents.

Hair growth in girls

In girls, hair growth is formed according to the female type: moderate hair growth in the armpit area, and on the pubis - in the form of a triangle. The hair on the limbs is inconspicuous and not coarse.

Pubic hair growth in girls is completed by the age of 16, going through several stages. Hair color and curl depend on genetic characteristics. At the age of 13, armpit hair appears.

Rice. Hair growth in girls (photos of types of pubic hair growth in girls)

Early hair growth in girls

In girls, puberty is considered premature before the age of 8 years. A cause for concern is swelling of the mammary gland and pigmentation of the nipple. The girl should be under the supervision of an endocrinologist, since this may be followed by an increase in the level of sex hormones and early hair growth in girls.

Precocious sexual development is associated with activation of the hypothalamus or pituitary gland. This leads to increased secretion of gonadotropins, which stimulate ovarian activity. Such conditions often develop with diseases and tumors of the central nervous system.

With tumors of the adrenal glands, early hair growth is also observed in girls. These are quite serious symptoms, which, among other things, can be considered a sign of polycystic ovary syndrome.

Increased hair growth in girls

Disorders of the endocrine system (hyperandrogenism) cause increased hair growth in girls in the pubic area and axilla, so you need to consult an endocrinologist to identify the causes of this condition. Increased hair growth in girls is associated with Cushing's syndrome and polycystic ovary syndrome, adrenal hyperplasia or tumor.

Rice. Hair growth in girls (photo of increased hair growth due to adrenal hyperplasia)

Increased hair growth is often accompanied by increased oily skin and the appearance of acne. Only a specialist after an examination can recommend androgen antagonist drugs that will reduce hair growth in girls.

Hyperandrogenism not only causes increased hair growth in girls, but is also accompanied by a number of complications in the woman in the future: menstrual irregularities, miscarriage, infertility, breast cancer.

Hair growth in boys

An important sign of puberty is pubic hair growth. Pubic hair first grows according to the female pattern, and hair growth begins at 12-13 years of age. Adolescent hair growth in boys aged 13-14 years is also characterized by the appearance of a delicate fluff above the upper lip. At the age of 14, hair in the armpits becomes noticeable. Complete hair growth in the cavities occurs by the age of 17. At the same time, facial hair appears: the fluff above the lip turns into a mustache, then a beard begins to grow. By the age of 16-17, male-type pubic hair growth ends and hair growth is noted throughout the body. Hair growth in boys has a direct connection with testosterone production.

Obstetrician-gynecologist

The sexual development of girls is a very difficult and delicate issue, which should be discussed with the child with extreme caution. Today we will talk about how to do this correctly, without abstruse phrases and unwanted silences.

The time has finally come when you are faced with a wonderful, albeit difficult age.

If you are a mother, then it is difficult for you to realize that your baby is getting older and now the thoughts in her head can suddenly become multi-colored butterflies or glossy black. At this age, my mother’s girl tries to defend her character, thinking that she can handle everything herself.

Meanwhile, she does not have time to keep track of the changes in her body, which undoubtedly worry her. And you, as the closest person, have been entrusted with the responsibility to tell, help, and direct in the right direction all the energy that is overwhelming your child.

If you are a young girl, you have already had many questions regarding everything related to the adult life of a woman. But these questions could have been put off earlier, since it was far away, maybe not very interesting, in no way connected with that life when you were a carefree girl.

Sex education for girls is a complex and time-consuming process that must be approached with caution. Not only mom, but also dad should take part in the process.

Let's start with the changes in the girl. Precisely in a girl, because perestroika does not begin when secondary sexual characteristics appear, but much earlier. On average, puberty lasts 10-12 years. During this time, the girl changes noticeably before the eyes of others.

Prepuberty is a period that begins at 7-8 years of age and ends with the arrival of the first menstruation. Usually this (menstruation) happens 1-3 years after the appearance of secondary sexual characteristics. Already from such an early age, you can notice changes in the child’s body. Hormones begin their activity, although not cyclically. But hormone releases occur constantly. In this connection, the transformation of a girl into a girl occurs.

Signs of puberty in girls

The first changes take place in the girl’s body - the hips are rounded, the growth of the pelvic bones begins. Mammary glands appear. You can already notice areas of hair growth on the pubis and armpits.

As a rule, a girl begins to grow sharply before the onset of menstruation.

All these signs may develop inconsistently. Now let’s look at each sign and the pathologies associated with it. There are several stages in the development of secondary sexual characteristics.

A few years before the onset of the first menstruation, a girl’s growth begins to grow sharply. Presumably, this happens 2-3 years before the onset of menstruation.

At this time, growth spurts can reach up to 10 centimeters per year.

Often during this period the child is awkward, since the bones do not grow evenly; first the hands and feet become larger, then the tubular bones and only then the torso.

Clumsiness in movements may also be observed, this is due to the fact that nerve fibers and muscles do not always keep pace with the growth of skeletal bones.

Skin

The skin develops according to the skeleton and muscles, for this purpose the secretion of the glands is increased in order to have good stretching, as a result of which the teenager suffers from rashes, which in science are called “acne”, “acne” or pimples. Hair also becomes oilier at the roots, so now you need to wash your hair more often.

Subcutaneous fatty tissue also develops. There is increased deposition of fat in the hips and abdomen. The shoulders are also rounded and the waist appears.

Telarche - development of the mammary gland. Typically, breast growth begins in girls at 10-11 years old, 1.5-2 years before the onset of menstruation. According to WHO, the appearance of signs of breast growth after 8 years is considered normal. The nipples become sensitive and can change color, depending on the amount of pigment in the body.

There is also an increase in the size of the nipple itself. Hair growth is possible around the areola of the nipple - this happens in women of Eastern and Caucasian origin and is not a pathology. The color, shape, and size of the breast depend on genetic factors and the amount of subcutaneous adipose tissue.

There are several degrees of breast development.

• Ma0- the gland is not developed, the nipple is not pigmented.
• Ma1- gland tissue is palpated in the area of ​​the areola and is painful.
• Ma2- the mammary gland is enlarged, the nipple and areola are raised.
• Ma3- the mammary gland takes the shape of a cone whose base is located between the III and VI ribs. The nipple does not stand out separately from the areola.
• Ma4- the gland has a hemispherical shape, the nipple is separated from the areola and is pigmented.

The mammary gland completes its development and grows to its maximum only after childbirth and feeding. And the final stage of mammary gland development is observed at about 15 years. The mammary gland itself may be painful during the growth period and before menstruation.

Hair growth

Pubarche - hair growth of the pubic area - begins at 10-12 years of age. Growing pubic hair forms a triangle, the base of which is located on the lower line of the abdomen. There may be isolated hairs rising towards the navel. But if the hair densely covers the entire area, forming a diamond, you should contact a gynecologist-endocrinologist.

By the age of 13-15, hair appears in the armpits and on the legs. The hardness, color and shape of hair is individual and depends on genetic predisposition.

Armpit hair:

• Ah0- no hair growth.
• Ah1- hair growth with single straight hairs.
• Ah2- the appearance of hair in the middle of the armpit.
• Ah3- hair growth throughout the axillary area.

Pubic hair growth:

• Pb0- no hair growth.
• Pb1- hair growth with single straight hairs.
• Pb2- the appearance of hair in the center.
• Pb3- hair growth of the entire pubic area along a horizontal line.

You need to learn how to properly maintain the smoothness of your legs, bikini area and armpits. Each girl chooses an individual method for achieving her goal. But do not rush into removal, because the first hair is softer, thinner and less noticeable. Over time or under the influence of external factors, they become tough.

Menarche - the beginning of menstrual flow, the first menstruation. This happens to everyone at different ages, and menarche also depends on genetics. As a rule, the first bleeding occurs from 12 to 14 years. After the start of the first menstruation, the girl's growth slows down, but other signs of puberty continue to develop.

Many girls' periods are not cyclical at the very beginning. For some, it takes some time - from six months to two years. In case of non-cyclical discharge, you should consult a doctor in the future.

During menstruation, the mammary glands may be tense and somewhat painful. Also, many girls and women experience aching pain in the lower abdomen before and during bleeding, and some experience discomfort in the stomach or intestines. All this can accompany mensis (menstruation) normally.

Before the critical days, the mood may change; more often the girl feels irritated, overwhelmed, and tearful. But all this passes during the first days of menstruation. Despite the irregularity of the cycle, a girl can become pregnant, and it is important to convey this to an immature person.

Deviations from the norm

As everyone knows, where there is a norm, there is also a pathology. Today, cases such as premature puberty in girls (PPD) are increasingly observed. And here it is important that the mother carefully approaches changes in the child’s body.

They speak of PPD if the girl herself is under 8 years of age at the appearance of her first sexual signs. At this age, a child cannot always adequately approach the innovations of his body.

Types of PPR

Precocious puberty in girls is divided into into several types.

1. True type. It occurs when the functioning of the endocrine glands - the hypothalamus and pituitary gland - is disrupted, which, in turn, stimulate the functioning of the ovaries.

• Full form. When all secondary signs begin to develop before the age of 7-8 years, growth slows down due to the closure of growth zones in the bones, and menstrual flow appears.
• Incomplete form. Here secondary signs appear, but the periods themselves come much later - at 10-11 years.

2. False type. It is characterized by a disorder in the ovary itself - the random production of sex hormones occurs, and therefore the order of appearance of secondary sexual characteristics in the child is disrupted. And there is irregular spotting, which can begin without the full development and formation of the mammary gland or hair growth.

3. Hereditary type. As a rule, if a girl has women in her pedigree (especially if it is her mother) whose maturation began earlier than the designated dates, then the child himself will turn into a girl earlier than his peers. In this case, the order of appearance of sexual characteristics will not be disrupted.

Causes of PPR

Causes of early puberty in girls can be:

• brain cysts;
• previous bacterial or viral infection;
• cerebral circulatory disorders;
• congenital anomalies (hydroencephaly);
• exposure (high exposure to radiation);
• poisoning by poisons (lead);
• consequences of brain injuries.

If you notice any changes in your princess that can be attributed to PPR, or there is a growth spurt before the age of 7, it is better to contact a gynecologist, endocrinologist and undergo an examination. Early sexual development is a process that requires mandatory supervision by a specialist.

Delayed puberty

Another problem for mothers and their girls is delayed pubertal development in girls (DSD).

Signs of delay:

• absence of onset of menstruation before age 16;
• lack of sufficient growth of the mammary glands before the age of 13;
• scanty hair growth by the age of 14;
• insufficient growth or abnormal development of the genital organs;
• lack of correspondence of height and weight to age.

Also, delayed development of maturity is a condition when a girl’s sexual development is only half complete. That is, the mammary glands have developed, there is partial hair growth, and then everything slowed down for more than a year and a half.

Causes of mental retardation

1. Congenital disorders of the brain.
2. Brain cysts and tumors.
3. Poisoning by poisons.
4. Heredity.
5. Exposure of the body to radiation or radiation therapy.
6. Removal of ovaries.
7. Strong physical activity.
8. Severe stress or malnutrition (exhaustion).
9. Complications after bacterial or viral infections, etc.

If you are concerned about your girl’s health, consult a doctor, he will conduct an examination and be able to make the correct diagnosis. It is easier and more effective to treat any condition of the body at the very beginning, when the pathology has not caused irreversible consequences. Everything needs to be done on time!

Another important moment in a girl’s development is growing up and becoming a girl, a woman from the inside.

Sexual development of girls should be given special attention from birth. Even from the cradle, a girl should feel like an important link in creating family comfort, since the atmosphere in the family mainly depends on her. In addition, the girl will face pregnancy, childbirth, and caring for a newborn in the future.

The child must prepare for the upcoming difficulties, and this is not bad when little girls push their dolls in strollers and already begin to experience maternal feelings and a sense of responsibility. When a girl tries to be like her mother and knows what awaits her, she enjoys all the changes and is not afraid to move forward.

If a girl is not talked to about the topic of transforming a girl into a girl, and then into a woman, all changes in her body are unpleasant for her, and the onset of menstruation generally frightens her. You need to explain everything to your princess as she grows into adulthood, step by step. It is important that next to the girl there is an older comrade in the person of a mother, friend, aunt, etc.

During adolescence, it is sometimes very difficult for teenagers to understand themselves, their mood can change dramatically, and the feeling of irritability and tearfulness does not allow them to calmly perceive changes. You should never ridicule or reproach a child during this period.

With the onset of adolescence, or rather, with its end, it is time to discuss the sexual side of her life with the girl. The girl’s behavior changes - she often looks at the opposite sex, experiences attractions, and is overcome by erotic fantasies. A teenager must understand everything and learn not to be ashamed of it. Sex education for girls is an important task that falls on parents.

In addition to the perception itself, it is necessary to convey to your child information about the possibility of becoming pregnant and contracting infections through sexual contact. You should also tell her about the negative effects of early sexual debut. Teenagers at this age often experiment, including in this area, and violent actions are possible.

Teach your child the rules of personal hygiene, purity of sexual relations and their protection, tell them about the frequency of showering during menstruation - all this is the task of a good parent. Having matured, the child encounters new conditions of his body. For example, thrush occurs - a fairly common disease that needs to be cured in time.

Often a teenager, feeling his imperfection, withdraws into himself and suffers for a long time from symptoms that can bring severe discomfort. It is worth paying attention to the appearance of acne, it is important to tell your child how to deal with them correctly, because we all know the tendency of children to squeeze everything out. This can lead to unpleasant consequences: scarring of the skin, blood poisoning.

Sex education is often the subject of much debate. But there are certain rules that are best adhered to - they will allow you to transition into puberty as smoothly as possible and preserve the girl’s health.

It is worth paying attention to the nutrition of a teenager; girls themselves often skip meals on purpose in order, as they think, to be more beautiful. A girl should eat well to avoid delays in the development of sexual characteristics and the onset of menstruation.

Under no circumstances should you treat a teenager like an adult. A person in adolescence already knows a lot, has his own point of view, but he is just starting on the path of growing up; your advice is important to him, although sometimes he does not show it. Control is never superfluous.

Masturbation is very important in the development of sexuality. There is nothing unhealthy or shameful about this behavior. This is how the child learns to relieve stress by fantasizing, imagining imaginary actions. Contrary to the thoughts imposed by the Bible and Soviet education about masturbation as something dirty and unacceptable for a self-respecting woman, today its benefits have been proven, of course, if you don’t “go too far.”

As a conclusion

The main goals of parents, especially mothers, during puberty, are:

• teach the girl to accept herself as she is;
• convey all knowledge regarding the technique of sexual relations, contraception and methods of protection against sexually transmitted infections;
• show all the beauty of a woman, mother, wife;
• determine the boundaries of decent behavior with the opposite sex;
• teach how to cope with some ailments associated with premenstrual syndrome, thrush, etc.;
• surround your child with love and care, especially when he needs it.

Of course, just like a child, you also grow up. Do not forget that the child has never been an adult, and you, adults, have already experienced all the hardships of this difficult period. How your child perceives everything depends largely on you.

We know a lot about babies, we argue about diapers, swaddling and vaccinations, but our daughters are growing up, the period of puberty begins, when a young maiden blossoms from an angular girl in one year. What kind of puberty is this, what is its peculiarity in girls and what do mothers need to remember and know about?

Puberty is a complex of physical changes in a girl’s body combined with psychological changes; they occur gradually and are manifested by the beginning of menstruation. Typically, this event occurs between the ages of 12 and 14 years, but can occur somewhat earlier or later, with an average range of 10 to 15 years. Each girl has her own menstrual cycle, the duration of menstruation will be from 3-4 to 7 days, in the first year menstruation will be irregular and there is no need to be afraid of this.

What will menstruation depend on?
The reproductive function of a girl will depend on the girl’s health and her compliance with personal hygiene rules. In healthy and seasoned girls who play sports, periods usually pass easily. But weakened, overtired or frequently ill girls may experience malaise, pain in the lower abdomen, headaches and aching in the lower back during menstruation. A healthy girl may also have slight weakness, but this usually does not interfere with her normal lifestyle, she just needs to slow down the pace of training and activities.

Girls can lead a normal life during their periods; they are not contraindicated from going to school or doing physical education; they only need to stop jumping, carrying heavy objects, or cycling. During menstruation, you should eat less salt and hot spices; they can increase the flow of blood during menstruation. Teach your daughter to keep a menstruation calendar, it will be calmer for both you and her - remember, sexual activity begins in teenagers without asking our permission, and if you have periods, pregnancy is always possible. While, unfortunately, her mother will have to think for the girl, the girls have wind in their heads. In a calendar, let him mark the start and end date of menstruation, its duration and abundance, this will also help to note health problems if they arise. Regular menstruation indicates puberty - that is, the ability to conceive a child, but this is far from the maturation of a girl as a person.

About the menstrual cycle.
Tell the girl about the menstrual cycle - this knowledge will help her be more careful in matters of her health and possible children. Menstruation is the beginning of the menstrual cycle, and not its end, as many people think. The cycle is calculated from the beginning of one menstruation to the beginning of the next. They follow each other continuously due to the cyclical nature of hormonal processes in the body, regulated by the girl’s maturing brain. On average, the cycle can be from 22 to 24 days, less often longer. Menstruation itself lasts 3-7 days. The entire cycle can be divided into several phases during which special changes in the body occur.

First period or menstrual bleeding– this is the first day of the cycle, during which the endometrium and its vessels are rejected, coming out with bloody discharge. This is a mixture of blood, mucus and mucous membrane cells; in one cycle, up to 30-100 ml of blood is lost, but if it is much more, immediately go with your daughter to the doctor. The first days of menstruation are more abundant, in the subsequent days they are scanty.

Second phase– this is follicular; during this period, under the influence of hormones, one follicle begins to mature in each cycle in one of the ovaries. Under the influence of estrogen, the inner layer of the uterus begins to grow, the follicle reaches 20-25 mm. Follicles are taken from ready-made buds; by the time a girl is born, there are about 400 thousand of them in the ovaries; about 500 will mature during her life.

Third phase- this is ovulation, it is at this time that the egg is released and it is during this time that women become pregnant. It is important to know this so that the girl understands the essence of protection against premature pregnancy. During ovulation, the follicle bursts and the egg enters the fallopian tube and moves along it. In the fourth stage, the egg moves through the tube, and if there is no pregnancy, the endometrium thickens and loosens, and the egg dies. A decrease in hormone levels and again a transition to the first stage of the cycle - endometrial rejection. If a girl becomes pregnant, her menstruation will stop - the absence of menstruation is the first sign of pregnancy, although they may be absent for other reasons.

What does menstruation depend on?
The correctness and regularity of a girl’s cycle depends on her sexual and hormonal health. The main gland in menstruation is the hypothalamus; after an equal amount of time it will send a command to the pituitary gland to release hormones that affect the ovaries and the entire reproductive system of the girl. The ovary, in response to these signals, produces estrogens and progesterone, which will allow the follicle to mature and prepare for a purely theoretical conception. If a malfunction occurs at any of the links in this chain, this leads to disruption in the development of menstrual function and requires the participation of a doctor. For the first two years, irregular menstruation is allowed, but by the age of 16-18, all menstrual functions should be clearly established, the cycle should become regular and not cause much discomfort. If this does not happen, this is a reason to contact a teenage gynecologist.

Teenage girls today have poor nutrition, often girls 15-18 years old are either obese or excessively thin, many live in constant stress from exams, unrequited love or family problems, all this unbalances hormones and the nervous system. These factors are inextricably linked with sexual function and its formation.

Normal ovarian function is possible at a certain weight - this is usually when a girl reaches a weight of 43-47 kg; in girls who are on a diet or exhausted, menstruation often disappears or occurs much later. Very low weight women are infertile due to their weight alone. Even if a girl had a normal weight and she loses more than 10-15%, this can lead to amenorrhea. This happens due to disturbances in the functioning of the pituitary gland, and then it is difficult to recover - so, if you want to become grandmothers, watch your daughter’s diet! But without diligence, the opposite state is no less dangerous. Fat chicks begin to menstruate earlier than usual, forming puberty earlier. This is due to an increase in estrogen due to the deposition of excess fat, which leads to earlier maturity.

Not only the quantity, but also the quality of food is important - alcohol, fatty, salty and spicy foods with excess meat lead to earlier ripening. If a girl, in pursuit of fashion, limits herself to some elements of nutrition or goes on a diet, this will affect her sexual functions, and sometimes this can be irreversible. Deficiency of vitamin A, zinc and iodine is especially dangerous; this is the exclusion of meat, fish and eggs from the diet.

Other factors.
There are also external factors that influence the onset of puberty - climate and geography of residence. Girls from mountainous latitudes and southerners menstruate earlier, but girls from lowland latitudes and northern regions menstruate later. On average, the timing of the arrival of menstruation varies by no more than 6-12 months. The timing of the onset of menstruation also depends on the social wealth in the family and the quality of life; in stable times and good families, puberty in girls occurs a little earlier.

Physical activity will also influence the onset of menstruation; girls in adolescence do not have very pronounced physical strength and endurance. Professional sport is a difficult test for them - it greatly affects the health of the sexual sphere and general health. Stress in sports or ballet inhibits the development of the sexual sphere and is combined with delays in growth and development in general. Look at the gymnasts and acrobats - they are all small and childish at 16-17 years old. In addition, female athletes during puberty may show signs of androgenization - the voice becomes rougher, the secretion of sebum increases, and menstruation is disrupted. This depends on strength training and muscle development - this happens among swimmers and rowers; half of the female athletes with medals have very serious problems as women. Therefore, think about what is more important to you: your daughter’s sporting achievements and medals, or the presence of grandchildren in the family.

Another significant problem is bad habits among girls. Our subculture and teenage parties instill in them the wrong styles of behavior - they try smoking as early as 12-14 years old, try alcohol secretly from their mothers, and even begin sexual activity long before adulthood. This leads to negative consequences - not only does health suffer in general, but the formation of menstrual function is also disrupted. Such girls with bad habits are more likely to develop acne and a pale complexion, and their voice becomes rougher - this is due to androgen hormones. They also affect the menstrual cycle - it becomes irregular and painful.

And bad habits also damage eggs so much that many years later, when a girl, having played enough, stops drinking and smoking, she will have a high probability of giving birth to a sick baby from an egg damaged by nicotine and alcohol.

Naturally, adolescence is a difficult test for a girl, but she has a main assistant - her mother. Dear mothers, help your daughter succeed as a woman, and in a few years she will help you succeed as a grandmother!

It seems like just yesterday your baby was trying to hold her head up, smile, crawl, talk, walk…. And today you notice strange changes in her. What's happening to her? Don't be alarmed by the changes taking place - your baby has most likely smoothly entered puberty in girls. And it doesn’t matter that she may be only 8 years old and still just a child. Already now she is actively preparing to become a woman, a mother. And right now you, parents, must help your daughter get through a difficult period in her life. And for this, you need to have an idea of ​​what puberty in a girl means and how it occurs normally.

• How does puberty differ between girls and boys?

Puberty of girls and boys is completely different; they are completely different processes. Puberty begins at different times, is perceived by children in completely different ways, and proceeds differently. For example, earlier puberty in girls is a fairly common occurrence, while in boys it is rather an exception to the rule. However, the premature puberty of girls should not be a cause for concern for parents at all - this is normal.

Puberty in girls and boys generally takes about five years. The timing of the onset of puberty, as already mentioned, is very individual and may well fluctuate greatly, both in one direction and the other. In cases where parents notice significant fluctuations - puberty in girls or boys is too early, or, conversely, too much delay - it makes sense to consult a pediatrician. The doctor is able to assess the most adequate state of the physical development of your son or daughter, and refer you for additional examinations, if necessary, in order to reliably determine the reasons for the deviation of the child’s sexual development from the norm.

However, serious hormonal problems are very rare. Almost always, the cause of such temporary deviations is a hereditary trait. The fact is that if at one time at least one parent also had some deviations in either direction, this increases by 50% the possibility of the same deviations in the child. This is especially evident in relation to the growth of children - if both parents are short, one should not expect the teenager to experience an intense growth spurt.

Modern medicine has established some frameworks within which the start of puberty should fit, both girls and boys. Puberty begins earlier for girls at the age of 8, and only at the age of 10 for boys; the deadline for puberty to begin for a girl is 12 years old, for a boy - 14 years old. If parents have any doubts about the sexual development of the child, they should seek advice from a pediatrician or endocrinologist. And remember: under no circumstances should you express your doubts or fears in the presence of your son or daughter - you risk causing the child quite serious psychological trauma, which you will have to struggle with for a long time in the future. Do not forget that the adolescent psyche is a delicate “instrument”, very, very vulnerable.

Actually, this is all that puberty has in common between girls and boys. Everything else is a complete difference that parents should be aware of.

• Sex education for girls

The first thing I would like to say is that sex education for girls should begin at a very young age, literally from birth. After all, instilling hygiene in a child is also sex education for girls. Each parent probably wants their daughter to grow up to be a soft, sensitive, caring woman who loves her children. This is what sex education for girls is all about at an early age.

You shouldn’t be a prude with your child, tell “fairy tales” about gender differences in childhood, and talk nonsense about storks and cabbages when answering the question “Where do children come from?” The main thing that is required from parents in the event of “uncomfortable” questions or situations is natural behavior, a willingness to answer everything comprehensively, and the ability to explain everything without fear or shame. Regardless of the child’s age, whether he is four, seven or fifteen years old, your answers must be truthful in content, objective and scientific. Be truthful with your child, but age appropriate, and answer clearly, concisely and to the point.

A child’s assimilation of his own gender role, his character, and the development of his sexuality largely depend on the family, which is able to harmoniously combine the social and biological principles of the future woman’s personality.

If you took the issues of sex education responsibly from the very beginning, then during puberty in girls you will not have any special problems; this difficult time will pass for your child and for you without any psychological trauma or misunderstandings in relationships. You can read more about what sex education for girls is in the article: “Sex education for children. Principles of sex education for boys and girls.”

• Puberty in girls

Puberty of a girl is a very intensive growth of the child, which lasts about two years, and precedes the onset of puberty of the girl. A girl's puberty begins with her first menstruation.

As already mentioned, it is impossible to name the exact age when puberty begins in girls. The average age at which girls begin sex education is approximately 11 years old, therefore, the first menstrual cycle should occur around 13 years old, that is, puberty will occur in two years. However, in recent decades there has been a trend towards “rejuvenation” of puberty - earlier puberty in girls increasingly begins at the age of 8-9 years. It happens, especially if the mother’s puberty was late, the girl’s puberty can begin at the age of 13, and the first menstruation, accordingly, at the age of 15.

There are cases, occasionally, but still, that a girl’s puberty starts at the age of 7 or 15. In this case, parents have cause for concern; such deviations are pathological in nature and require special medical correction. If this occurs, premature or excessively early puberty in girls, it is necessary to consult a doctor.

When the deviations are not so drastic, they should not frighten parents. Minor deviations do not signal any hormonal disruptions in the child’s body or malfunctions of the hormonal glands. Most likely, this is just a hereditary predisposition. If you yourself don’t remember when your puberty began and how it went, ask your parents - they will probably be able to dispel your doubts. And, of course, under no circumstances should you give your child any hormonal medications - this can simply cause irreparable harm to the girl’s health and even lead to infertility in the future. Such drugs should be prescribed exclusively by the attending physician.

• Signs of puberty in girls

Height. Puberty in girls is accompanied by the following characteristic signs, each of which manifests itself in its own life period and begins with growth:

• At 7-8 years of age, the baby grew approximately 7 centimeters over the course of a year.
• By the age of 9, nature begins to sharply slow down the growth process, and it is only about two centimeters. This will continue throughout the tenth year of life - not exceeding 1 - 3 centimeters of increase in height per year.
• During the 11th year, a powerful growth spurt usually occurs - over the next couple of years, the average increase in height per year will be about 10 centimeters. In addition, her weight will begin to grow rapidly - the usual 2 kilograms per year will be replaced by approximately 6 kilograms of weight gain. However, this will not be noticeable outwardly, except that the girl may simply develop a “brutal” appetite, due to the body’s need for a large amount of nutrients to ensure such a rapid growth spurt.

Mammary gland. A girl's puberty is accompanied by significant changes in her body. At its very beginning, an enlargement of the mammary glands is noted, which occurs as follows: the first changes concern the areola and nipple, which slightly enlarge and protrude forward. A little later, the mammary gland itself begins to change. During the first year after the onset of puberty in girls, the mammary gland takes on the shape of a cone. About a year before the first menstruation begins, the girl's breasts will take on a more familiar, rounded shape.

Hair growth and body changes. When a girl begins puberty, vegetation appears in the perineal area and armpits. The figure changes, acquiring more feminine outlines: gradually the girl’s hips begin to widen, and her waist becomes visible. In addition, during puberty, girls' hair and skin structure changes dramatically, which is affected by certain hormones.

First menstruation. Around the age of 13, a girl’s first menstruation occurs. However, the formation of the menstrual cycle is a very long process that can last up to one year. Before the menstrual cycle is established, menstruation may be extremely irregular and vary in length - but no more than 5 days of menstrual bleeding. Such irregularity is a completely normal phenomenon, which should not cause any concern for parents. When the first menstruation occurs, the girl’s growth seriously slows down; in general, she will subsequently gain no more than 5 centimeters in height.

The mother of a girl should pay especially close attention during menstruation. Regardless of how old a girl’s first menstruation began - at 11 or 15, this event always turns out to be stressful for her. One can only imagine how serious the stress will be if the girl knows absolutely nothing about what is happening to her? As psychological practice shows, a girl may begin to panic, and she will not even tell her mother about what is happening to her and her body.

That is why the mother is absolutely obliged in a timely manner, before the first menstruation occurs, to prepare the girl psychologically for the upcoming physiological changes, teach her how to use the necessary hygiene items, and tell her the rules of behavior during menstruation. Of course, a girl can learn about everything from other sources, for example, from her friends. However, in this case, do not be surprised if she shares the news that she has become a girl, and other events in her life, with a friend, and not with you. Also, you should not react too violently to the onset of menstruation in a girl, and especially not publicly inform relatives and friends about it - this can seriously confuse the girl, provoke the appearance of complexes, and the fear of telling you something in the future.

Clumsiness. It is during a rapid growth spurt that the same “clumsiness” familiar to many appears in a teenage girl. Parents should not worry about this - such disproportion of the body is completely normal and does not indicate any pathology. The “ugly duckling” period will soon end irrevocably, and your little princess will turn into a real beauty. Be sure to talk to the girl about this, she also needs to understand this, explain what is causing this change, and that it will end soon.

• Psychological difficulties during puberty in girls

During puberty in girls, the skeleton grows most intensively, but unevenly. The fact is that bones grow at different speeds, absolutely not synchronously - first the bones of the hands and feet grow, then the bones of the arms, and the skull of the face. And only at the very last stage does the body “catch up” with them. This explains the fact that teenage girls often have too long legs and arms, and a slightly elongated face. In addition to all this, the rate of muscle growth is often significantly lower than the rate of bone growth, as a result, a certain clumsiness and angularity of the teenager’s movements.

Signs of puberty are usually pronounced in girls, and if premature puberty occurs in girls, problems of a psychological nature occur. A girl may feel embarrassed by the changes taking place, especially if her peers have not yet begun to experience them. If this issue is quite painful for your daughter, try talking to the teacher, the class teacher, who will make sure that the girl does not become the subject of ridicule at school. It would not hurt to seek advice from a child psychologist; he will explain to the child in a tactful manner and with knowledge of the psychological characteristics of children and adolescents that all changes are absolutely natural and normal.

Remember : How a girl perceives the changes that occur in her body depends to a large extent on how good and close her relationship is with her mother. Try to communicate with your daughter as often and as much as possible, answer all her questions, even if they seem ridiculous and stupid. Believe me, your daughter’s trust will more than pay off, and it will be much easier for you to survive the difficult adolescence.

Equally, psychological problems can be associated with a girl’s late puberty. If she begins to understand that at the age of 13-14 she practically does not experience the same changes that her friends and classmates experience, then she may begin to experience discomfort and worry. A girl may begin to feel extremely awkward in the company of her peers, and develop a strong inferiority complex, feeling worse than everyone else.

In this situation, only constant confidential communication with the daughter can help; she needs to explain everything and periodically remind her that this is normal, and the girl’s puberty is simply inevitable. Mom can use herself as an example, even if she has to slightly embellish the reality. In especially difficult cases, if the daughter does not make contact and the mother cannot cope, we advise you to contact a child psychologist. Do not ignore the problem, because such psychological traumas are quite strong, and an acquired inferiority complex can poison a girl’s existence for the rest of her life.

The sexual development of girls may well have different variations, and not only with age. Sometimes the appearance of hair can vary significantly in its sequence. Usually, breast growth and development occurs first, then pubic hair appears, and armpit hair appears last. However, in some cases, hairs appear in the armpits first, but other signs are not yet noticeable. Sometimes hair appears on the genitals first, and then all other signs.

Also, doctors noticed one pattern - the earlier a girl’s puberty began, the faster it proceeds, and, conversely, the later a girl’s puberty began, the longer the process takes. For example, in a girl who started puberty at the age of 9, its duration is no more than one and a half years, while its onset in a 14-year-old girl will last about two and a half years.

Therefore, support your princess, be that as it may, because the most important period in her life is happening now. She is about to turn from a girl into a girl, and then into a woman, and soon she will take on your role - the role of a mother.

The period of puberty of a child begins with a sharp increase in growth, sometimes up to 10 centimeters per year. A girl reaches her final height by the age of 18, after which more throughout her life.

Skeletal bones, muscles and nerve endings sometimes develop differently, which is why a teenager during this period appears angular and awkward. Don’t worry, the difference will quickly smooth out and the girl’s figure will become feminine.

Simultaneously with growth, the sebaceous glands on the skin are activated due to a hormonal surge. This can lead to acne. To avoid such problems, you need to pay special attention to your hygiene at this time.

Clean your face several times a day with a special lotion, additionally use wet wipes throughout the day and you will minimize all manifestations of acne.

Menstrual cycle

In addition, to start menstruation, a girl must gain a certain body weight; if a teenager has a small weight, menstruation may begin much later.

A regular cycle should finally be established within a year from the first discharge. It is important at this time to start keeping a calendar in which all start dates will be recorded. Your gynecologist may need this information to determine when to start your cycle.

With the arrival of menstruation, the so-called puberty period begins, which is characterized by the formation of the external and internal genital organs, including the vulva and genital cleft.

Video on the topic

With the arrival of menstruation, the female body is able to perform reproductive function. This period of growing up occurs individually for each girl. On average, menstruation begins at 12-14 years of age, but there are exceptions. The appearance of the first menstruation is influenced by many things - hormonal levels, nutrition, area of ​​residence, etc.

Instructions

The first menstruation occurs after the appearance of secondary sexual characteristics in girls. By about the age of 10, significant changes occur in the body - hair begins to appear on and in the armpits, the amount of female hormones - follicle-stimulating and luteinizing - increases. Many girls begin to outstrip their male peers in height. The external shape of the girl also changes - breasts begin to form, hips become rounded, under the influence of the girl’s “hormonal background” or.

Scientists have noted that the maturation of eggs is influenced by many factors, for example, the average annual ambient temperature. Thus, peoples living closer to the equator experience earlier puberty than peoples. Residents of the north get their period on average at 14-15 years old, and for southern women - at 10-11.

For puberty, normal functioning of the endocrine glands is necessary, but all hormones are produced with the participation of minerals, vitamins and provitamins. If the body lacks any components, there is a malfunction of the endocrine glands and puberty is delayed.

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 and 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

Early puberty is its onset before 8 years of age. For European countries, this age is still relevant, but in the USA it is proposed to use a 7-year-old threshold for white girls and a 6.5-year-old threshold for representatives of the African-American population.

Differences between Europe and the United States in early puberty may be due to ethnicity, different prevalence of obesity, or methodological reasons. Puberty is now progressing earlier than in the past, but there is little evidence that today's girls are experiencing menarche at an earlier age; it is thought that the rate of puberty may be slower when it starts early than in past generations. In boys, the boundaries of normal sexual development are still determined by 9 years of age.

Types of early sexual development

It is necessary to distinguish between “true” (or “central”) and “false” early puberty. With true early puberty, all the signs of normal puberty develop earlier, while with false puberty, only individual signs develop, depending on the production of androgens or estrogens. Excess production of estrogen in girls or testosterone in boys leads to isosexual development. On the contrary, excess or early production of estrogen in boys or testosterone in girls leads to heterosexual development.

There are also two forms of partial development that are generally considered normal: premature adrenarche, or pubarche (early growth of pubic hair) and thelarche (breast development). (It should be noted that since the first sign of true precocious puberty in girls is breast enlargement, differential diagnosis between precocious puberty and early thelarche cannot be made only on the basis of a single objective examination: it is important to take into account height and bone age, which are in within the normal range for early thelarche and ahead of normal values ​​for premature puberty.)

Symptoms

True (central) precocious puberty

True premature puberty is characterized by:

• harmonious development of all structures involved in puberty - enlargement of the mammary gland, growth of pubic hair in girls, maturation of the uterus and ovaries after menarche; enlargement of the testicles and penis, growth of pubic hair in boys;
• simultaneous development of secondary changes, for example mood swings, acne, the appearance of a specific body odor;
• teenage growth spurt;
• rapidly progressive advance of bone age, which leads to premature closure of the epiphyseal growth plates and a decrease in final height.

True precocious puberty can be idiopathic (by far the most common form in girls) or caused by pathology of the central nervous system (more often in boys). These may include congenital anomalies, hypothalamic hamartomas, increased intracranial pressure and tumors that can occur after radiation, especially in girls. Intracerebral lesions may occur de novo or against the background of existing predisposing diseases, such as neurofibromatosis. Early puberty in rare cases can be observed in primary long-term hypothyroidism due to sequence homology between the TSH and human chorionic gonadotropin (hCG) proteins.

In girls adopted from developing to developed countries, puberty may begin slightly earlier, with rapid progression to menarche from 11+ years (vs. 12+ years) and decreased height in adulthood.

Subacute ovarian torsion causes marked and maturation of stromal cells; Estrogenization, mammary gland development, and androgenization due to testosterone production by the ovaries are often observed. Clinically, it is very difficult to differentiate this condition from central precocious puberty; The diagnosis is aided by a test with inhibition of the LH-FSH axis and typical ultrasound signs.

False precocious puberty

False sexual development is characterized by:

• hypertrophy of affected tissues due to excess production of hormones;
• regression or suppression of structures that normally produce hormones during adolescence;
• advanced bone age;
• increase in growth rate.

Early puberty may be isosexual or, less commonly, heterosexual due to tumors of the adrenal glands that produce either testosterone or estrogen; non-salting congenital virilization in adrenal hyperplasia, administration of exogenous gonadotropin or sex steroids, gonadal tumors that produce estrogen or testosterone, gonadotropin or hCG-producing tumors, ovarian cysts that produce estrogen. Heterosexual precocious puberty in girls is often the result of pronounced clitoral hypertrophy, which can serve as a differential diagnostic difference from premature adrenarche.

In Albright-McCune-Sternberg syndrome, discordant puberty is observed.

Patients are characterized by the presence of café au lait pigment spots, usually located on one side of the upper body. Foci of bone dysplasia and cysts are also observed in long bones and skull bones. Signs of puberty are usually contradictory - early onset of menstruation and lack of gonadotropin cyclicity. The syndrome is more often observed in girls; in rare cases, thyrotoxicosis, gigantism and Cushing's syndrome may be detected. The syndrome is caused by a general mutation of part of the G protein (a secondary signal transmitter for receptor activation) in endocrine tissues, which leads to an increase in their activity.

Separate from the cases of pathological secretion by tumors described above, there is excessive production of estrogens from testosterone with the help of peripheral aromatase, which leads to excess body weight in boys and gynecomastia in adolescence. Breast development and lactorrhea caused by prolactinoma are extremely rare.

Testotoxicosis is a familial male disease accompanied by premature puberty, general changes characteristic of male puberty, but small testicles that do not correspond to the degree of virilization are often observed. In this disease, there is no cyclic activation of gonadotropin, puberty is caused by constitutive activation of LH receptors, which leads to early production of testosterone in the absence of circulating LH.

Premature adrenarche, or pubarche

Premature adrenarche, or pubarche, is characterized by:

• hair growth in the armpits and pubic area;
• acne, the appearance of a specific body odor and other androgen-mediated effects;
• slightly advanced bone age;
• usually normal growth rate.

Adrenarche is a normal age-related process of maturation of the adrenal cortex, possibly under the influence of ACTH (or other “central adrenarche-stimulating hormones”) causing increased secretion of DHEA and other androgenic testosterone precursors. Their effects are usually limited to adolescence. With early maturation, signs of virilization become noticeable. Idiopathic displacement of adrenarche from adolescence is more often observed in girls than in boys. There is evidence of genetically determined hyperactivity of one of the pathological pathways for the synthesis of adrenal steroids, 17,20 desmolase, which can lead to familial adrenarche and, in some cases, familial polycystic ovary syndrome. Most girls with premature adrenarche develop an SPC-like phenotype, including “metabolic syndrome X.” Premature adrenarche may also be secondary to nonprogressive intracranial lesions, predominantly mediated by abnormal production of ACTH or central adrenarche-stimulating hormones. The most common intracranial causes are hydrocephalus and the consequences of meningitis (especially tuberculous meningitis). Because in some cases these manifestations may be severe or familial, differential diagnosis may need to be made against late manifestations of atypical or nonclassical congenital adrenal hyperplasia (CAH).

Hirsutism

Other causes of increased adrenal activity or androgen production that cause excess hair growth in girls (with or without late-onset male pattern baldness) include the following diseases.

• Classic VGN.
• Late-onset CAH is common but poorly diagnosed. The non-classical subtype of the disease is associated with human major histocompatibility complex antigens - HLA B14 and B35.
• Cushing's syndrome.
• A secondary increase in the level of testosterone secreted in polycystic ovaries, which, in turn, may be caused by increased adrenal activity and hyperinsulinemia or be a primary manifestation of puberty.
• Idiopathic hirsutism is also observed with increased activity of 5a-reductase in the skin. Treatment involves blocking the enzyme, for example with finasteride.
• Some girls or their parents have cosmetic problems associated with normal dark hair growth.
• It has been noted that hirsutism limited to the lower body argues for an adrenal origin of androgens. Along with treating the causes of hirsutism, cosmetic correction is also carried out: lightening and destruction of hair with electric current, depilation.

Premature thelarche

This benign condition is characterized by:

• enlargement of the mammary gland, usually at an early age (may occur in later childhood), accompanied by cyclical clinical symptoms over the course of a month;
• absence of any subsequent manifestations of puberty;
• normal growth and skeletal maturation. With premature thelarche, periods of follicular development (more than 3-4 mm) occur during induction by FSH aromatase. Laboratory tests may reveal low estrogen levels.

Various variants of diseases with similar symptoms have been described with central precocious puberty and thelarche, in which the level of FSH is increased (as opposed to true puberty, in which the level of LH > FSH).

Isolated premature menarche

This poorly explained condition occurs in prepubertal girls, often during the summer. There may be cyclic bleeding every 4-6 weeks for 3-4 days for several months in a row. There are no signs of increased gonadotropin concentrations, but a small echo-positive endometrial layer is detected during the bleeding phase. Differential diagnosis includes sexual violence, vaginal malignancies and cervical erosion; if the history is unclear and the data are atypical, an examination under anesthesia may be necessary.

Screening for early puberty

History and physical examination

When taking a medical history during early puberty, it is important to clarify the following points: listed below.

• The exact time of puberty symptoms; Girls are asked whether their breasts enlarged before or after the appearance of pubic hair.
• Vaginal discharge, which may be thick mucous or mixed with blood.
• Height (has increased rapidly recently? - changes can be noted in relation to the height of peers or by changes in clothing or shoe sizes).
• Any signs of hypothyroidism.
• Any neurological or ophthalmological symptoms.
• Family history of precocious puberty or suspected neurofibromatosis.
• Past illnesses affecting the nervous system.
• Taking any medications (estrogens, androgens, cimetidine). Medicines may be prescribed or taken accidentally (eg, accidental use of contraceptives) or spontaneously. Precocious puberty has been reported in both boys and girls when taking traditional Chinese herbal medicines. Organochlorine pesticides of the DDT (dichlorodiphenyltrichloromethylmethane) group can cause steroid-like effects.
• Eating poultry and meat overly processed with veterinary drugs.

An objective examination during early puberty should include the following steps.

• An accurate description of the stage of sexual development (for long-term follow-up, chest circumference is useful).
• Height, sitting height and body weight, their assessment relative to standard indicators and previous measurements (due to the fact that the growth of the spine is partly determined by the influence of sex hormones, with early puberty, sitting height is relatively greater than the length of the limbs).
• Examination of the color of vaginal mucus; pale color indicates estrogenic activity.
• Signs of hyperandrogenization (hirsutism, enlargement of the clitoris or penis, acne). Hirsutism can be assessed using a simple scale. Hirsutism in the lower body only is most often of adrenal origin.
• Blood pressure (increased with 11 β-hydroxylase form of adrenal hyperplasia or with increased intracranial pressure).
• Examination of congenital pigmentations.
• Thyroid size and signs of hypothyroidism. In boys with hypothyroidism, testicular volume may be larger than would be expected based on other sex characteristics. In girls with hypothyroidism, menstruation may come earlier than the stage of breast development would suggest.
• Hepatomegaly and tumor-like formations in the abdominal cavity.
• Tumor-like formations in the pelvic cavity (for example, ovarian cysts or tumors) on transabdominal or rectal examination.
• Neurological examination (including fundus examination).

Interpretation of the data obtained

True early puberty

• In girls with no other symptoms or syndromes = idiopathic precocious puberty confirmed by CT or MRI.
• In the presence of neurological symptoms or syndromes = central nervous system damage.
• If there are more than five café-au-lait spots or freckles in the axillary area, with or without family history = neurofibromatosis and optic glioma or other central nervous system tumors.
• Enlarged thyroid gland and/or typical symptoms and syndromes = hypothyroidism.
• Tall boys and girls with early growth of pubic hair, sweating and other signs of puberty may have a non-salting form of CAH, in which there is a pronounced advance in bone age, in contrast to false precocious puberty.

False early puberty

Positive family history = adrenarche or atypical 21-hydroxylase deficiency.

• Hypertension in girls with signs of virilization or in a boy with false puberty = 11 β-hydroxylase deficiency.
• Clitheromegaly, advanced bone age and accelerated growth = androgenization is not a consequence of adrenarche.
• Random café-au-lait spots and/or radiographic evidence of lytic bone lesions = Albright-McCune-Sternberg syndrome.
• Tumor-like mass in the pelvic cavity or mass palpable through the rectum = ovarian tumor.
• Hepatomegaly = liver tumor (hCG producing).
• Tumor-like formation in the abdominal cavity = adrenal tumor.
• Gynecomastia with unilateral testicular enlargement = germ cell tumor.
• Gynecomastia without testicular enlargement = intra-abdominal tumor (often not palpable) or extraglandular aromatase conversion during puberty (most common, but not always + in obese adolescents).
• Previous diseases with damage to the nervous system = premature adrenarche.
• Early enlargement and cyclical course = premature thelarche.
• A positive family history in boys = familial testotoxicosis.

Additional Research

Assessment of growth when determining the stage of puberty is a fundamental criterion for determining the tactics of further examination depending on the sex of the child.

In-depth examination of early puberty in girls

If a little girl has only a slight enlargement of the mammary glands without any other signs of estrogenic activity, and growth parameters are within normal limits, then further studies may be limited to x-rays of the bones of the hand and wrist to determine bone age. If bone age is not ahead of calendar age, the child can be examined after a few months, when the decrease or progression of symptoms, pubic hair growth, and growth rate are assessed. If there is no progression of symptoms of early puberty and the growth rate is within normal limits, the most likely diagnosis is premature thelarche or temporary exposure to exogenous estrogens. Further research is needed and parents should be instructed to seek immediate medical attention if any other signs of puberty appear. The detection by ultrasound of one or two follicles in the ovary of small volume in the absence of uterine enlargement requires re-examination.

If signs of estrogenic activity are detected (active development of the mammary glands, thick mucous discharge, pale mucous membrane of the vaginal opening, psychological changes, increased growth rate and advanced bone age), the following studies are indicated.

• Determination of the concentration of basal estradiol (E2), LH, FSH.
• Analysis of thyroid function - T 4 s and TSH.
• Ultrasound of the abdominal cavity to determine the size of the ovaries and uterus.
• Determination of the concentration of inhibin B (a derivative of granulosa cell glycoprotein, which returns to the pituitary gland and inhibits the production of FSH), which increases during thelarche (the concentration of inhibin A produced in the corpus luteum does not increase); to differentiate from true puberty, at which the level of inhibin A and B increases. If there are doubts regarding the determination of estrogens, a cytological examination of vaginal secretion (percentage of squamous cells) is performed.
• A test with luliberin in a specialized department: - before the onset of puberty, the increase in LH and FSH is insignificant, while the level of FSH increases more than LH; - during puberty, the levels of LH and FSH increase equally, LH is increased more than FSH in the middle of late puberty; - thus, the ratio of LH to FSH (>1) can be used as an indicator of “reaching” puberty.

If evidence of true early puberty is obtained (E2 concentration more than 50 pmol/L, LH/FSH ratio >1, peak increase in LH) in the absence of hypothyroidism, it is necessary to determine the cause using CT or MRI of the brain.

If evidence of false precocious puberty is obtained (increased E2 concentrations, decreased LH and FSH levels even after administration of luliberin), further targeted studies are necessary to identify the cause. Most tumors are detected by ultrasound of the ovaries, liver and adrenal glands; in rare cases, tumors can be localized inside the chest cavity. Sometimes a CT scan is necessary to detect small lesions of the adrenal glands.

If there are signs of a slight excess of androgens with normal bone age and growth of the child, then benign premature adrenarche can be assumed, in which case further studies are not indicated. (This usually reveals a slight increase in serum DHEA sulfate levels, and a slight increase in urinary steroid profile shows a slight increase in adrenal metabolites.) Confirmation of non-classical 21-hydroxylase deficiency, which may simulate premature adrenarche, to determine the basal level and increase in 17a-hydroxyprogesterone, it is necessary to conduct a test with short ACTH (synacthen).

For more severe virilization, accompanied by clitoromegaly, increased rate of bone growth and maturation, a urine steroid profile and measurement of 17a-hydroxyprogesterone, DHEA, DHEA sulfate and androstenedione will identify most forms of CAH and androgen-secreting tumors. The localization of the tumor is clarified by ultrasound or CT.

In the presence of pathological pigmentation, skeletal radiography will confirm Albright-McCune-Sternberg syndrome, in which it is also necessary to evaluate the function of the thyroid gland and adrenal glands.

In-depth examination of early puberty in boys

If signs of early puberty are detected and in the form of testicular enlargement, it is recommended to determine the basal level of testosterone in the blood serum, LH, FSH and conduct a test with luliberin in a specialized department. If the testosterone level is elevated (>1.0 mmol/l), and the luliberin test corresponds to pubertal indicators (see above), true precocious puberty is diagnosed. Since the incidence of brain pathology in boys with precocious puberty is relatively high, a CT scan or MRI of the brain is required.

If, with small testicles during early puberty, testosterone levels are increased, a diagnosis of false precocious puberty is likely, as evidenced by the suppression of LH and FSH during the luliberin test. Additional determination of other steroids in urine and serum (androstenedione, DHEA, DHEA sulfate, and 17a-hydroxyprogesterone) is indicated to determine the source of androgen increases. Based on relative magnitude, it is possible to differentiate premature adrenarche (relatively rare in boys), exogenous steroid use, various non-salting forms of CAH, and adrenal tumors.

When isolated gynecomastia is detected, determination of testosterone, prolactin, E2, hCG and LH is indicated. HCG and/or E2 levels are elevated in some estrogen-secreting tumors, which may be of testicular origin (determined by ultrasound) or extragonadal origin (determined by ultrasound and CT). Gynecomastia in the absence of other signs of puberty can also be detected with primary testicular damage (the level of menopausal LH is increased), as well as with hypothalamic or pituitary hypogonadism (the level of LH is not determined). Very rarely, in children with early puberty, prolactinoma is detected, which usually manifests itself with symptoms of central nervous system damage and is the only cause of lactorrhea. If estrogen levels are slightly elevated and all other tests are normal, extragonadal conversion of testosterone by aromatase is most likely.

Treatment

True precocious puberty, which results in decreased final height, precocious puberty can create psychological problems in the child. For this reason, treatment is usually carried out in specialized departments. Currently, treatment consists of administration (intramuscular or subcutaneous) of stored luliberin (depending on the drug with slow release every 4-12 weeks).

To prevent initial hyperstimulation and enhance precocious puberty, in the first 6 weeks of treatment, competitive administration of blockers of the synthesis of steroid sex hormones is carried out - cyproterone at a dose of 100 mg/m 2 body surface per day for 2-3 doses. (Ciprosterone can be used alone to treat precocious puberty, however, while effective in relation to the progression of sexual development, it does not affect final growth. In addition, the drug may have side effects such as increased fatigue and leads to hypocortisolism, which necessitates the introduction of glucocorticoids into stressful situations). Treatment of early puberty and GnRH analogues continues until normal growth is achieved and signs of puberty appear in the child’s peers. After this, puberty continues from the point at which it was suspended at the beginning of treatment; To date, no delayed side effects of this treatment regimen have been observed.

The most reasonable treatment option for testotoxicosis and Albright-McCune-Sternberg syndrome, gonadotropin-independent conditions that do not respond to therapy with luliberin analogues, is the use of cyproterone or ketoconazole (which blocks some steps in the synthesis of steroids, including testosterone). If the bone age in these conditions goes well beyond 12 years, true puberty (of central origin) develops. In such cases, additional treatment with GnRH may be necessary.

False early puberty caused by tumor secretion of sex steroids requires consultation and subsequent surgical intervention.

Treatment of any form of CAH, occurring with or without virilization, hypertension, as well as late-onset non-classical 21-hydroxylase deficiency, consists of steroid hormone replacement therapy. In case of true central early puberty, luliberin is additionally prescribed.

Adrenarche, like isolated hirsutism, being benign conditions, leads to cosmetic problems. Treatment may be required to restore your menstrual cycle if you have polycystic ovary syndrome. In older pediatric patients, it is possible to prescribe antiandrogen drugs in combination with contraceptives under the strict supervision of a physician. The problem of excess hair growth is solved by applying depilatory creams and electrolysis. Acne sanitation is achieved with skin cleansing and topical products.

Thelarche usually does not require any treatment. In a progressive form with an increase in FSH (“telarchic variant”), luliberin analogues are used in some cases with limited effect.

The best treatment for idiopathic gynecomastia during early puberty is surgical treatment (due to the proven ineffectiveness of drug treatment).