Puberty involves a series of hormonally mediated changes in a girl’s body and brain. Although many people think of puberty as an event marked by the first menstrual period, the term in fact refers to the entire developmental sequence that leads to sexual and reproductive maturity. Its physical signs include accelerated growth, breast development, pubic and axillary (armpit) hair growth, and the body odor that results from the activation of apocrine glands in those areas (adrenarche). The first menstrual period (menarche) occurs near the end of this process. This entire sequence usually takes about four and a half years, although some girls go through it far more quickly than others. (The range is from a year and a half to six years.)
Listen to Your Body
Breast budding is the first stage of breast development. The nipples can become very sore during this time. Reassurance that this is normal will itself help to decrease the pain, as will following a good diet. Following breast budding, the areolae widen. Then the breast itself enlarges under the nipple area. Though one breast will always be slightly larger than the other, some girls have a marked asymmetry. It may take several years before the breasts are approximately the same size. It’s possible for breast growth to continue until a girl is eighteen or so, though she usually reaches her adult breast size within a couple of years after menarche.
In addition to breast budding and the growth of pubic hair, a girl’s adolescent body goes through major changes in composition. Both her lean body mass and total body fat increase, and her body fat percentage also increases from its prepubertal level. This results in part from a complex change in the interaction between estrogen and leptin, a hormone produced by fat cells that helps regulate their metabolism. Much of this new fat goes to her buttocks and hips.
In the months prior to their first period, it is common for girls to develop a vaginal discharge that is either clear, white, or slightly yellow. This discharge is the result of increased vaginal secretions stimulated by estrogen. Many girls are frightened by this and some are concerned they have developed cancer. This is one example of why, even in the best of circumstances, some anxiety during puberty is normal and to be expected.
The blossoming of sexual desire and interest is also perfectly natural at this stage. And so is masturbation. But if a child has been taught that sexual feelings are dirty or shameful, she may interpret this to mean that she herself is bad or shameful.
What Causes This
The changes of puberty begin in the brain. Starting at about age ten or eleven, two hormones known as gonadotropins—LH (luteinizing hormone) and FSH (follicle-stimulating hormone become elevated to the same high levels seen in a postmenopausal woman! The elevation of these hormones begins several months before the beginning of breast development, when the hypothalamus starts to release pulses of gonadotropin-releasing hormone. Apter1 This, in turn, signals the pituitary gland to release FSH and LH, which tell the ovarian follicles to begin developing and producing estrogen and testosterone. It is estrogen that stimulates breast development, bone growth, and female fat distribution, while testosterone stimulates sex drive and the increased sebaceous-gland secretions that can lead to acne.
Once a critical threshold of physical growth has been achieved, the central mechanism in the brain that controls the onset of puberty can be activated by the production of estrogen, regardless of its source. Since fat cells produce estrogen, girls who have a higher percentage of body fat usually begin the process of puberty earlier than the average. They also reach menarche earlier. (For reasons that are probably related to the secretion of melatonin, so do girls who are blind.)
It takes a while for regular ovulation to become established. In the meantime, a girl’s periods are usually anovulatory and can be irregular or heavy. It’s common for 25 to 50 percent of adolescent girls to still have some anovulatory periods four years after menarche. Read2
There is a wide range of difference in how girls go through puberty. Some speed through the process quickly, while others seem to hang on to childhood as long as possible, then suddenly blossom at the age of sixteen, long after everyone else. Yet for all it’s twists and turns, puberty is a normal life process that seldom requires medical attention.
Spiritual and Holistic Options
Sanitary products have come a very long way since the old belt and pad of my adolescence. However, I generally recommend that a girl use pads until her periods become more regular—particularly if her periods are heavy. Avoid using scented pads because the chemicals in the scent can be quite irritating.
Some girls prefer tampons. These are fine on occasion, but I’d prefer that young girls avoid using them regularly. The adolescent cervix undergoes fairly rapid growth and change in the area known as the transformation zone, where mucosal cells change into squamous cells in the acidic environment of the vagina. This is the area from which Pap smears are taken. Tampons can cause irritation here. (I’ve seen a number of cervical ulcers resulting from the use of scented tampons.) If a young girl does use tampons, she should make sure to change them at least every six hours.
- Apter, D., et al. (1993). Gonadotropin-releasing hormone pulse generator activity during pubertal transition in girls: pulsatile and diurnal patterns of circulating gonadotropins. J Clin Endocrinol Metab, 76 (4), 940–49.
- Read, G. F., D. W. Wilson, A. Hughes, K. Griffiths. (August 1984). The use of salivary progesterone assays in the assessment of ovarian function in postmenarcheal girls. J Endocrinol, 102 (2), 265–68; Vuorento, T., and I. Huhtaniemi. (October 1992). Daily levels of salivary progesterone during menstrual cycle in adolescent girls. Fertil Steril, 58 (4), 685–90.