For girls, the hormones that start puberty are follicle stimulating hormone (FSH) and luteinizing hormone (LH). These 2 chemicals are sent from a portion of the brain to the ovaries (2 small round organs in the pelvis that hold the eggs to create babies). FSH and LH stimulate the ovaries to produce estrogen and progesterone. These hormones will continue to be produced until a woman goes through menopause (stopping of menstrual cycles) usually in her 50s.
· Puberty causes rapid growth of the entire body, also called “growth spurts”. A girl may grow several inches and her weight will also increase. Sometimes girls will often gain weight around their stomach, hips, butt and thighs. Sometimes they may feel “fat” or “pudgy”. Often, the body will hold fat in these areas just prior to a growth spurts. The weight will usually even out or redistribute on the body as the growth spurt occurs. Talk with your healthcare provider before dieting or trying to lose weight. The hips become rounder and overall the body will develop more curves.
· Breasts develop (occurs in 5 stages): Sometimes one breast will grow faster than the other. But, they usually even out as they develop. Most women will have one breast that is slightly larger than the other. Breasts may be tender or hurt. Wearing a bra, starting with a sports type bra, may help with tenderness.
o Stage 1: Before puberty, the nipple is flat and there is no breast tissue. “Prepuberty”
o Stage 2: (8 to 13 years old) The areola, pink area around the nipple, grows and a small amount of breast tissue may form. The nipple may feel firm. This is also called a “breast bud”.
o Stage 3: (9 to 14 years old) The breast continues to grow and stick out away from the chest wall. This is known as “breast elevation”.
o Stage4: (10 to 15 years old) The areola will grow in size and develop papilla, small raised bumps. The breast tissue also continues to grows. This stage is known as the “areolar mound”.
o Stage 5: The breasts are fully developed.
· Pubic hair grows (occurs in 5 stages)
o Stage 1: “Prepuberty” the entire area has no pubic hair
o Stage 2: (9 to 13 years old) A few straight, fine and light colored hairs being to grow. This is known as the “presexual stage”.
o Stage 3: (10 to 14 years old) More hair begins to grow it becomes thicker, darker and start to curl. “Sexual stage”
o Stage4: The hair may cover the mons pubis, fatty pad of tissue above the pelvic bone but does not extend onto the thigh. It may be thick, dark and curly. mid- escutcheon
o Stage5: Adult pattern pubic hair covering the entire genital region. female escutcheon
· Under arm hair grows: this usually accompanies the growth of pubic hair.
o Sweat glands also begin to produce more serum or sweat. This produces the dreaded “B.O.” or body odor.
o You can reduce B.O. by showering daily and wearing clean clothes. It is important to shower after exercise or sports activities.
o You may decide to use antiperspirants or deodorants.
· Skin changes
o Acne, zits or pimples may develop on the face, back or chest. This is due to hormones increasing the amount of oil produced by the skin.
o Cleansing with mild soap twice a day can help reduce the amount of oil on the skin. However, over cleansing will actually cause the skin to produce an even greater amount of oil to replace what has been removed.
o There are many product available to cleanse skin and treat acne. If your acne is moderate to severe, you may want to see a dermatologist (skin specialist). Most birth control pills can also help clear acne.
o Oil production also increases in the hair follicles and can cause oily hair. Washing hair and using a gentle conditioner can help decrease the oily appearance.
o Stretch marks are also called striae. Yes, these are the same stretch marks that pregnant women get when their bellies grow. However, in puberty, stretch marks may occur anywhere on the body where rapid growth occurs. This can include the legs, hips, buttocks, and breasts. Stretch marks may be red to purple in color. Over time they will lighten or fade to a silvery skin color. Girls who are overweight will likely have more stretch marks.
· Vaginal discharge: a clear to white milky fluid may be noticed on girls’ underwear.
o This is caused by the increase of hormones. This is a natural way for the vagina to lubricate and cleanses itself.
o Some girls may find this unappealing and want to wash away the discharge. It is important to hold back from over cleansing that vagina or vulva area. Aggressive washing and/or douching can cause bacterial vaginosis (an overgrowth of bacteria) in the vagina. This will leads to more discharge with a yellow or green color and odor. Proper cleaning of the vulvar and vagina should include mild soap and water only.
· Periods begin: (9 to 15 years old) This is known as menarche or the start of menses.
o This usually occurs about 2 years after breasts begin to develop. However, every girl is different.
o The menstrual cycle or periods typically occur once a month with bleeding lasting from 2 to 7 days.
o The bleeding may be very light (brown to pink color) or heavy (red).
o It can be normal for period to be irregular. This means that you may skip a month or have 2 periods in one month. However, if you do not have a period at least every 3 months, you should see a healthcare provider.
o Girls will need to learn to use pads or tampons during their periods.
o If using pads, these should be changed every time the girl goes to the bathroom (urinates or passes stool). Pads can be worn overnight.
o Tampons should be changed at least every 8 hours, even if the flow is light.
§ Use the smallest/lightest tampon that can handle the flow of the period.
§ Tampons should not be used for anything other than menstrual flow.
§ Toxic Shock Syndrome (TSS) is a rare infection that can occur if a tampon is left in the vagina for too long. Symptoms include: fever, sunburn like rash, dizziness, diarrhea, muscle aches, and/or fainting. If these symptoms occur, you need to seek immediate medical attention.
§ Some girls may be concerned that the tampon may wander off or get lost in their bodies. Because the vagina is essentially a dead end, there is nowhere for the tampon to go. Occasionally, women will not be able to remove a tampon if it push high into the vagina. If this occurs, see your healthcare provider for assistance removing the tampon.
· Emotional changes
o Mood swings can be caused by the fluctuations in hormones, as well as, concerns about the changes in the girl’s body.
o Girls may become short tempered or have anxiety about their appearance.
o They may be confused about their feeling and feel embarrassed to ask questions.
o Girls may also begin to feel strong emotions of love or physical excitement (lust) toward boys or other girls.
o Teens become very aware and interested in sex as they advance through puberty. Although I do not recommend that teens engage in sex, the reality is that it happens.
o If teens do chose to have sex, they should be knowledgeable about how to protect themselves from both pregnancy and sexually transmitted diseases (STDs-also known as sexually transmitted infections or STIs).
o Please review the birth control options and STD pages on this site.