Adolescence is considered as the period in which the most intense hormonal, physical, psychological and social changes of childhood occur. On the one hand, the child tries to physically adapt to his changing body, on the other hand, he tries to be an emotionally separate individual and gain his personality.

Hormonal axis in the brain consisting of firstly the hypothalamus, then the pituitary gland and then the ovaries in the girls start the puberty by stimulating the testicles in the boys.

In childhood, there is no warning from the hypothalamus, and thus the hormonal axis is not activated. In this way, luteinizing hormone (LH) levels are very low in children. At the beginning of adolescence, pulsatile hormone release (GnRH) starts from the hypothalamus and LH levels rise asleep first. FSH (follicle stimulating hormone) in girls is a hormone that stimulates the development of egg cells from the ovaries. LH (luteinizing hormone) is the hormone required for both egg development and ovulation (egg cracking). From the beginning of adolescence, FSH and LH values ​​will start to increase and E2 (estradiol) will increase.


Normal puberty development process

The first finding in 85% of girls for adolescence is breast development and in 15% hair growth in the genital area. For the onset of breast development, the age range of 8-13 is normal, but the average age is specified as 10,4. Genital area hair usually starts 6 months after breast development. After that, it is accepted that the girl starts to have menstruation on average as 13 years old. Girls enter the adolescence period on average 2 years earlier than boys.

The onset of breast development is called thelarche, the beginning of the genital area and the armpit pubescence are the pubarche and the beginning of the menstruation is the menarche. It should be remembered that the beginning of menstruation in a sense expresses the beginning of fertility ability, how much the physical, emotional and social development can change, and from time to time children can adapt to this process more difficult. More sweating occurs in the armpit, the skin becomes more oily and pimples. Although sweating causes problems for children from time to time, the most common problem is acne. The dermatologist should be asked for help, and the child should be supported in the treatment of acne and should try to teach hygienic rules repeatedly but without disturbing them.

Breast development may not always be symmetrical. One of the breasts may begin to develop first. The other breast tissue will catch the first one in 6 months. Apart from that, every woman may have a natural symmetry difference between her two breasts.

Mons pubis, also known as venus triangle as well as hair growth in the genital area, is lubricated and becomes a little fluffy. Large lips (labium majus) become larger and slightly pigmented as a bit of pigment. The vagina lengthens, the uterus grows, and the cervix grows. The vagina begins to accommodate the normal vaginal flora by forming the beats of the beaters. Vagina is now an acidic and moist environment.

The growth hormone is also stimulated by the increase of estrogens, bone development accelerates, and with the development of naturally accelerated cartilage, epiphyses close after a while and the lengthening stops. This process will not be the same for every child, of course, but on average, the child who has regular periods should be expected to have a height of 5-6 cm after the first menstruation.

Although the adolescence period is between 2-5 years, it is 3 years on average.

The growth boom occurs in the early stages of puberty in girls, unlike boys. With the increase in estrogen level in adolescence, development of internal and external genital organs, the appearance of typical fat distribution, increased bone mass and sex-specific cognitive functions and behaviors are observed in the brain.

Adolescent age can vary depending on many factors. The most important determinant here is the genetic structure. In addition, geographical location, obesity, nutrition and general health status, exposure to light and psychological structure may also affect adolescence onset age.

In order for the girl to start menstruation, the rate of fat in the body should reach 20%. For this reason, the menarche age of children who do heavy sports and have anorexia nervosa problem can be delayed.

When menstruation begins, the first menstruation is mostly anovulatory (no ovulation). This process can continue for 1-2 years and naturally irregularities can be seen. There is no point in using menstrual medications and it would be more appropriate to follow this irregularity. In the meantime, if the child is too weak and too fat, the diet and physical activity should be reviewed and necessary precautions should be taken. 7 of 10 girls with obesity in adolescence will continue their lives as an obese adult, and menstrual irregularities and painful periods can be observed more frequently in the obese group. For whatever reason, it is known that starting birth control pills in these age girls and their long-term use (except for short-term treatment requirements) are not known and you should spend this period in patience with your physician.

Early puberty (puberta precox) begins in adolescents before 9 years of age, and late puberty (puberta tarda) is started later than 16 years of age. In both cases, a child endocrinology specialist should definitely be discussed due to the developmental problems and causes and the consequences that these causes may cause. Taking early action can prevent many undesirable consequences. Early puberty requires investigation of all the causes of hormonal problems that may be related to the early maturation of the central nervous system. This group includes central nervous system tumors, ovarian tumors, adrenal gland diseases, trauma, drug use, congenital anomalies and many more.