Normal and abnormal puberty in girls

Revised 2014

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What is puberty?

Puberty refers to the specific physical changes that happen as a child develops into an adult. Though they happen in different areas of the body, these changes are all related to each other.

Some of these changes include: bone growth; getting taller; making hormones in the adrenal glands and ovaries; growing pubic hair, underarm hair, and breasts; and the start of regular, monthly menstrual bleeding. Ultitmately puberty causes the girl to become fertile and release eggs regularly.

During puberty, the brain starts to send increasing signals to the ovaries and adrenal glands. In response, the ovaries make the hormones estrogen and
progesterone. Adrenal glands make small amounts of the “male” hormones (androgens) that are made in females. These cause the breasts to grow, cause pubic and underarm hair to grow, and start the menstrual periods.

How can puberty be measured?

In the most general sense, puberty can be measured in 3 ways:
  1. Timing – age it started
  2. Sequence – stage of puberty
  3. Tempo – how fast or slow changes occur

What is normal timing of puberty?

In general, the first signs of normal puberty in girls can start as early as age 7. African-American girls may have normal puberty signs as early as age 6. Puberty before that age is considered early and should be checked by a health-care provider.

Several factors can change when puberty will begin. Body weight can affect the timing of puberty. Girls with increased body weight may show signs of early puberty. Girls who are underweight may have puberty later.

Girls who do not have any signs of breast changes by age 13-14 or girls who have breast changes but no menstrual periods by age 15 may need to see a healthcare provider.

What is the normal sequence of puberty in girls?

The order of changes in puberty is different from person to person. Generally, the first major signs of puberty are getting taller and the beginning of breast
changes. Rapid changes in a girl’s height happen later. Pubic hair often appears next, followed by the beginning of menstrual periods, full breast maturity, and the release of eggs from the ovary every month (ovulation). Sometimes, pubic hair can come before breat development

How fast should puberty occur?

Puberty usually takes several years from beginning to end. If these changes happen over several months instead of several years, this may be a sign of abnormal puberty and should be checked by a healthcare provider. If a girl does not have menstrual periods within 5 years of beginning puberty, this may be a sign of delay.

Are there psychological changes that occur during puberty?

For most girls, puberty causes some stress. Girls may have changes in self-esteem, independence, and sexuality. Some girls may feel depressed or nervous during this time. With earlier puberty, girls’ bodies may develop faster than their emotions, intellect, or sexuality. For many girls, puberty is accompanied by more interest in relationships and dating.

What are the causes of early or late puberty?

There are many different causes. In many girls, no specific cause is found. Early or late puberty may run in families. Other causes may be due to genetics, hormones, anatomy, body weight, or exposure to medicines.

How can a diagnosis of early or delayed puberty be made?

This diagnosis is generally made by a reproductive or pediatric endocrinologist after a careful history and physical examination, often with additional blood tests or x-rays. An x-ray can check a girl’s bone age, which should be about the same as her actual age.

What is the treatment for abnormal puberty?

Treatment for abnormal puberty depends on the cause, which may or may not be serious. Each girl with abnormal puberty will have her own treatment plan.

Fact Sheets/Booklets

View more fact sheets and booklets written by the ASRM Patient Education Committee.

Assisted Reproductive Technologies (booklet)

This booklet will help you understand in vitro fertilization (IVF) and other assisted reproductive technology (ART) that have become accepted medical treatments for infertility.

Hormonal Contraception

Hormonal contraceptives contain a progestin (progesterone medicine) with or without an estrogen.

What do I need to know about Zika virus and trying to have a baby?

Common symptoms include fever, rash, joint pain, conjunctivitis (red eyes), muscle pain, and headache.

Third-Party Reproduction

The phrase “third-party reproduction” refers to involving someone other than the individual or couple that plans to raise the child (intended parent[s]) in the process of reproduction.

Resources For You

The American Society for Reproductive Medicine (ASRM) is committed to providing patients with the highest quality information about reproductive care.

Female Fertility

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SART Fertility Experts - Fertility Myths and Realities for Black Women

Black women are more likely to experience infertility and less likely to seek and receive timely treatment. Listen to the Episode
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SART Fertility Experts - Wellness and Fertility: Diet, Sleep and Exercise

Drs. Timothy Hickman and Rashmi Kudesia discuss the links between lifestyle and fertility. Listen to the Episode
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SART Fertility Experts - Preconception Counseling

This podcast episode covers the topic of preconception counseling.  Listen to the Episode
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Female Fertility Journey

If you've been trying to get pregnant for more than a year, you may have infertility. Infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children.

View the Patient Journey
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SART Fertility Experts - Endometriosis

Endometriosis is a condition that can affect many facets of a person’s life, from pelvic pain to struggles with infertility.   Listen to the Episode
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SART Fertility Experts - IVF: Cycles of Hope and Heartbreak

Does stress cause infertility or is it the other way round?  Listen to the Episode
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SART Fertility Experts - Fibroids and Fertility

Fibroids and their impact on fertility are discussed in this episode featuring Dr. Elizabeth Stewart, interviewed by host Dr. Brooke Rossi.  Listen to the Episode
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Infertility: an Overview (booklet)

Infertility is typically defined as the inability to achieve pregnancy after one year of unprotected intercourse. View the booklet
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Optimizing Natural Fertility

Before attempting pregnancy, a woman should make sure she is healthy enough for pregnancy by adopting a healthier lifestyle and taking prenatal vitamins. If she has a medical or genetic condition or risk of one, she should seek advice from a medical professional before conceiving (becoming pregnant) View the fact sheet
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Infertility is the result of a disease (an interruption, cessation, or disorder of body functions, systems, or organs) of the male or female reproductive tract which prevents the conception of a child or the ability to carry a pregnancy to delivery.  Watch Video
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Basic Infertility Evaluation

Dr. Roger Lobo of the American Society for Reproductive Medicine discusses the various methods to evaluate infertility. Watch Video
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What is Recurrent Pregnancy Loss (RPL)?

This is a condition when a woman has 2 or more clinical pregnancy losses (miscarriages) before the pregnancies reach 20 weeks. View the fact sheet
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Hypothyroidism and pregnancy: what should I know?

Hypothyroidism (underactive thyroid) is when the thyroid gland produces less  thyroid hormone than it should. View the Fact Sheet
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Female Cancers, Cryopreservation, and Fertility

Yes! New technology lets your doctor remove and freeze eggs, fertilized eggs (embryos), or ovarian tissue before treating your cancer. This way, you may be able to have children after your treatment. View the Fact Sheet
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Weight and fertility

One of the easiest ways to determine if you are underweight or overweight is to calculate your body mass index (BMI). View the fact sheet
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Stress and infertility

It is not clear how exactly stress impacts fertility. Read the Fact Sheet
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Am I Ovulating?

Ovulation is the release of an egg from a woman’s ovaries and is essential for getting pregnant. View the Fact Sheet
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Dilation and Curettage (D&C)

“Dilation and curettage” (D&C) is a short surgical procedure that removes tissue from your uterus (womb). You may need this procedure if you have unexplained or abnormal bleeding or if you have delivered a baby and placental tissue remains in your womb. View the Fact Sheet
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Evaluation of the Uterus

If you haven’t been able to get pregnant after trying for 6 months, some tests can be done to help find the reason. Your doctor may test your hormone levels, your partner’s sperm, and your reproductive organs (ovaries, fallopian tubes, and uterus [womb]). View the Fact Sheet
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Abnormalities of the Female Reproductive Tract (Müllerian Defects)

Sometimes the uterus and fallopian tubes may not form like they should. These malformations are called müllerian anomalies or defects. Müllerian anomalies may make it difficult or impossible to become pregnant. View the Fact Sheet
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Conditions Treated with Adnexal Surgery

Surgery can be used to treat problems with your ovaries or fallopian tubes such as cysts, endometriosis or infections. Adnexal surgery involves any of the organs that are on the sides of (“next to”) the uterus (womb), such as the fallopian tubes and ovaries.

  View the Fact Sheet
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Diagnostic Testing for Female Infertility

An evaluation of a woman for infertility is appropriate for women who have not become pregnant after having 12 months of regular, unprotected intercourse. View the Fact Sheet
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Endometriosis (booklet)

Women with endometriosis may experience infertility, pelvic pain, or both. This booklet will describe options for diagnosing and treating pain or infertility that may be attributed to endometriosis. View the Booklet
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Fertility Drugs And The Risk of Multiple Births

Infertility treatments that cause multiple eggs to develop make it more likely that you will become pregnant with twins, triplets, or more. This is called multiple gestation. View the Fact Sheet
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Ovulation Detection

Ovulation, the release of an egg from its follicle in one of a woman’s two ovaries, is one of the most important factors in conceiving a child. View the fact sheet
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FAQ About Infertility

Infertility is not an inconvenience; it's a disease of the reproductive system that impairs the body's ability to perform the basic function of reproduction. Learn the facts
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Female Fertility Infographics

ASRM has prepared infographics to illustrate the subject of Female Fertility better. View the Infographics
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Ovarian Reserve Infographics

ASRM has prepared infographics to illustrate the subject of Ovarian Reserve better. View the Infographics

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