Puberty in girls is a period of profound biological, morphological, and psychological changes between childhood and adulthood that leads to maturity and fertility. Key changes include breast development, pubic and underarm hair growth, increased height, and menstruation occurring between ages 10-16 with peak onset at 13 years. Precocious puberty refers to signs of secondary sex characteristics before age 8 or menstruation before 10. It can be central, involving normal progression of puberty starting too soon, or peripheral, caused by excess sex hormones from problems in ovaries, adrenal glands or pituitary gland. Diagnosis involves assessing growth, bone age, hormone levels and ruling out tumors or other lesions. Prognosis is generally good with

2. DEFINITION
Puberty in girls is the period which links childhood to
adulthood.

3. Profound BIOLOGICAL, MORPHOLOGICAL
and PSYCHOLOGICAL changes which lead to
full maturity and eventually fertility.

4. MORPHOLOGICAL CHANGES
Breast
Pubic and Axillary hair
Height
Menstruation
Completed between the age of 10
to 16 years

5. MENARCHE
First menstruation in life
10 – 16 years  peak time 13 years
First period is usually anovular
Ovulation may be irregular during variable periods
following menarche and may take 2 years for regular
ovulation to occur.

6. GROWTH
Increase in the height due to the hormones ( GH,
estrogen, insulin like growth factor)

7. GENITAL ORGAN CHANGES

8. OVARIES
Elongated shape becomes bulky and oval
Ovarian bulk is due to follicular enlargement at
various stages of development and proliferation of
stromal cells

9. UTERUS
Uterine body : cervix ratio = 1:2 (at birth)
= 2:1 (after
menarche)

10. VAGINA, VULVA
Thin layers of epithelium  stratified epithilium of
many layers
Cells are rich in glycogen due to oestrogen
VULVA – more reactive to steroidal hormones

11. Mons pubis and labia minora - increase in size
Breast – due to oestrogen  proliferation of duct
systems and deposition of fat. Becomes prominent
and round

15. Definition
The term precocious puberty is reserved for girls who
exhibit any secondary sex characteristics before the
age of 8 or menstruate before the age of 10

16. Causes
For the majority of children, no underlying medical
problem and no identifiable reason for the early
puberty.
2 Types of Precocious Puberty
Central / Complete / True
Peripheral / Precocious pseudopuberty
Incomplete

17. Central
Most common form of precocious puberty
Puberty process starts too soon, but the pattern
and timing of the steps in the process are normal
Constitutional, intracranial lesions

18. Central
Tumor in brain or spinal cord
Brain defect present at birth
Hyperthyroidism

19. Peripheral
Less common
Excess oestrogen or androgen
Caused by the release of estrogen into the body
because of problems with the ovaries, adrenal
glands or pituitary gland

20. Aetio - pathology
Constitutional – premature activation of HPO axis 
bone maturity accelerated  leading to premature
closure of the epiphysis.
Intracranial lesions – tumour (hypothalamus)  early
release of gonadotrophins from pituitary
Premature thelarche – isolated development of
breast tissue before the age of 8.

21. Premature puberche – isolated development of
axillary and or pubic hair prior to the age of 8.
(excess androgen production due to adrenal
hyperplasia)
Premature menarche – isolated event of cyclic
vaginal bleeding without any other signs of
secondary sexual development. (unusual endocrine
sensitivity of the endometrium)

22. DIAGNOSIS
TRUE PRECOCIOUS
CONSTITUTIONAL – H/O early menarche in mother
and sisters. Puberty changes in order. No cause can be
detected
PREMATURE THELARCHE – somatic growth not
accelerated. Bone age not advanced. Nipple
development absent. Vaginal smear – negative
oestrogen effect

23. PREMATURE PUBERCHE – no ovarian enlargement.
Adrenal tumour may be the cause.
PREMATURE MENARCHE – if no foreign body or
injury and if bleeding is cyclic- then diagnosis confirmed

24. PROGNOSIS
Apart from the short stature due to accelerated bone
maturity, they have got a normal menstrual pattern in
future. The fertility rate is also expected to be normal.