How can I judge a girl

Hormones in an uproar

When does puberty begin?

Puberty is initiated by a rhythmic release of a special hormone from the hypothalamus, the gonadotropin releasing hormone (GnRH). This is preceded by a cascade of information. An important prerequisite is, for example, a minimum amount of fatty tissue, since messenger substances produced in fatty tissue also play an important role in inducing puberty. GnRH stimulates the pituitary gland to produce control hormones such as LH and FSH, which in turn trigger the secretion of sex hormones (estrogen, then also progesterone) in the ovary.

The start time varies from person to person. However, the development of puberty follows a pattern that is well known over time, on the basis of which one can distinguish between constitutional development delays and genuine disorders in sexual development. The pubarche, that is, the beginning of pubic hair, and the thelarche, the beginning of breast development, precede the first menstrual period by about two years. About a year before the first menstrual period, there is a growth spurt or the greatest speed in length growth.

The average age of the first menstrual period in Germany is 12.8 years. 90 percent of all 14-year-old girls already had a menstrual period (1).

If the girl has not had menarche by the age of 16, the gender development must be assessed as abnormal. One then speaks of primary amenorrhea (failure of the menstrual period without it having taken place before) or pubertas tarda, a delayed development of puberty. If puberty begins before the age of eight, this is known as precocious puberty.

Assess deviations

Not every late development of puberty is a pathological occurrence that requires intervention. The pharmacy team can reassure you here: If the mother or older sister also had their first bleeding very late, the delay in development is very likely to be family-related.

If the thelarche started more than two years ago, but there is no menstrual period, the course of development is probably disturbed. The next diagnostic steps are an initial physical examination to assess the girl's height, weight and the precise developmental situation as well as the determination of individual hormone levels in the blood. A gynecological examination is not absolutely necessary for this first contact.

On the basis of the hormone values, the doctor can assess whether the hypothalamic-pituitary-ovarian axis is already activated or whether there are possibly relevant disruptive factors that impair (further) development. This can be, for example, an excessive production of male hormones (hyperandrogenemia) or of prolactin (hyperprolactinemia) or a pronounced disorder of the thyroid gland.

Malformations should also be searched for. Depending on the situation, it may be necessary to rule out chromosomal disorders (2).

Weight affects menarche