Adolescent Female

Pediatricians do not see adolescents as often as children under five years. When I do see female adolescents, certain questions commonly come up. One of the most frequently asked questions relates to the puberty. When will she have her first period? She has too few or too many menstrual periods. How do I know she is normal?

These questions are very important to parents and for their adolescents. This is a major milestone in a young women’s development and misinformation can lead to all types of problems.

During late childhood, important chemicals originating from the brain are released. These stimulate the ovaries to produce additional, essential chemicals like progesterones and estrogens. The first physical signs of puberty are breast budding. This appears around 11 years of age in about 85% of girls, but can be present as early as 8 or as late as 13 years. The appearance of public hair follows, although it may be the first sign of puberty for 15%- 20% of adolescents.

The estrogen release I mentioned earlier will change the character of the vagina and a thin, colorless, odorless fluid or discharge will precede the actual start of menstrual periods. This start of the menstrual cycle is called the menarche. Concern about this discharge is common. You can expect the menarche with menses in about 6 to 12 months following this early sign.

Menarche follows the breast budding or pubic hair of early puberty and will occur by about 12 to 16 years of age. Family history is very important. The date of onset of puberty of the mother corresponds to within one year of the age when puberty will begin for her daughter. In other words, the age when mom started her puberty is an accurate predictor of the age of puberty of her daughter.

During the first 6 to 12 months after menses begins, no egg is shed from the ovary. Because of this, it is common to notice that the periods are very irregular. Some girls may only experience one or two periods the first year while other girls will have regular monthly periods. If there has been no period by the age of 16 then I recommend a thorough evaluation by a pediatric endocrinologist or a gynecologist.