Puberty in Girls – The Ultimate Survival Guide for Parents

Puberty can be a confusing time for girls, so here’s everything you need to know about puberty in girls – the stages, signs and ways to support them.

When you look back at your life, you’ll probably realise that the early days of parenthood were probably the most confusing time of your life. But you know what comes a close second?

Puberty!

Yes, the age of acne, awkwardness and questionable dressing choices. And now you get to go through it all over again, with your child!

Puberty is a time of change in every aspect of a child’s life – physical, emotional, and social. To help parents navigate this confusing time and provide the best support for their children, we’ve decided to do a series on puberty, with individual focus on boys and girls. Today, we are going to talk about puberty in girls – the stages, signs, possible concerns and tips for support.

The Stages of Puberty in Girls

Puberty begins when the pituitary gland starts the production of two hormones – luteinizing hormone (LH) and follicle-stimulating hormone (FSH). This then triggers a long-term process that affects nearly every system of the body, including the reproductive system, skeletal system and more.

However, these changes don’t happen all at once; they happen in stages. It starts with the ovaries increasing in size and producing estrogens, after which secondary sexual characteristics appear, followed by the first period.

These changes of puberty in girls can be classified into different stages, known as the Tanner Stages, named after British paediatrician  James Tanner. It is also known as the Sexual Maturity Rating (SMR), and is a helpful tool for parents and healthcare professionals.

Stage 1: This is the prepubertal stage, where there are no visible changes, but the ovaries have started growing

Stage 2: This is where physical changes begin to appear, such as budding breasts, enlarged clitoris, increased height, altered body odor and some pubic hair

Stage 3: This is where physical changes are more pronounced as the breasts get larger, armpit hair appears, and the skin and scalp get oilier, leading to acne

Stage 4: By this time, physical changes are fully visible, with the areolas becoming prominent, pubic hair getting thicker and height increasing. This is also when menstruation begins, which is about two years after Stage 2.

Stage 5: This is the final stage of puberty in girls, and development is complete. All body hair is now visible, and girls reach their adult height.

Typically, puberty in girls begins between 8 and 13 years of age. Puberty usually ends between 15 and 17 years of age, by which time physical development is complete. However, there may be specific cases when girls may start puberty much earlier or later.

Early Puberty in Girls

Puberty in girls is considered early if it occurs before the age of 8. The technical term for it is precocious puberty.

You’ve probably heard reports about how girls are getting their period earlier and earlier, and how this is a cause for concern. You’ve also heard people saying it’s because of all the chemicals in our food and water.

The truth is that there aren’t any concrete studies confirming this yet, although the age of onset for puberty in girls has decreased over the last century and more, from an average age of 16 to 12 today. This can largely be attributed to improved nutrition and a decline in infectious diseases.

Here are some reasons why some girls get their period earlier than usual.

Causes of Early Puberty in Girls:

• Obesity, or a higher BMI
• Abnormalities in the pituitary gland, thyroid gland or hypothalamus
• Problems with the ovaries
• Any damage to the brain, due to a tumour, infection or surgery
• Genetic disorders like McCune-Albright syndrome
• Prolonged exposure to medication containing estrogen or androgen
• Extremely small size at birth
• Being of South Asian, black, or Hispanic descent

Diagnosis and Treatment of Puberty in Girls:

Early puberty can lead to multiple problems, including shorter adult height, which in turn can lead to other psychological problems like low self-esteem. Early diagnosis is crucial, and this can be done with frequent blood tests to measure the levels of LH and FSH, as well as an X-ray of the hand and wrist to find out the bone age. In some cases, an ultrasound or MRI may be needed for further investigation.

Treatment for early puberty in girls will depend upon the underlying cause. Medication generally works to reduce hormone levels to slow down sexual development. This may be in the form of an injection, administered once every 3 months, or as an implant that lasts for a year.

Delayed Puberty in Girls

Causes of Delayed Puberty in Girls:

• Decreased body fat, especially in girls who are into sports and athletics
• Eating disorders like anorexia nervosa or bulimia
• Ovarian problems like primary ovarian insufficiency due to issues like Turner syndrome
• A deficiency of pituitary hormones LH and FSH, or the growth hormone
• Chronic illnesses like diabetes or kidney disease
• Having a family history of delayed puberty
• Being of Chinese or Korean descent

Diagnosis and Treatment of Delayed Puberty in Girls:

Diagnosis of delayed puberty is usually made with blood tests that measure the levels of the LH and FSH hormones, as well as estradiol.

Treatment will depend upon the cause; for example, girls with low body fat may need to eat more calories and gain weight to kickstart the puberty process. For hormonal issues, long-term estrogen replacement may be prescribed, as a tablet or a patch.

Physical Changes of Puberty in Girls

1. Breast Development

The medical term for breast development is thelarche, and it usually begins as small lumps or buds under the nipples. This is usually one of the first signs of puberty in girls.

Over the next few years, the breasts get larger, and the areolas become more prominent. It is common for each breast to develop at a rate different from the other. The breasts may also feel tender or sore at times.

2. Body Hair

About 6-12 months after the breasts start budding, pubic hair begins to appear. It starts off as scant hair and gets thicker and coarser over time.

In about 15% of girls, pubic hair appears before breast budding, and this is normal, too. Armpit hair comes in next, followed by hair on other parts of the body.

3. Body Size Changes

Puberty in girls is accompanied by an increase in height and weight, as well as changes in the shape of the body. These changes usually happen earlier in girls than in boys.

Girls’ height starts increasing in the second stage of puberty, and they experience a growth spurt 1-2 years before menarche. Six months before the first period, they have another fast growth spurt, and after they get their period, growth slows down and stops. Most girls don’t grow more than 1-2 inches after getting their first period.

Puberty is also when girls gain weight, about 10-11 kg. Their body fat gets redistributed along the thighs, upper arms and breasts. The hips widen as the waist narrows, and the reproductive organs and genitals – uterus, vagina, labia, clitoris – increase in size.

4. Vaginal Discharge

Six to twelve months before getting their period, it is normal for girls to experience some vaginal discharge. This is usually clear or white and thick. This is due to the increasing estrogen in the body, and there is nothing to worry about.

4. Periods

The first period is called menarche, and is a major milestone in every girl’s life. Most girls get their first period within 2-3 years of starting to grow their breasts.

The first few months after menarche can be irregular and unpredictable. Some girls may have bright red blood, while others have a reddish-brown discharge. Sometimes the period may be heavy, while in some cases it may be just spotting. Some cramping or pain is also common. These variations are a normal part of puberty in girls as the body takes time to adjust to the new changes.

6. Acne

The changing hormone levels can lead to an increase in oil production. This, in turn, results in clogged pores and trapped bacteria, leading to breakouts and acne.

Acne can appear on the face, as well as the chest and back. Most girls are free from acne by the time puberty ends, while others may suffer for longer.

7. Hair Texture Changes

The increased oil production doesn’t just affect the skin – it also affects the hair and scalp. Girls may have trouble with an oily scalp and unmanageable hair. During puberty in girls, hair can change texture and become straighter or curlier, smoother or frizzier.

8. Sweating

During puberty, the sweat glands go into overdrive, leading to an increase in sweat production, especially under the arms. This, along with the boost in oil production, can lead to increased body odour, due to which most girls start using deodorants.

Please remember that these physical changes happen over years, and not all at once. Some of these may be more intense while others may not be a big bother – it differs from girl to girl. However, do take your daughter to the doctor if you notice any of the following:

• Starting to show signs of puberty before 8 years of age
• No breast budding by the age of 13
• Not getting their first period by age 16
• Not having a menstrual cycle within five years of breast development
• Extremely heavy periods where blood soaks through clothing or sheets
• Extreme period cramps that cause absence from school or activities

Emotional Changes of Puberty in Girls

Puberty in girls may seem like it’s all about physical changes to the body, but the truth is that there’s a lot happening on the emotional side as well. During puberty, the amygdala is also changing and growing. This is the part of the brain that is associated with emotional regulation.

This means that a girl growing through puberty is already dealing with many physical changes, and now she also has to deal with unfamiliar, uncomfortable emotions. As a result, it is natural for her to behave differently, especially toward her family members.

1. Becomes moodier – It’s a known fact that hormones can alter a person’s mood, and this is particularly true during puberty in girls. When their hormones are all over the place, they may tend to become moodier and sullen.

2. Withdraws from the family – Teenage girls are in the awkward stage between child and adult, and this can cause some friction at home. They are drawn toward independence but aren’t yet ready, and these conflicting feelings can cause them to be irritated and withdrawn.

3. Draws closer to friends – Girls of adolescent age feel more drawn to people of their own age, and start developing peer groups. Friends’ opinions matter a lot, and they develop deeper friendships in this phase.

4. Shows interest in romantic relationships – Those raging hormones are also responsible here – your daughter may start developing romantic feelings towards specific people. They may also become more curious about sex and sexuality.

5. Has strong opinions – Gone is the child who could be swayed by distractions – teen girls can be stubborn! They also have strong opinions on grown-up topics like religion, politics and gender. They are more interested in their future and the world around them.

Main Concerns in Adolescent Girls

1. Anxiety and Depression

Anxiety and depression are serious mental disorders in teens, with 15% of the global burden affecting children in the 10-19 age group. In fact, they are the leading causes of disability among teenagers, with suicide being the third leading cause of death in young people.

Symptoms of anxiety and depression often manifest as irritability, trouble sleeping, poor academic performance, lack of interest in daily activities and an inability to concentrate.

2. Body Image Issues

Our society has a tendency to treat certain body parts as ‘shameful’ which results in young girls having body image issues as their bodies change during puberty. For instance, a girl whose breasts are developing faster than her friends’ may feel ashamed of them.

Feeling self-conscious about their bodies is common for teen girls, especially as society constantly pushes an ‘ideal’ upon us. Despite several awareness programs and body-positive campaigns, commercial media and popular culture still celebrate skinny as beautiful, and this affects young girls who lose confidence in themselves.

3. Eating Disorders

Several studies have shown that teen girls are greatly influenced by what they see in the media, and not meeting the ‘female body ideal’ can make them feel upset. The result is that a large percentage of adolescent girls end up with eating disorders in an attempt to be skinny and attractive.

Eating disorders like anorexia nervosa and bulimia nervosa are serious illnesses that can lead to several medical complications and even suicide. They are among the mental illnesses that are most likely to lead to death.

4. Risky Behaviours

With so many changes happening at once, puberty in girls is a chaotic time for them, and this can lead to rebellion. Some children’s curiosity may get the better of them, leading to them engaging in risky behaviours like alcohol or drug use and unsafe sex. In fact, studies have found that globally, 22% of teens aged 15-19 consumed alcohol.

5. Societal Restrictions

Studies report that as girls approach adolescence, they experience more sexual harassment than earlier. However, instead of educating girls about it, most families end up restricting girls’ movement. This leads to them missing out on valuable opportunities and experiences.

In societies like India, teen girls are also expected to contribute more to household chores than boys, including caring for younger siblings. They are faced with more rules about what they can and cannot do now that they’re older, and the lack of autonomy can irritate them further.

The sudden onset of physical and emotional changes during puberty in girls can be overwhelming and can affect their mental health. It is important for parents to be aware of how their daughters are doing and be able to spot if something is wrong. Here are some warning signs to look out for:

• A sudden decline in academic performance
• Bunking or missing classes
• Inability to handle academic workload
• Feeling overwhelmed
• Lack of interest in activities they previously enjoyed
• Withdrawing from friends and social events
• Changes in appearance or personal hygiene
• Constant irritability
• Suddenly breaking out in tears or anger

Talking about Puberty to Girls

1. Start early and talk often

Many parents find it awkward to talk to their children about puberty in girls, but it is very important that you do. If not, your daughters will seek information from other sources like the internet, and this may be riddled with misinformation.

According to a study sponsored by the Bill and Melinda Gates Foundation, 71% of Indian girls are completely unaware of menstruation before getting their first period. This is why it is crucial that parents start the conversation early, at about 7 or 8 years.

Start with very simple terms and let them ask questions. The more freedom they have to ask questions, the more comfortable they will feel about the subject. This way, you can ensure that the conversation is an ongoing one, and not a one-time affair.

2. Use the correct terms

This is similar to the advice given to parents when talking to kids about sexual abuse. Use the right terms for body parts instead of a generic ‘private parts’ or other nicknames. Using words like ‘vagina’, ‘breasts’ or ‘menstruation’ may feel weird if you’re not used to it, but that awkwardness will soon fade.

Using the right terms helps normalize these words and the changes with the associated body parts. This enables girls to feel more comfortable about their body and what’s happening to them.

3. Assuage fears and dispel myths

It is normal for young girls to feel afraid about so many things happening to them. They may worry that something is wrong with them, especially when it comes to bleeding, cramps or sore breasts. By starting the conversation about these topics early, you can assuage their fears, and reassure them that all this is normal. Please note that while you reassure them, it is important to not downplay their pain or discomfort.

Indian society also tends to associate shame with breasts and menstruation, and this can cause long-lasting trauma for young girls. Help girls understand that their bodies are beautiful, and that there is nothing shameful about having a period or buying period products or wearing a bra.

4. Talk about risky behaviours

Puberty in girls isn’t just confusing for them, it may also make them vulnerable to risky behavior like substance abuse or unsafe sexual activity. Sex education is a good way to educate girls about sex and sexuality, and also about how unnecessary risks can have far-reaching consequences.

Several schools have special programs to educate kids about drugs, but parents need to do their part too by talking about the dangers at home. Kids need to be educated about how to resist peer pressure and stick to safe spaces.

5. Set boundaries and consequences

Living with teenagers means quite a bit of unpredictability and a great deal of worry, so it is important to ensure that your home environment’s rules are stable and predictable. Make sure your child is clear about her boundaries and what is expected of her. If she oversteps, she will have to face the consequences, which should be communicated to her beforehand.

Making everything clear at the start will save you a good deal of negotiation later, and although kids may make a fuss, they’ll feel better knowing what they can and cannot do.

6. Take the help of other resources

Being the parent of a teenage daughter isn’t easy, and if you feel like you’re completely at a loss about how to talk to her, take the help of other resources. Take items lying around your home, for instance, like a sanitary pad or a bra. Ask your child what they know about it and their response should give you a good idea of where to start.

You can also use other opportunities to trigger a conversation, like if you see something on TV, or you hear a story about someone in your social circle. Ask them what they think, and answer their questions in an age-appropriate manner.

Puberty and Menstruation in Indian Culture

In many parts of India, menstruation is still considered something ‘dirty’. Menstruating women are asked to stay away from their families and sometimes even their homes. Several myths about menstruation make it appear like a woman’s period can ‘contaminate’ food items. Some even say that if a menstruating woman touches a cow, the cow becomes infertile. Then there are those who associate menstrual blood with evil spirits and ghosts.

Due to severe restrictions like these, many girls in rural areas drop out of school once they hit puberty. In some places, menstruating women aren’t allowed to bathe for the first few days of their period. This is extremely unhygienic and can lead to infections.

Please teach your daughter that menstruation is a perfectly normal bodily process, and women all over the world continue with their usual daily activities while they’re on their period. Maintaining good personal hygiene is crucial, such as changing pads/tampons frequently, wearing clean underwear and washing regularly.

In some parts of our country, puberty in girls is considered a special occasion, and celebrations are held when a girl gets her first period. Some girls seem to enjoy the festivities while others would rather be left alone. If this is a practice in your family, talk to your daughter and see how she feels. It may not be a good idea to force her to participate if she doesn’t want to.

Caring for Adolescent Girls

Periods

1. Once you’ve explained all about menstruation to your daughter, make sure she has everything she’ll need whenever she gets her first period. Show her how to use these items properly so she can handle things even if you’re not available at the time.

2. Explain the various options of menstrual products available these days, and if your daughter would like to try each out, help her.

3. Help her download a period-tracking app so she can track her period dates. Such apps also send reminders a few days before the next period is expected to start, which is a great help for girls who’ve just started menstruating.

Face and Body Care

1. Puberty in girls is also when they start taking more care of their appearance, but they should also be reminded to consider personal hygiene. Get them a deodorant that’s suitable for teenagers and advise them to use it every day.

2. Teach your daughter not to pop her pimples, however tempting it may seem. Get her medicated acne creams, or if her breakouts are severe, see a dermatologist.

3. It is normal for young girls to feel embarrassed about their growing breasts. Your daughter may feel more comfortable in looser clothes during this phase. You can also help her get a training bra when the time is right.

Nutrition

1. Make sure you are following the recommended calorie intake for the stages of puberty in girls, as shown below:

• 9-13 years: 1,400-1,800 calories, or up to 2200 calories if they are very active or into sports
• 14-18 years: 1,800-2,000 calories, or up to 2,400 calories if they are very active or into sports

2. A large percentage of India’s 120 million adolescent girls suffer from anaemia. Ensure your daughter is not one of them by giving her iron-rich foods like green leafy vegetables and meat. Vitamin C-rich foods like citrus fruits can improve the absorption of iron.

3. Puberty in girls is also a time when they need more calcium so they can build strong bones and teeth. Milk and finger millet are some examples of calcium-rich foods.

4. Try to minimise your daughter’s consumption of food that is too salty or sugary. Foods like these can lead to obesity, which in turn can cause several health issues, well into adulthood.

Wellbeing

1. Encourage your girls to move and be active. Our society tends to encourage boys to go out and play, but puberty in girls seems to act as the end of the road for them when it comes to being active. Getting them to join a sports class is a great way to ensure they stay fit.

2. Your teenager needs her privacy, and you need to respect it. Try to make knocking a habit before entering her room, and while you need to be aware of what’s happening in her life, try not to appear too nosy or interfering.

3. Most importantly, be a good role model, especially when it comes to body acceptance. Be very careful about the language you use when you’re around a teenage girl, and never make fun of another person’s body in front of her – even your own. Show her how to love and accept your body and give it all the love it deserves.

Books and Resources for Puberty in Girls

The American College of Obstetricians and Gynaecologists has a detailed FAQ section on various questions related to puberty in girls.

Puberty in girls is a challenging time, but it’s also an exciting part of their lives. Every girl goes through it differently, and no two girls’ experiences will be the same. However, you can make this important transition in their life smooth and happy. When your child knows that no matter what, you are always there to answer her questions and help her out, she will grow up to be a confident, happy and secure young woman!

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