Precocious Puberty in Girls

January 07, 2015
The habit of consuming junk food today means that many girls eat a less healthy diet than in the past, and this can sometimes result in earlier puberty. Concerned parents often come to me with a whole range of questions: “Will early puberty make my daughter shorter?”and “Will my daughter’s growth stop after she starts menstruation?” This article seeks to put parents’ minds at ease by offering answers to frequently asked questions about early puberty in girls. 

Q: What is precocious puberty?

A: Precocious puberty in girls is the appearance at an early age of signs of pubertal development, such as enlarged breasts before the age of 8 .

Q: What are the signs of precocious puberty in girls?

A: Girls undergoing precocious puberty will have enlarged and swollen nipples, typically about 1-2 cm. They will also have an increased appetite and grow more rapidly than their peers. 

Q: What are the causes of precocious puberty?

A: While precocious puberty occurs when hormones are released from a pituitary gland situated underneath the brain at an early age, the causes are unknown in most cases. However, some genetic factors are associated with precocious puberty and girls with a family history of precocious puberty are more likely to experience this condition. Precocious puberty is also more prevalent in overweight children. In a minority of cases, this condition is caused by a brain tumor.

Q: What is the mechanism for precocious puberty? 

A: Puberty is triggered by hormonal signals from the pituitary gland, which releases gonadotropins that stimulate the ovaries to produce estrogen, a female sex hormone. 
The exact factors stimulating the release of the biochemicals are not known, and there is no clear evidence indicating what is responsible for the early hormone production that leads to precocious puberty. However, family genetics and nutrition are known to play an important part. Girls who are underweight are more likely to have delayed puberty, while puberty may come early in overweight girls.

Q: What are the physical changes that occur in girls during adolescence?

A: Puberty usually starts in girls between the ages of 8-13. The first evidence of puberty is breast development. Most girls usually start their periods within 1½-2 years after their breasts begin to develop. It is common for girls to have irregular periods during the first 1-2 years as their bodies adjust to the regular cycle of menstruation. Most Thai girls usually start their periods between the ages of 12-13.

Q: What are the problems caused by precocious puberty in girls?

A: Precocious puberty can cause 2 major problems for girls due to the early release of the female sex hormones:
  • Short Adult Stature: During childhood and adolescence, girls grow rapidly due to the female sex hormones. Girls experiencing precocious puberty are generally taller than their peers at an early age as a result of rapid bone maturation. However, this also causes them to stop growing at an earlier age resulting in them being relatively short in height as adults. 
  • Emotional Problems: Girls with precocious puberty have a mature body, but immature mind. They may be embarrassed about their enlarged breasts while their peers have no physical changes. This combination of a mature body but immature mind can lead to earlier sexual encounters and unwanted pregnancies. It could also be more difficult for some girls to take care of their personal hygiene. 

Q: What is the treatment for precocious puberty?

A: The treatment for precocious puberty depends on the cause. To determine whether the child has inadvertently been taking female sex hormones, the doctor will ask questions about the use of any medications or consumption of certain foods. The doctor will also look at the girl’s growth history during the past 1-2 years to identify any signs of rapid growth. The doctor may also use an x-ray of the hand to evaluate growth. If necessary, a pelvic ultrasound or MRI brain scan may also be used, and the doctor will follow up with the patient if any abnormalities are found. If the cause of the precocious puberty is not known, a physical examination may be performed to test the level of hormones released from the pituitary gland. If these hormone levels are high, the synthetic hormone GnRH analogue can be injected into a muscle to slow down the onset of puberty. This medication blocks the hormones being released from the pituitary gland. It is given at intervals of every 4 weeks until the girl reaches the age of 12-14 years.

Q: What are the goals of treatment for precocious puberty in girls?

A: The goals of treatment for precocious puberty in girls are: 
  • To stop or slow down advanced bone aging, so that the girl will become taller when fully grown.
  • To reduce the emotional and behavioural problems caused by precocious puberty.

Q: Will girls undergoing precocious puberty grow any taller after starting their periods?

A: Girls experiencing precocious puberty will grow at a slower rate at first and then stop growing vertically altogether 2-3 years after starting their periods. They will typically gain about 5-7 cm after their first periods. 
By Dr. Pavintara Harinsoot Somnuke and Dr. Anuttara Pothikamjorn, two pediatricians specialized in pediatric growth, endrocrinology and diabetes at the Children’s (Pediatric) Center, Bumrungrad Hospital
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