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Sexual development of girls. Early puberty in girls. Puberty of girls

For the vast majority of girls, puberty begins at 8-13 years of age (on average 10.5 years).

Stages of puberty in girls

Stages of breast development	Stages of pubic hair growth
Stage 1. Prepubertal. Only the nipples protrude above the surface of the skin	Stage 1. Prepubertal. Only vellus hair growth is noticeable, which is no more pronounced than on the anterior wall of the abdomen, i.e. no pubic hair
Stage 2. Bud stage. The breast gland and nipple protrude slightly above the surface of the skin, the areolas increase in diameter	Stage 2. Growth of lightly pigmented sparse vellus hair located only along the labia
Stage 3. Further enlargement of the mammary glands	Stage 3. The hair becomes much darker, coarser, and more crimped. There is sparse hair growth above the pubic joint
Stage 4. The areola and nipple protrude above the surface of the mammary gland in the form of a mound	Stage 4. Full pubic hair is similar to that of an adult, but the surface area covered is noticeably smaller than that of most adults.
Stage 5. Maturity stage. Only the nipple protrudes above the surface of the gland, and the areolas continue the contour of the mammary gland	Stage 5. Pubic hair, both in quality and type, corresponds to the adult period and is distributed in the form of a triangle turned upside down. Hair growth is also noted on the inner surface of the legs, but not along the linea alba, and does not extend above the base of the pubic hair triangle

During the pre-pubertal period, the level of gonadotropins and gonadal steroids is low. At the same time, under the influence of ACTH, the secretion of adrenal androgens begins to increase in girls from 6-7 years of age, i.e. several years before the activation of the hypothalamic-pituitary-gonadal system in puberty. This phenomenon is called adrenarche. The growth spurt observed before puberty and sometimes the appearance of axillary and pubic hair are associated with the action of adrenal androgens. The secretion of hormones from the adrenal cortex gradually increases until late puberty. Pubic hair growth is caused by androgens from the ovaries and adrenal glands, and hair growth is assessed separately from the degree of development of other signs of puberty.

Hair in the armpits appears at approximately 13 years of age, and at the same time the apocrine sweat glands, which are localized in the armpits, genitals and mammary glands, begin to function. Acne and acne occur in girls at the age of 13 as a result of increased secretion of steroids from the gonads.

The first sign of the onset of puberty in girls is the acceleration of growth, which precedes the pubertal growth spurt. The onset of puberty is usually associated with such an easily observable symptom as enlarged mammary glands. The shape and size of the mammary glands are also determined by genetic factors and nutrition, but characteristic stages of gland development are observed in all girls without exception. The diameter of the nipple practically does not change in the 1st-3rd stages of mammary gland development (amounting to 3-4 mm), but increases significantly in subsequent stages, reaching 7.4 mm in stage 4 and up to 10 mm in stage 5 as a result of increased estrogen secretion during menarche.

Under the influence of estrogens, the fundus/cervix ratio increases. The latter takes on a pear-shaped shape, while lengthening from 3 cm in the prepubertal period to 5 cm. The ovaries increase in volume from 1 ml in prepuberty to 2-10 ml. The length of the vagina increases from 8 cm at the beginning of puberty to 11 cm at menarche.

Pubertal growth acceleration occurs under multilateral endocrine control, in which the leading role is given to growth hormone and sex hormones, in the absence of which the pubertal growth spurt decreases or does not occur at all. By enhancing the secretion of growth hormone, sex hormones indirectly stimulate the synthesis of IGF-1 and, in addition, directly activate the formation of IGF-1 in cartilage. Sex hormones stimulate the maturation of chondrocytes and osteoblasts, which leads to the closure of the epiphyseal growth zones. On average, girls grow 25 cm during puberty, and the later puberty begins, the higher their final height is (due to the longer period of puberty).

From the beginning of puberty, the growth rate of the legs is faster than the growth rate of the body, but during the growth spurt these rates level out. The distal parts of the limbs (feet and hands) begin to grow before the proximal parts begin to grow, so a rapid increase in shoe size is the first harbinger of the pubertal growth spurt.

From mid-puberty, estrogens can stimulate the secretion of gonadotropins. The frequency of GnRH secretion peaks increases to normal values, which predominantly increases the secretion of LH compared to FSH. This stimulates the synthesis of estrogen by the ovaries and leads to a midline surge in LH secretion, which causes ovulation. However, in the first menstrual cycles, despite the median release of gonadotropins, ovulation does not always develop: up to 90% of menstrual cycles in the first year after menarche are anovulatory, and 4-5 years after menarche, up to 20% of cycles still remain anovulatory. The onset of menarche correlates closely with skeletal age 13 years.

Most parents believe that a girl’s sexual development begins with the onset of adolescence, at about 12-14 years old; this is a widespread misconception. In reality, sexual development begins much earlier. At an early age, the concept of sexual development first of all needs to include the child’s gender identification, which includes issues of a psychological rather than a physiological nature.

Puberty in girls begins at approximately 8-9 years of age. Puberty includes several stages and lasts 9-10 years. By the age of 17-18, the process of puberty should be completely completed.

The first stage is prepubertal. It is characterized by a growth spurt, the development of secondary sexual characteristics, and further development of the genital organs. The first stage of puberty ends with the appearance of the first menstruation (menarche).

The second stage begins with the onset of menarche. During the second stage, the development of secondary sexual characteristics is completed, growth slows down, and ovulatory cycles appear. With the completion of this stage, sexual and somatic development ends and the body becomes capable of childbearing.

Let's look at the main signs of puberty in girls.

Height

Growth during the onset of puberty accelerates significantly and makes a sharp jump towards the beginning of the first menstruation. The first menstruation occurs when growth has already slowed down. Most growth is determined by genetic factors, but according to modern research, each subsequent generation is, on average, several centimeters higher than the previous one.

A sharp increase in height is the reason for the disproportion and awkwardness of teenage girls. This is due to the fact that bones do not grow synchronously; different bones have different growth rates. Due to the increase in bones, the skin stretches and, in order to avoid cracks, sebaceous oils are activated, as a result, the skin and hair become oilier, and acne appears.

Development of secondary sexual characteristics

Simultaneously with the acceleration of growth in girls, the phase of growth and maturation of the mammary glands begins.

First, the size of the nipple and halos increase, and then the mammary gland as a whole begins to grow. Breast growth continues for a long time. Breasts reach their final size only after feeding the child, and the penultimate stage of growth is completed at approximately 16 years of age.

Along with breast growth, pubic hair begins to grow. Sometimes pubic hair can appear before age 10. From about 13 years old, girls begin to develop hair on their legs and under their arms.

Due to the deposition of subcutaneous fatty tissue and expansion of the pelvis, the figure changes and the girl acquires a characteristic feminine silhouette.

Menses

The first menstruation usually appears at 12-15 years of age. The appearance of the first menstruation before the age of 10, as well as the absence of menstruation before the age of 16, is a deviation from the norm; in this case, you should consult a doctor.

A regular menstrual cycle is established somewhere within a year, but even with irregular periods a girl can become pregnant. It should be noted that a recently established cycle can easily be disrupted under the influence of factors such as stress, climate change, overwork, etc.

Thanks to the full puberty of girls, the generative function of the body is ensured. The reproductive system is formed and strengthened, which as a result allows you to conceive, bear a child, give birth to him and breastfeed him. The onset of sexual development in girls does not begin with the onset of adolescence, but much earlier, and parents should begin to take care for its successful development from a very early age of their daughter. A girl's sexual development plays a big role in her adult life.

Periods of puberty in girls

On average, the duration of puberty for girls is 10 years, and this entire cycle is approximately divided into 3 stages, during which corresponding processes occur in the body.

The first period of puberty in girls ranges from 7 to 9 years of age and is called prepubertal. It is characterized by the release of gonadotropin in an acyclic mode every 5-7 days and the maturation of hypothalamic structures. The second period of puberty begins at age 10 and lasts until age 13, and is called the first phase of puberty. At this time, estrogen production in the ovaries increases, and daily cyclicity is established. The third period occurs from the ages of 14 to 17 years, and is called the second phase of puberty, during which the formation and consolidation of the reproductive type of functioning of the hypothalamic-pituitary system occurs, in which a two-phase ovulatory menstrual cycle is established, which is already full.

Signs of a girl's sexual development

A girl’s puberty, as a rule, begins with a sharp “jump” in growth; a girl grows 10 cm per year. Signs of a girl’s puberty include “clumsiness” and disproportionality of the body, associated with the disparity in the growth rate of the girl’s different bones. Sexual development is associated with changes in a girl’s skin, on which acne and pimples may appear, causing some discomfort. In addition, the girl’s mammary glands begin to mature and grow. Breast growth begins with the nipple and areola, after which the overall growth of the gland begins. Signs of a girl's sexual development also include the appearance of pubic hair, and hair begins to grow in the armpits and on the legs.

The sequence of appearance of sexual characteristics in girls

Secondary sexual characteristics are characterized by the passage of several stages of development, during which obvious changes occur in the body. The sequence of appearance of sexual characteristics in girls is as follows:

At the age of 9-10 years, the pelvic bones begin to grow, the buttocks begin to round, and a slight swelling of the areola is noted.
At 10-11 years old, the mammary gland begins to rise, hairs appear on the pubis;
At 11-12 years old, a girl’s vaginal epithelium begins to change and her genitals begin to enlarge;
At the age of 12-13 years, the glandular tissue of the mammary glands develops. At the same time, the peripapillary region continues to predominate, and a pointed cone is formed at the top of the mammary gland. Pigmentation of the nipples appears, the alkaline reaction of the vaginal secretion changes and becomes strongly acidic. The girl may have her first period;
At 13-14 years old, hair begins to grow in the armpits. In most cases, irregular menstruation is present;
At the age of 14-15 years, sharp changes in the shape of the buttocks and pelvis are noted. During this period, pregnancy is already possible;
At 15-16 years old, acne may appear. At this age, a regular menstrual cycle is established;
At the age of 16-17, a girl’s skeleton stops growing.

Secondary sexual characteristics can develop within 1.5-7 years. If you carefully monitor this development, the girl will grow into a healthy and full-fledged woman.

The time has finally come when you are faced with a wonderful, albeit difficult age.

If you are a mother, then it is difficult for you to realize that your baby is getting older and now the thoughts in her head can suddenly become multi-colored butterflies or glossy black. At this age, my mother’s girl tries to defend her character, thinking that she can handle everything herself.

Meanwhile, she does not have time to keep track of the changes in her body, which undoubtedly worry her. And you, as the closest person, have been entrusted with the responsibility to tell, help, and direct in the right direction all the energy that is overwhelming your child.

If you are a young girl, you have already had many questions regarding everything related to the adult life of a woman. But these questions could have been put off earlier, since it was far away, maybe not very interesting, and in no way connected with the life when you were a carefree girl.

Sex education for girls is a complex and time-consuming process that must be approached with caution. Not only mom, but also dad should take part in the process.

Let's start with the changes in the girl. Precisely in a girl, because perestroika does not begin when secondary sexual characteristics appear, but much earlier. On average, puberty lasts 10 - 12 years. During this time, the girl changes noticeably before the eyes of others.

Prepuberty is a period that begins at 7–8 years of age and ends with the arrival of the first menstruation. Usually this (menstruation) happens 1 to 3 years after the appearance of secondary sexual characteristics. Already from such an early age, you can notice changes in the child’s body. Hormones begin their activity, although not cyclically. But hormone releases occur constantly. In this connection, the transformation of a girl into a girl occurs.

Signs of puberty in girls

The first changes take place in the girl’s body - the hips are rounded, the growth of the pelvic bones begins. Mammary glands appear. You can already notice areas of hair growth on the pubis and armpits.

As a rule, a girl begins to grow sharply before the onset of menstruation.

All these signs may develop inconsistently. Now let’s look at each sign and the pathologies associated with it. There are several stages in the development of secondary sexual characteristics.

A few years before the onset of the first menstruation, a girl’s growth begins to grow sharply. Presumably, this happens 2 - 3 years before the onset of menstruation.

At this time, growth spurts can reach up to 10 centimeters per year.

Often during this period the child is awkward, since the bones do not grow evenly; first the hands and feet become larger, then the tubular bones and only then the torso.

Clumsiness in movements may also be observed, this is due to the fact that nerve fibers and muscles do not always keep pace with the growth of skeletal bones.

Skin covering

The skin develops according to the skeleton and muscles, for this purpose the secretion of the glands is increased in order to have good stretching, as a result of which it suffers from rashes, which in science are called “acne”, “acne” or pimples. Hair also becomes oilier at the roots, so now you need to wash your hair more often.

Subcutaneous fatty tissue also develops. There is increased deposition of fat in the hips and abdomen. The shoulders are also rounded and the waist appears.

Thelarche is the development of the mammary gland. Typically, breast growth begins in girls at 10 - 11 years old, 1.5 - 2 years before the onset of menstruation. According to WHO, the appearance of signs of breast growth after 8 years is considered normal. The nipples become sensitive and can change color, depending on the amount of pigment in the body.

There is also an increase in the size of the nipple itself. Hair growth is possible around the areola of the nipple - this happens in women of Eastern and Caucasian origin and is not a pathology. The color, shape, and size of the breast depend on genetic factors and the amount of subcutaneous adipose tissue.

There are several degrees of breast development:

Ma0— the gland is not developed, the nipple is not pigmented;
Ma1- gland tissue is palpated in the area of the areola, painful;
Ma2— the mammary gland is enlarged, the nipple and areola are raised;
Ma3- the mammary gland takes the shape of a cone whose base is located between the III and VI ribs. The nipple does not stand out separately from the areola;
Ma4- the gland has a hemispherical shape, the nipple is separated from the areola and is pigmented.

The mammary gland completes its development and grows to its maximum only after childbirth and breastfeeding. And the final stage of mammary gland development is observed at about 15 years. The mammary gland itself may be painful during the growth period and before menstruation.

Hair growth

Pubarche - hair growth of the pubic area - begins at 10 - 12 years of age. Growing pubic hair forms a triangle, the base of which is located on the lower line of the abdomen. There may be isolated hairs rising towards the navel. But if the hair densely covers the entire area, forming a diamond, you should contact a gynecologist-endocrinologist.

By the age of 13-15, hair appears in the armpits and on the legs. The hardness, color and shape of hair is individual and depends on genetic predisposition.

Armpit hair:

Ah0- no hair growth;
Ah1- hair growth with single straight hairs;
Ah2- the appearance of hair in the middle of the armpit;
Ah3- hair growth of the entire axillary area.

Pubic hair growth:

Pb0- no hair growth;
Pb1- hair growth with single straight hairs;
Pb2- appearance of hair in the center;
Pb3- hair growth of the entire pubic area along a horizontal line.

You need to learn how to properly maintain the smoothness of your legs, bikini area and armpits. Each girl chooses an individual method for achieving her goal. But do not rush into removal, because the first hair is softer, thinner and less noticeable. Over time or under the influence of external factors, they become tough.

- the beginning of menstrual flow, the first menstruation. This happens to everyone at different ages, and menarche also depends on genetics. As a rule, the first bleeding occurs from 12 to 14 years. After the start of the first menstruation, the girl's growth slows down, but other signs of puberty continue to develop.

Many girls' periods are not cyclical at the very beginning. For some, it takes some time - from six months to two years. In case of non-cyclical discharge, you should consult a doctor in the future.

During menstruation, the mammary glands may be tense and somewhat painful. Also, many girls and women experience aching pain in the lower abdomen before and during bleeding, and some experience discomfort in the stomach or intestines. All this can accompany mensis (menstruation) normally.

Before the critical days, the mood may change; more often the girl feels irritated, overwhelmed, and tearful. But all this passes during the first days of menstruation. Despite the irregularity of the cycle, a girl can become pregnant, and it is important to convey this to an immature person.

Deviations from the norm

As everyone knows, where there is a norm, there is also a pathology. Today, cases such as premature puberty in girls (PPD) are increasingly observed. And here it is important that the mother carefully approaches changes in the child’s body.

They speak of PPD if the girl herself is under 8 years of age at the appearance of her first sexual signs. At this age, a child cannot always adequately approach the innovations of his body.

Types of PPR

Precocious puberty in girls is divided into into several types.

1. True type. It occurs when the functioning of the endocrine glands - the hypothalamus and pituitary gland - is disrupted, which, in turn, stimulate the functioning of the ovaries.

full form. When all secondary signs begin to develop before the age of 7–8 years, growth slows down due to the closure of growth zones in the bones, menstrual flow appears;
incomplete form. Here secondary signs appear, but the periods themselves come much later - at 10 - 11 years.

2. False type. It is characterized by a disorder in the ovary itself - erratic production of hormones occurs, and therefore the order of appearance of secondary sexual characteristics in the child is disrupted. And there is irregular spotting, which can begin without the full development and formation of the mammary gland or hair growth.

3. Hereditary type. As a rule, if a girl has women in her pedigree (especially if it is her mother) whose maturation began earlier than the designated dates, then the child himself will turn into a girl earlier than his peers. In this case, the order of appearance of sexual characteristics will not be disrupted.

Causes of PPR

Causes of early puberty in girls can be:

If you notice any changes in your princess that can be attributed to PPR, or there is a growth spurt before the age of 7, it is better to contact a gynecologist, endocrinologist and undergo an examination. Early sexual development is a process that requires mandatory supervision by a specialist.

Delayed puberty

Another problem for mothers and their girls is delayed pubertal development in girls (DSD).

Signs of delay:

absence of onset of menstruation before age 16;
lack of sufficient growth of the mammary glands before the age of 13;
scanty hair growth by the age of 14;
insufficient growth or abnormal development of the genital organs;
lack of correspondence of height and weight to age.

Also, delayed development of maturity is a condition when a girl’s sexual development is only half complete. That is, the mammary glands have developed, there is partial hair growth, and then everything slowed down for more than a year and a half.

Causes of mental retardation

Congenital disorders of the brain.
Brain cysts and tumors.
Poisoning by poisons.
Heredity.
Exposure of the body to radiation or radiation therapy.
Removal of ovaries.
Strong physical activity.
Severe stress or malnutrition (exhaustion).
Complications after bacterial or viral infections, etc.

If you are concerned about your girl’s health, consult a doctor, he will conduct an examination and be able to make the correct diagnosis. It is easier and more effective to treat any condition of the body at the very beginning, when the pathology has not caused irreversible consequences. Everything needs to be done on time!

Another important moment in a girl’s development is growing up and becoming a girl, a woman from the inside.

Sexual development of girls should be given special attention from birth. Even from the cradle, a girl should feel like an important link in creating family comfort, since the atmosphere in the family mainly depends on her. In addition, the girl will face pregnancy, childbirth, and caring for a newborn in the future.

The child must prepare for the upcoming difficulties, and this is not bad when little girls push their dolls in strollers and already begin to experience maternal feelings and a sense of responsibility. When a girl tries to be like her mother and knows what awaits her, she enjoys all the changes and is not afraid to move forward.

If a girl is not talked to about the topic of transforming a girl into a girl, and then into a woman, all changes in her body are unpleasant for her, and the onset of menstruation generally frightens her. You need to explain everything to your princess as she grows into adulthood, step by step. It is important that next to the girl there is an older comrade in the person of a mother, friend, aunt, etc.

During adolescence, it is sometimes very difficult for teenagers to understand themselves, their mood can change dramatically, and the feeling of irritability and tearfulness does not allow them to calmly perceive changes. You should never ridicule or reproach a child during this period.

With the onset of adolescence, or rather, with its end, it is time to discuss the sexual side of her life with the girl. The girl’s behavior changes - she looks at the opposite sex more often, experiences attractions, and is overcome by erotic fantasies. A teenager must understand everything and learn not to be ashamed of it. Sex education for girls is an important task that falls on parents.

In addition to the perception itself, it is necessary to convey to your child information about the possibility of becoming pregnant and contracting infections through sexual contact. You should also tell her about the negative effects of early sexual debut. Teenagers at this age often experiment, including in this area, and violent actions are possible.

Teach your child the rules of personal hygiene, purity of sexual relations and their protection, tell them about the frequency of showering during menstruation - all this is the task of a good parent. Having matured, the child encounters new conditions of his body. For example, thrush occurs - a fairly common disease that needs to be cured in time.

Often a teenager, feeling his imperfection, withdraws into himself and suffers for a long time from symptoms that can bring severe discomfort. It is worth paying attention to the appearance of acne, it is important to tell your child how to deal with them correctly, because we all know the tendency of children to squeeze everything out. This can lead to unpleasant consequences: scarring of the skin, blood poisoning.

Sex education is often the subject of much debate. But there are certain rules that are best adhered to - they will allow you to transition into puberty as smoothly as possible and preserve the girl’s health.

It is worth paying attention to the nutrition of a teenager; girls themselves often skip meals on purpose in order, as they think, to be more beautiful. A girl should eat well to avoid delays in the development of sexual characteristics and the onset of menstruation.

Under no circumstances should you treat a teenager like an adult. A person in adolescence already knows a lot, has his own point of view, but he is just starting on the path of growing up; your advice is important to him, although sometimes he does not show it. Control is never superfluous.

Masturbation is very important in the development of sexuality. There is nothing unhealthy or shameful about this behavior. This is how the child learns to relieve stress by fantasizing, imagining imaginary actions. Contrary to the thoughts imposed by the Bible and Soviet education about masturbation as something dirty and unacceptable for a self-respecting woman, today its benefits have been proven, of course, if you don’t “go too far.”

As a conclusion

The main goals of parents, especially mothers, during puberty, are:

teach the girl to accept herself as she is;
convey all knowledge regarding sexual techniques, contraception and methods of protection against sexually transmitted infections;
show all the beauty of a woman, mother, wife;
determine the boundaries of decent behavior with the opposite sex;
teach how to cope with some ailments associated with premenstrual syndrome, thrush, etc.;
surround your child with love and care, especially when he needs it.

Of course, just like a child, you also grow up. Do not forget that the child has never been an adult, and you, adults, have already experienced all the hardships of this difficult period. How your child perceives everything depends largely on you.

The growth of mammary glands, pubic and armpit hair before the age of eight is caused by premature puberty. If these signs appear, you should consult a doctor to avoid serious gynecological problems in the future.

Last consultation

Allah asks:

The girl turned 8 years old in August and began to notice that her breasts were swollen. We went in September and did an ultrasound of the mammary glands and an ultrasound of the thyroid gland, everyone said well, the thyroid gland corresponds to age, and the mammary glands said the formation of the gland and ducts, after that in November we went to the endocrinologist, there was no free time at the doctor. She looked and said that in appearance, both in height and in principle in weight, she was normal, maybe she was just early, especially now many children are early, so even if it turns out that she is really developing, we will not treat it. She gave us appointments to take hormone tests and undergo an ultrasound. In December I had a crazy work schedule, so I decided to do this in January after the holidays. Yes, and she was so reassuring. So we took the tests, but when we took the tests, she was kicking and screaming, we could barely hold her together with the three of us. Well, thank God they passed, phew. And here are the bad tests. And they did an ultrasound of the pelvis and said everything was fine, only there were follicles in the right ovary a little more than in the left, ultrasound of the kidneys and adrenal glands, everything was fine there, only the right kidney was a little drooping, but with the kidneys at 4 years old we were in the hospital for examination, our right one was a little twisted , the doctor said with age it will fall into place, maybe it will drop a little, and that’s what happened. And the ultrasound of the abdominal cavity says everything is fine, only the gall bladder is twisted, this is what we have had since we were little. In general, she is cheerful and active, but she drinks a lot of water, pees, and loves to eat especially sweets. It’s like saying that she somehow feels bad, no. I also wrote on one forum where the doctors all write that an MRI is necessary because prolactin is elevated. I can’t imagine how to do an MRI on her, the blood was donated by mistake. The only thing is that one oncologist wrote that no MRI is needed, it’s not a tumor, the clinic is not the same. And what should I do? I’ve been sitting at work all day today, my head hurts, I’m thinking all the time, wondering what to do. Tell me what to do? One doctor says you need to do an MRI, the second says you don’t need to do it, just retake the tests in a month and look at the diagnostics, because according to them the result is despite the fact that the numbers are such prolactin is normal. Thinking about what to do, she turned to someone else, after looking at all the tests and ultrasound, she says you have hypoplasia of the thyroid gland. I'm in shock... I'm sitting crying, I don't know what to do.

Answers:

Good afternoon, you did not send the results of the thyroid ultrasound. However, if prolactin is elevated, it is indeed recommended to perform an MRI of the pituitary gland. During this examination, you will be allowed to be near your daughter and hold her hand so that she is not afraid. Also, you need to find a specialist who will analyze the results of your examinations, scattering among different specialists, it will be difficult for you to understand what your actions should be.

Aliya asks:

Hello! The doctor diagnosed my child (girl, 8 years 10 months) with partial early puberty. Based on ultrasound and tests, I gave the following conclusion. (I don’t describe all the medical indicators) The girl’s height is now 150, from the age of 7 the development of the mammary glands, light hair growth according to the female type. Now an encrinologist and head. calving clinics are sounding the alarm that I need to take diferilin, otherwise I might go on my period and my growth will stop. When we visited the gynecologist, the doctor said that this is inevitable, don’t do anything, don’t give any injections, now some children already have early sexual development, I went to a homepath, took the prescribed pills, she also said there will be early individual development, don’t give injections. And at the site they are sounding the alarm, it’s time to take diferilin. The tests are normal, there are no deviations to be nervous, there is accelerated growth and development is ahead of peers. I’m worried, my eldest girl died from anaphylactic shock, they couldn’t save her. Tell us about diferilin?

Answers Krasulya Elena Stanislavovna:

Hello! If you are recommended diferelin, then your diagnosis should be Premature puberty (PPS) of central origin, complete or incomplete form. Since only the central form (damage at the level of the pituitary gland) can be treated with this drug. It should also be clarified and indicated what happened to the pituitary gland (benign tumor, hyperfunction, or, for example, some syndrome that is accompanied by dysfunction of the pituitary gland). Here is an excerpt from the official document:
"LABORATORY RESEARCH
Determination of FSH, LH, prolactin, TSH, estradiol, testosterone, 17-OP, DHEAS, cortisol, free T4 and T3. A single determination of LH and FSH levels is not very informative in the diagnosis of PPS.
Carrying out tests that stimulate and suppress the production of steroid hormones.
-A test with a synthetic analogue of GnRH is carried out in the morning after a full sleep. The initial values of LH and FSH are determined twice - 15 minutes and immediately before the administration of GnRH. Basal concentration is calculated as the arithmetic mean of 2 measurements. A daily GnRH analogue (triptorelin) is administered rapidly as a single intravenous dose of 25–50 mcg/m2 (usually 100 mcg), followed by venous blood sampling at baseline, 30, 45, 60, and 90 minutes. Compare the initial concentration with any three highest stimulated values. The maximum increase in LH concentration is determined, as a rule, 30 minutes after administration of the drug, FSH - after 60–90 minutes. An increase in the content of LH and FSH by more than 10 times from the initial or additional values characteristic of the puberty period, i.e. exceeding 5–10 IU/l, indicates the development of complete gonadotropin-dependent PPS. An increase in FSH concentration while maintaining minimal LH concentrations in response to a test with triptorelin in patients with premature thelarche indicates a low likelihood of developing gonadotropin-dependent PPS. In children with other partial forms of PPS, the levels of LH and FSH after the test are equal to those in children under 8 years of age."
In short, you had to have tests done, but they are done only in hospitals, and not in every city.
X-ray of the hand should show that the bone age is exceeded by more than 2 years, or the growth zones are closed (it is too late to treat short stature). Electroencephalography and echoencephalography should reveal at least some abnormalities. MRI of the brain in T2-weighted mode is indicated for all girls with the development of mammary glands before 8 years of age and the appearance of pubertal hair before 6 years of age.
I understand that everything is fine with you. No menstruation yet, sparse hair growth, female type. Most likely you have an Idiopathic (sporadic or familial) variant of the disease. Puberty begins at a time close to physiological, and an early surge in the growth and development of the mammary glands is observed. Pubertal values of LH, FSH, estradiol or pubertal response to GnRH stimulation in the absence of organic and functional pathology of the central nervous system.
I most likely would not prescribe such a drug. He is far from harmless. Its use is justified; the benefits far outweigh the risks. When If the mother is 1.9 in height, and the daughter is 1.5, then maybe you should worry...
Also... You didn't indicate the child's weight, and this is important. All information about the drug is available on the Internet. Make a decision.

Tatiana asks:

My daughter is 5 years old. The endocrinologist examines us for PPR. Preliminary results are disappointing: follicles are maturing in the ovaries, cortisol is elevated. While we are talking about the examination. The doctor recommends examination by a neurologist. It suggests that this disease may be caused by hypertension syndrome. Is it possible to treat this disease by eliminating intracranial pressure, or can it only be treated by suppressing the production of hormones by the adrenal glands?

Answers Shevchenko Venera Nadirovna:

Hello Tatiana! Your daughter needs to be examined in a pediatric endocrinology department. Without receiving the results of a complete examination, it is difficult to recommend anything or make predictions. In addition to a neurologist, you need “bone age”, ultrasound of the adrenal glands, a complete hormonal examination (you indicated only cortisol, and not only the absolute amount of each hormone is important, but also their ratio). You did not indicate how PPR manifests itself: breast growth and/or pubic hair growth. The scope of the examination depends on this. Have you been seen by a gynecologist? If the laboratory of your clinic is available, it is better to take a smear from the vestibule of the vagina for a “hormonal mirror”, the result of which can indirectly indicate the estrogen saturation of your daughter’s body. If there are no other reasons other than increased intracranial pressure or impaired blood supply to the brain, a eurologist will actually be involved in the treatment. If there is no effect after 6 months, you must return to the endocrinologist and gynecologist. An increase in the level of cortisol alone does not indicate increased production of hormones by the adrenal glands. By the way, cortisol increases sharply if the child was very afraid of the blood sampling procedure. Other adrenal hormones need to be assessed. I advise you to be patient and undergo further examination. If you have any questions, please provide the results of all examinations and we will try to figure it out. Although it is easier for a doctor to interpret examination data in combination with an external examination of the girl. Be healthy!

Tonya asks:

Hello, I'm 15 years old. I'm dating a guy and I want to start having sex. What is the best way to choose protective equipment? and the main question is how can parents find out about this? Is the doctor obligated to keep this secret? thank you very much in advance.

Answers Karapetyan Eliz Martinovna:

Hello, Tonya! It is very good that you took care of the issues of contraception before starting sexual activity. Modern medicine has a large arsenal of contraceptives. All types of contraception are described in detail in the article Methods of modern contraception (protection against unwanted pregnancy). Doctors recommend the use of a condom for young, healthy girls who are beginning to become sexually active. If you have hormonal disorders, your doctor may recommend tablet contraceptives, which will not only protect you from pregnancy, but will also have a therapeutic effect. So be sure to consult a gynecologist - after 14 years of age, girls can visit him on their own, without their mother. Don't be afraid that the information you share with your doctor will reach your parents. This is a medical secret and keeping it is the responsibility of every doctor. Do not be ill!

Lena asks:

Hello dear consultants! Daughter is 5 years old. At the age of 4, after taking antibiotics due to itching due to candidiasis, she discovered masturbation. We tried everything: not paying attention and scolding and scolding and explaining that it’s not nice and you can’t behave like that. But the child says, “I like it, it’s ticklish there.” Is this a sign of precociousness? Where to go is a question for a pediatric gynecologist (there is no such thing in the city) or a neurologist. If this is not a pathology, then I don’t really want to advertise this, but what if it’s worth sounding the alarm?

Answers Shevchenko Venera Nadirovna:

Hello, Lena! In every major city, and especially in the capital of the country, there is a Center for Pediatric Gynecology. If your local pediatrician does not know the address of the Center, contact the deputy chief physician for outpatient services. Masturbation occurs against a background of prolonged itching, so it is important to undergo a full examination by specialists. I advise you to be examined for dysbacteriosis, because it creates dryness of the mucous membrane of the external genital organs, and hence itching of the vulva. Against the background of dysbiosis, a regular smear is normal; it is better to take a more detailed smear test (smear for dysbiosis). Itching can be caused by allergies, poor diet, helminthic infestations, changes in the composition of urine, and more. When ruling out all possible causes of itching or when treating identified problems, it is better to visit a psychologist without your daughter, who will tell you how to behave correctly with a child who has been diagnosed with masturbation. It is considered a violation of behavior if a girl masturbates in front of people. I wish you patience and be healthy!

Julia asks:

I am almost 18 years old when I was a child, about 4-5 years old, I remember that the first hair appeared on my pubic area, not fluff, but hard hair, and one breast was a little larger than the other, I grew in height very quickly, ( Could this be pre-mature puberty?) My mother and I didn’t go to the gynecologist then, now I have a lot of different problems and questions about gynecology, but I can’t go to the gynecologist with my mother, since I have a boyfriend and if I go with Mom, she will probably find out that we had sex and she will hardly understand it. please advise something

Answers Shevchenko Venera Nadirovna:

Hello Julia! The appearance of mammary glands or pubic/armpit hair before the age of 8 is called precocious puberty. So you are right in your assumptions. Regarding a visit to the gynecologist. At your age, you have the right to maintain medical confidentiality about the intimate side of your life, i.e. about the beginning of sexual activity.
Therefore, your fear is unjustified. In addition, when talking with a gynecologist, you can discuss not only health problems, but also questions about family planning, i.e. method of contraception. Among the highly effective, modern, micro-dosed hormonal contraceptives, there are those that have medicinal properties for correcting hormonal status, which forms against the background of premature pubic hair. Those. you catch two birds with one stone - you get high protection against unplanned pregnancy and correct your hormonal status. Be healthy!

Elena asks:

A 1.7-year-old girl with breast swelling since birth was diagnosed with PPP thelarche. The tests are normal, and the bone age is 4 years. What threatens the future?

Answers Medical consultant of the portal “health-ua.org”:

Hello, Elena!
The isosexual type of precocious puberty in girls can manifest itself in one or another clinical variant. One of them is the cerebral form. The main reasons for this situation are considered to be functional or organic - in this case, such disorders appear as a result of the peculiarities of intrauterine development of the fetus, the course of the intranatal period (immediate birth of a child - birth injuries, “oxygen starvation” of the brain, etc.), as well as diseases of the child in the first year of life with the involvement of the central nervous system (encephalitis, meningitis - infectious and inflammatory processes in the brain and its membranes).
Much less frequently, brain neoplasms (tumor processes) can serve as factors for the cerebral form of premature sexual development. Therefore, it is the latter that determine the particular severity of the prognosis. However, if such circumstances are excluded, after examination by a pediatric neurologist/neurosurgeon, as well as special paraclinical research methods recommended by them, you only need to remember regular examinations by a neurologist, endocrinologist, gynecologist to assess the child’s development over time.
Treatment of the underlying disease in the cerebral form of this disease is carried out by a neurologist/endocrinologist, and, if necessary, a neurosurgeon.
The incomplete form of the cerebral type of premature puberty (thelarche), in general, is manifested by a “extended” primary phase of puberty in time.
The age of menarche (first menstruation) in such cases, as a rule, occurs at 10-11 years.
Features of the hormonal background of sex hormones also determine the growth characteristics of the child (height up to 150-152 cm). Be healthy!

Tatiana asks:

Two months ago, my daughter developed a lump in her breast around the nipple, we went to a pediatric gynecologist in Akhdet and took tests for the hormones prolactin-115.9 (normal 40-355)
Estrodiol-0.08 (norm 0.029)
Lg-0.16 (norm 0.9-14.4)
Fsg-6.15 (norm 1.1-9.5)
Blood sugar 4.1 (normal 3.9-6.4)
The doctor said that hormones are normal at 7 years old, this is a variant of the norm, they prescribed me to drink potato juice. After a month, the thickening went away, leaving a slightly enlarged nipple. Now a lump has appeared in the other breast, slightly painful on palpation, we went back to the doctor and was prescribed to transfer prolactin using another method and drink potato juice. The doctor says that after 7 years it is normal for growth sake and therefore does not require hormonal treatment. But what confuses me is that menstruation may come soon and the child may stop growing; height at the moment is 126 cm, weight 23 kg, there have been no jumps in height and weight. Maybe it’s necessary before examination or treatment, but the doctor doesn’t prescribe it, I’m afraid to miss the moment.

Answers Rumyantseva Tatyana Stepanovna:

Hello!
Everything you describe is truly a variant of the norm. Each person is an individual and each person develops differently.
Remember yourself at 10-12 years old... Many of your classmates were already familiar with menstruation and wore bras..... In physical education lessons, some girls stood in front, and others at the back of the line...... Where do you live? What you eat? When did your period start? When is your mom's??? Yes, it’s possible that your girl’s period will begin earlier than that of her peers – and this happens.
The growth and development of our children is influenced by many factors, even just such a factor as living in a large metropolis. Don't worry about your baby's growth. The onset of puberty will not lead to a stop in growth, but on the contrary will give an impetus to its acceleration.
From the examination, I would advise you to undergo an ultrasound of the pelvic organs. An ultrasound will clearly show all the processes that occur there. You can do this, say, once every six months.
You will still need to monitor your baby closely. Drink freshly squeezed juices - carrot, apple and potato - make a mixture of them - believe me, it is not only tasty, but also very healthy!
Try to make your child more of a child and less of an adult, I mean conversations, movies, games, books, even clothes - everything has an impact.
If you see that the process of growing up continues, you will need to simply and clearly tell the girl about menstruation so that she is not afraid of spotting. And if menstruation does happen, we’ll talk about hygiene these days. Of course, doing this at 10-12 years old is somewhat easier than, say, at 9-10 years old. But I believe you will succeed!

Julia asks:

Hello. We have a problem. My seven-year-old daughter began to grow hair under her arms and on her pubic area, her voice began to change, acne appeared on her face, and she began to somehow stretch out in height. Tell me, what could this be and who is the best person to contact?

Answers Rosokha Ekaterina Miroslavovna:

Hello. The clinical picture you describe may be a manifestation of a disease such as premature sexual development. This pathology occurs as a result of disruption of the adrenal cortex, which, in turn, leads to excess production of male sex hormones. The disease is clinically manifested by the early appearance of male pattern hair, acne, enlargement of the clitoris, change in voice, male physique, and accelerated growth. With timely diagnosis and initiation of treatment, it is usually possible to reduce the level of male sex hormones in the blood and normalize the process of sexual development. Therefore, you need to immediately contact a gynecologist-endocrinologist who can carry out the necessary treatment and prescribe adequate treatment in a timely manner.

Ksenia Seryogin asks:

Hello, please help me figure this out. My daughter is almost 1 year and 9 months old, from early childhood she was diagnosed with swollen mammary glands, after I stopped breastfeeding they began to decline, now they are almost not pulped at all. But our endocrinologist sent us for tests:
1) hormones - LH 0.10 mIU/ml; FSH-3.28mIU/ml; Prolactin-7.48ng/ml; Estradiol-5.0 pg/ml; TSH-2.03 µIU/ml, so no one really told me whether it was normal or not;
2) Ultrasound of the hand with the wrist joint - showed us the age of 4.5 years;
3) Ultrasound of the pelvis - the uterus and ovaries from 3.5-4.5 years and the ovaries in the stage of formation (as the ultrasound specialist told us, this only happens at 7 years);
4) MRI of the pituitary gland - it showed nothing, they said neither a cyst nor a tumor was visible.
My question: is there really no alternative to treatment or only Defirilin? It is very scary to treat hormones with hormones. I’m already exhausted, she’s not even 2 years old yet, and all the doctors are scary. If it's not difficult, explain her tests to me. Thank you in advance.

Answers Krasulya Elena Stanislavovna:

Hello, Ksenia!
Your hormonal tests are normal. Diferilin is prescribed only for gonadotropin-dependent PPS and after a test with GnRH (if there is any doubt, it must be carried out, this is done in specialized hospitals in large regional centers).
But most likely you have Gonadotropin-independent PPS (isosexual) premature thelarche. Breast enlargement is most common in girls under 3 and over 6 years of age. As a rule, there is no pigmentation of the nipple areola, sexual hair growth and signs of estrogenization. The physical development and size of the internal genital organs corresponds to age.
The advance in maturation of the skeletal system does not exceed 1.5–2 years and does not progress further. In girls with isolated premature thelarche, in 60–70% of cases, follicles are found in the ovaries, sometimes reaching a diameter of 0.5–1.5 cm. In the hormonal status, deviations from the normative indicators for age of LH and FSH are most often absent. When tested with GnRH, girls with premature thelarche show an increased level of FSH response compared to healthy peers. The LH response is prepubertal.
Typically, the mammary glands spontaneously decrease to normal size within a year, but in some cases they remain enlarged until puberty.
Instability of gonadotropic regulation can lead to progression of sexual development in 10% of patients.
No specific treatment is required - only observation, healthy eating, regimen, vitamins.

Tatiana asks:

The girl is 6 years old, over the past year she has grown sharply and gained weight, sweating has appeared, and her character has deteriorated. She either becomes aggressive for no reason or falls into a state of melancholy. What is happening to the child, can it start like this? sexual development Is this normal at her age?

Answers Medical consultant of the portal “health-ua.org”:

Hello Tatiana!
The timing of the onset of sexual development varies from person to person, and this is especially pronounced in the case of family predisposition (constitutional, genetic factors). Thus, with the constitutional form of premature sexual development, the appearance of secondary sexual characteristics is noted - the formation of mammary glands, hair growth in the axillary areas and the pubic area - as well as menstrual-like discharge at the age of up to 7 years. All external manifestations of sexual development are initially accompanied by massive hormonal surges, “restructuring” of the neuroendocrine regulation of the child’s body as a whole (hypothalamic-pituitary centers, limbic-reticular structures), so not only physical changes, but also psychological ones are natural.
However, in order to confirm the individual physiological nature of precocious puberty, it is necessary to exclude other conditions that, accompanied by externally considered changes, may be caused by pathological disorders on the part of the structures regulating these processes.
So, taking into account the described signs, it is necessary, first of all, to confirm the “well-being” of the hypothalamic centers.
The hypothalamus is the main center for regulating the autonomic functions of the body, and the appearance of hyperhidrosis (sweating) and a sharp increase in body weight may indicate changes in the activity of this particular nervous structure, as well as the pituitary gland. Therefore, you should definitely consult a pediatric endocrinologist or neurologist.
Be healthy!

Margot asks:

Tell me, what age is considered the most favorable for starting sexual activity?

Answers Karapetyan Eliz Martinovna:

Good afternoon At 18-20 years of age, the hymen is elastic, highly extensible, and its rupture is accompanied by slight bleeding. With age, the hymen begins to lose its elasticity and thickens. 80% of the elasticity of the hymen is lost by the age of thirty. By the way, every woman’s hymen has its own characteristics. Size, type, shape, thickness, as well as the supply of blood vessels - everything is strictly individual. This leads to the fact that all women experience defloration differently. Usually there is some bleeding and pain during defloration, but there are no rules without exceptions. According to statistics, approximately 10% of women experience no bleeding or pain during their first sexual intercourse. Be healthy!

Olya asks:

My girl is 4 years old, dark long hairs have appeared under her arms, this is premature sexual development?

Answers Medical consultant of the portal “health-ua.org”:

Hello, Olya!
It is considered possible to talk about premature sexual development in a child when secondary sexual characteristics (growth of mammary glands, appearance of hair growth in typical areas, appearance of menstrual-like discharge) appear in a child under 7 years of age.
In turn, premature sexual development can be of a hetero- or isosexual type. The causes of the latter form may be cerebral, constitutional or ovarian factors. In the cerebral form of disorders of sexual development, as a rule, there are indications of functional or organic disorders of the central nervous structures (the hypothalamic-pituitary system with the natural involvement of the ovaries in the process).
This form of disorders of sexual development can be complete (when both secondary sexual characteristics and the onset of menstruation are observed) and incomplete - when hair growth appears in areas typical of the female body according to a characteristic type or development of the mammary glands in the absence of menstrual function.
The ovarian form of precocious puberty is associated with the development of hormone-producing ovarian tumors or follicular cysts.
In the constitutional form, as a rule, the age of the first menstruation in a girl (at 8-9 years) is of diagnostic importance.
Therefore, taking into account all of the above, you should immediately seek advice from a pediatric endocrinologist. Take care of your health!

Marina asks:

Good afternoon My daughter is 15 years old. Already at the age of 6, hairs began to appear on the pubis and under the arms. I then consulted a gynecologist-endocrinologist about this. At that time, the doctor identified a slight inflammation, but no treatment was prescribed for early development. First menstruation at age 11. Menstruation is irregular, with breaks of 1-2 months. Hair growth is still higher than normal: there is some on the face, thighs, butt, and a little on the chest. Six months ago (my daughter was 14 years old), during a medical examination at school, the gynecologist gave a referral for tests and an ultrasound due to irregular menstruation and complaints about hair growth. An ultrasound was performed in pediatric gynecology (slight enlargement of the ovaries, free fluid to the left of the uterus 25-10 mm) Tests: testosterone 1.0 (normal 0.01-0.5), free testosterone 9.3 (normal 0.1- 4.1), DEHA-s 4.5 (norm 0.9 - 3.6). Having this data, we came for a consultation with a gynecologist. We received referrals: ultrasound of the adrenal glands (result was normal), analysis of secretions (minor inflammation - currently treated), general clinical blood and urine tests (normal), to a neurologist, psychotherapist, ophthalmologist, pediatrician. The ophthalmologist (vascular condition) did not find any pathology. The neurologist sent for an EEG, since in childhood (up to 1 year) the child was treated for left-sided hemiparesis. EEG result: computer-topographic analysis of a resting EEG in a disorganized pattern represented by alpha activity of medium amplitude with sharply smoothed zonal differences reveals significant diffuse changes with moderate interhemispheric asymmetry in the temporal leads in the alpha and theta frequency ranges. The use of active methods of physiological control causes signs of activation of the median structures with the appearance of bilateral bursts of sharp waves, and a decrease in the threshold of paroxysmal readiness.

All surveys were carried out in October-November. After this, the gynecologist prescribed treatment with traumeel, viburkol, mulimen, veroshpiron, lymphomyosot, lactofiltrum, and vitamins. Based on the EEG results, the neurologist also prescribed treatment, but softened it due to the large number of medications taken.
After a month of this treatment, new tests were done: progesterone 0.8 (below normal), LH 2.8 (fol. phase 2.0-12.0), FSH 8.7 (normal). The doctor prescribed hormonal treatment, canceling the previous course. Since December, my daughter has been drinking Klimen. January tests: testosterone 0.5 (normal 0.01-0.8), free testosterone 10.9 (normal 0.1-4.1). They did an ultrasound again: limited. the fluid area is 27-8 mm, OD is slightly increased, OS is not increased. Doctor's decision: continue "Climen" with T monitoring. March tests: LH 5.9 (normal), FSH 9.2 (normal), testosterone 0.9 (normal 0.01-0.8), T free. 3.6 (norm 0.1-4.1) DEHA -s 4.3 (norm 0.9-3.6). Ultrasound in March: the ovaries are not enlarged, there is no fluid. May tests: Testosterone 1.2 (normal 0.01-0.8), free Testosterone 15.4 (normal 0.1-4.1), DEHA-c 4.7 (normal 0.9-3.6) .
We have been drinking Clymene for the 6th cycle already. Menstruation occurs on time. The hair growth has not disappeared, but the hair on the body has softened and decreased somewhat. However, the tests are very far from normal. At the same time (I don’t know if there is a connection), a neurologist at the district hospital said that the encephalogram (the one in October) was simply terrible.
Please excuse this huge description. But, having received the latest tests today, I am simply at a loss. We treat for 6 months. What should I do, continue treatment as before or contact someone else in Donetsk? Thank you in advance for your response.

Answers Gavrilova Irina Vsevolodovna:

Dear Marina!
According to the information you provided (somewhat chaotic), the child has polycystic ovary syndrome (unfortunately, you did not provide information about the level of LH and FSH before starting treatment).
What you write about the ultrasound does not contain sufficient information - what is important is the size of the uterus, (the ratio of width and anterior-posterior size), the thickness of the endometrium, the volume of the ovaries, the condition of the follicular apparatus, the location of the follicles in relation to the ovarian capsule. A fairly complete examination has been ordered; treatment by a neurologist is necessary. Gynecological diseases in adolescence most often develop against the background of various diseases of other organs and systems.
It is advisable for your girl to be treated by a gynecologist-endocrinologist or a pediatric gynecologist with experience in treating endocrine gynecological pathologies. It may be advisable to conduct diagnostic tests with hormones, change the drug, test for C-peptide (you do not write if you are overweight or have acne). Treatment of your daughter requires a systematic approach and must be long-term. The selection of prescribed drugs requires an individual approach. As far as I know, there are enough qualified specialists in this field in Donetsk, there is a specialized department of pediatric gynecology (you have someone to turn to) and a full-fledged consultation with a doctor will never be replaced by a correspondence consultation on the Internet.

Tanya asks:

Hello! The doctor diagnosed my child (girl, 1 year 3 months) with partial early puberty. Based on ultrasound and tests, he gave the following conclusion: True premature sexual development, incomplete form, isosexual type, thelarche. Examination:
1) PRP195mIU/l is normal
2) Ee49.8 pg/ml norm up to 30,
3) T 0.18 nmol/l is normal,
4) LH 1.99 mIU/ml norm 1.57
5) FSH 5.27 mIU/ml, normal 2.54
2) Colpocytology - CPI 0%, superficial 5%, intermediate 10%, parabolic 65%, basal 20%.
Ultrasound OMT UL 20*15*21mm
OLD 19*12
OLS 20*10
The sizes of higher education programs correspond to 3-7 years.
We were prescribed to drink melatonin, one tablet a day at 18:00. We don’t drink. Please tell us whether we should drink it or not? The instructions don’t write anything about this, it says that the drug can be taken from 12 in other sources from 16 years old. Now we drink instead of tablets, potato juice 3 times a day, a dessert spoon.
Enlargement of the mammary gland has been observed since the birth of the child. We consulted a pediatrician, he says everything is normal, this happens, the gynecologist has the same opinion. Please tell us what we should do, treat or not treat, how serious is all this? The doctor says that if we don’t treat the child, all the signs will appear sexual development. Also in a child at 2 months. there was increased muscle tone. Subepidimal cysts, but everything went away, an ultrasound was done a year later, everything was normal. At birth, the child weighed 4250 g. height 57 cm. Now 11 kg, height 79 cm.
. Thank you very much for your answer.

Answers Buyalo Valentina Vitalievna:

Tanya, this is a very serious question to answer without seeing the child. In order to take the pills (we use Androcur and Diferelin or one of the two, depending on the indications), you could undergo further examination and look at the dynamics of the tests, find out (necessarily) your bone age. How quickly did the mammary glands enlarge or were they simply enlarged from birth as you write, the size of the VPO (I would like to estimate it myself), how the pregnancy and childbirth went, etc. Consult an endocrinologist (you can conduct a test to detect the presence of PPR), again with a pediatric gynecologist - You can take a referral to our clinic, Kiev, Stretenskaya Street 7/9, KDP "Okhmatdet". Take your time with melatonin.

Ekaterina asks:

Hello. My daughter is 5 years old. At the age of 3, in 2012, she was diagnosed with PPD of central origin. Idiapotic form. height 109. weight 21.5 bone age 7 years. hormone indicators: - LH 2.76 IU/l, prolactin-1300 mIU/l, TSH-3.15 mIU/l, free T4- 15.00 pmol/l, FSH-8.60 IU/l, estradiol -126.08 pmol/ l..Dimensions of the uterus for 9 years. The follicles in both ovaries are 4-5 mm in size. MRI - MRI revealed no changes in the brain and pituitary gland. No formations were found in the pelvis. DECAPEPTYL DEPOT 1.875 was prescribed once every 28 days. After 1 year of receiving the drug (2013), bone age 7.5 years, height 119, weight 25.5 kg Lg, FSH, TSH, T4 free, prolactin is normal, Estradiol is 115.3 pmol/l. The follicular apparatus is not traced.. The dose was increased to 3.75 once every 28 days. After 9 months of treatment, the indicators are as follows: bone age 8.5 years LH, FSH, TSH, free T4 are normal, Estradiol - 126.0 pmol/l, (at 27 after the injection); 18.6 pmol/l (on the 21st day after the injection) 25.pmol/l (on the 7th day after the injection) Prolactin 646.0 mIU/l, Pelvic ultrasound - follicles of 2.5-3 mm appeared in both ovaries. Height 126, weight 28 kg. We underwent a repeat MRI examination - MRI revealed no changes in the brain and pituitary gland, no additional formations were found in the pelvis. The size of the uterus corresponds to 7 years. Tested with Synacthen depot
17-OP before the test 3.26 nmol/l, Cortisol 360.70 nmol/l, after injection of Synacthen depot after 6 hours 17-OP - 8.75 nmol/l, Cortisol - 1671.00 nmol/l, after 24 hours 17- OD 10.81 nmol/l, Cortisol - 1536 nmol/l. Based on the test results, there is no data for non-classical VDKN. We had an appointment with 4 specialists, their opinions differed:
1- bone age 8.5 years. Treatment Decapeptil depot 1 time for 28 days. Look for pituitary adenoma.
2-bone age 10 years, replacing the drug with diferelin once every 28 days. Prognosis of final height 148 cm
3- bone age 8.5-9 years. treatment with decapeptil depot 1 time every 21 days. 4- bone age 12 years. treatment: replacement of the drug with diferilin once every 28 days. Please tell me what is the reason for the increase in bone age and why the level of estradiol does not fall. Do we have the time and opportunity to correct the current situation.

Answers Rumyantseva Tatyana Stepanovna:

Hello! The picture you described fits into the PPR. This is a very serious problem - which is not easy to treat, because treatment with hormones is almost always difficult to predict. It is very important to determine the cause of PPR, and then decide on treatment. The growth of bone age depends on the level of estrogen in the blood - the higher the level, the older the age. But, if the level is high, then at an early age growth will stop and perhaps the height will remain at the level of 145-155 cm. If, during treatment with estrogen blockers, the ossification of bone tissue is stopped until the age of 8-10 years, then after stopping the drugs, the formation of M\ is possible functions are normal. The estradiol level does not fall because perhaps the dose of the drug was chosen incorrectly - it is small. Or its production is higher than the expected value and therefore its production is not suppressed. Treatment should be long-term and constant until the age of 8-10 years or more. I don’t know what city you live in - but definitely the treatment of such a problem should be at the clinic level and not just at the local doctor. Take your doctor’s recommendations seriously and follow all requirements - this will ensure positive dynamics in your treatment. As a doctor and as a mother and grandmother, I sincerely wish you success and health for your girl! Don't lose hope! The one who walks will master the road!