Egg sacs which are called as follicle start to develop within ovaries in mother’s womb and reach the highest amount in the 5th month of pregnancy (6-7 million). Follicle amount of the baby reduces to 1 to 2 millions after delivery, reduces to 300-400 thousand and vanishes in menopasue period. Although no menstruation develops until adolescence, follicles disappear via apoptosis. Pituitary gland starts to excrete GnRH and this activates ovaries. Hormones excreted from ovaries cause breast development, axillary and pubic hairing; height increases and body shape starts to resemble mature body. Breast development is evaluated according to Tenner staging.
Puberty continues respectively with breast development, axillary and pubic hairing, rapid height growth and menarche (first menstruation) between the ages of 8 – 14. Approximate menarch age is accepted as 12 and generally it appears 2,5 years after the first signs. There are many factors which affect puberty age. Today, especially obesity and noursihment problems affect puberty negatively.
Puberty cociocus (Early puberty): is initiation of puberty before the age of 8. It is divided into two as central and peripheral. There may be also conditions where the changes which develop during puberty appear isolated (isolated breast development, isolated axillary and pubic hairing). There are sub-groups, either. In some cases, medications called as GnHr agonists may be used in order to delay puberty.
Delayed puberty: is the condition which sexual characteristics don’t maturate and the onset of the menarche is not seen until the age of 14 or absence of menarche until the age of 16 in the patient whose sexual characteristics maturated. This may be related to loss of function of the ovaries due to congenital or environmental factors (such as radiotherapy, chemotherapy), loss of function of the hypothalamus (the gland in the brain which activates ovaries) due to congenital or variety of diseases (hypogonadotropic hypogonadism).In order to make diagnosis many tests may be required by evaluating the findings of the patient.