Physiology of pubertal development in females

Puberty is the critical time when children develop into sexually mature adults. The span of time over which puberty occurs is often referred to interchangeably as adolescence. Adolescence can be an emotionally and physically challenging time for not only the adolescent, but also for their family. The onset and tempo of puberty is controlled by many factors, and the step-wise progression through pubertal milestones in females is best described as the Tanner stages of pubertal development. Puberty in females normally begins with breast development (thelarche) and then progresses to pubarche (onset of pubic hair), peak growth velocity (also known as the growth spurt), and menarche. The onset of puberty is controlled by the hypothalamic-pituitary-gonadal (HPG) axis. Another hormonal cascade, known as the hypothalamic-pituitary-adrenal (HPA) axis, is responsible for stimulating other supporting (secondary) sexual characteristics. An understanding of normal physiology of puberty is essential in order to recognize deviations from the norm and the disorders associated with pubertal development. This article reviews various aspects of the physiology of pubertal development in females.