The problem of adolescence is that the girl regards herself as a grown up adult where as the physical and emotional maturity are not achieved until several years after menarche, points out Consultant Gynaeclogist Dr. Rukmani Gopal.
Adolescence is a period of life during which the carefree child becomes a mature adult and this period varies in duration from one individual to the another. On the other hand, puberty is characterised by physical and sexual differentiation with the onset of activity of the sex organs. In short, it is a state whereby an individual becomes capable of procreation. Puberty is really the first part of adolescence the other aspects being mental and emotional adaptation to adulthood. Puberty occurs at the age of 12years in girls and 14yeas in boys.
During childhood, the growth hormone from the pituitary is concerned with the physical growth. Other endocrine organs like adrenal thyroid gonads start exerting their influence around the age of 6 to 9 years, later these endocrine changes of puberty are reformed to as pubertal milestones.
The first event of puberty is ‘adrenarche’. The adrenal androgens starts increasing by the age of 8-9 years the effect of it is seen with the appearance of axillary and pubic hair as well as transient acceleration of bone growth.
It is well known that girls experience pubertal growth spurt earlier than boys. Simultaneously, the hormone which stimulate the gonads are referred to as gonadotrophion are secreted in spurts from the pituitary which in turn is controlled by the centre in the Hypothalamus of the brain.
The activation of Hypothalamo-Pituitary-gonadal axis (hpo axis) and when it goes through a process of maturation in a progressive manner triggers the onset of menstruation called “Menarche”.
Under the influence of oestrogen from the gonads and growth hormone the female breast begins to enlarge and by the age of 9-10 yr with the development of duct, and fat deposition, the breast becomes prominent and this event is referred to as “Telarche” and actually menarche is the last feature of puberty – the order being adrenarche, telarche and menarche.
The average age of menarche is 13-14 yrs. The age of Menarche varies to some extent with family, race and social class. Menstruation tends to occur earlier in higher social classes and in urban surrounding and thus diet and environment have a definite influence on the age of menarche. The first period may be short or long and thereafter the cycle is often irregular as a result of gradual maturation process taking place in the HPO axis.
A more (or) less regular rythym is established within 2 to 3 years. All these changes have an impact on the general health / sexuality and reproductive capacity of the adolescence. The term delayed puberty is used when secondary sexual characters like breast and hair development are absent and menstruation does not begin by the age of 16 years and this requires evaluation.
Precocious puberty is when there developments are present before age of 10 years. Adolescent obesity of minor degree (Puppy Fat) tends to disappear by the age of 20 years. Obesity is always associated with overeating and stress and requires strict diet control.
During puberty and adolescence the psychological changes are profound. The happy so lucky tomboy changes into self-conscious girl who is interested in her appearance, may be moody and secretive and often imaginative and curious sex urge becomes manifest. The management of adolescence is difficult and a mature approach is necessary. She should not be ridiculed and her independence must be respected.
Attention and trust are the key to success in handling them. She should be encouraged to be continually occupied in either work (or) healthy recreation. Above all parents must be ready to accept that their child is a grown up, and encourage the disappearance of childhood dependency.
A girl who is well informed about these psychological changes of puberty and menstruation will be able to cope with the changes better than a girl who is uninformed reacts emotionally with fear and shame and gets embarrassed by the changes in her figure and sensitive to comment.
Sex education should become part of general education in the schools. Children are curious and they ask question about sex. They should be answered promptly and truthfully in the course of family conservation. While it is very necessary for children to the well informed learning the same through the present day cinema, TV and certain magazines etc does more harm than good hence the importance of “guided sex education”.
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