1. Puberty Is the period which links the childhood and adulthood

2. Female Pubertal Developments Period: 4-5 years (1.5-6 years)

3. Female Pubertal Sequences: Growth 9.8 years Thelarche 10.0 years Adrenarche 10.5 years Menarche 12.8 years

4. Time of Puberty Family Sex Nutrition Obesity Psychological Genetic General health Geographical location Exposure to the light

5. Physiology of the female puberty Hormonal & physical changes

6. I- During childhood Low levels of hormones (gonadostat): GnRH FSH&LH Estrogen

7. Suppression of the Activity Levels of Hormones Hypersensitivity of the Hypothalamus Intrinsic CNS inhibition

8. II- During Adolescence Increase levels of hormones: Adrenal androgen (Adrenarche) Gonadotrophic hormones (FSH&LH) Estrogen (Gonadarche)

9. High Activity Levels of Hormones Decrease sensitivity Maturation of Hypothalamus Increase amplitude & frequency of pulsative GnRH

10. The Release of Pulsative GnRH Increase Gonadotrophic & steroids Appearance of secondary sexual characteristics Menarche Ovulation (estradiol-LH)

11. Secondary Sexual Characteristics: Breast development Pubic and axillary hair growth Female fate distribution Vaginal and uterine growth Skeletal growth

12. Growth Growth spurt, express as increase linear growth velocity in cm per year.

13. Growth Peak: 2 years after breast budding Height: reached maximum at age 17-18 years Skeletal changes: * Insulin-like GF * Growth hormone * Sex steroid

14. Thelarche The earliest sign of of puberty to become evident is usually breast growth

15. Adrenarche The growth of pubic and axillary hair is due to increase production of adrenal androgen

16. Adrenarche Increase androgen: 6-15 years Is not under control of the following: * Gonadotrophin * ACTH * Prolactin

17. Tanner Staging The breasts and of pubic hair growth of puberty have been classified into five stages

19. Gonadarche Factors which induce gonadarche in late pre-puberty: * Anterior pituitary response GnRH * Follicle reactivity to FSH&LH

20. The Age of Menarche is decline: Improve nutritional status Body weight (47.8 kg) Percentage of fat (16-23%) Obese girls (23-30%)

21. In summary Puberty Increase levels of gonadotrophins&steroids Appearance of secondary sexual characteristics Pulsatile GnRH (10-16 years) Central negative inhibition Maturation of positive feedback