DEAR DOCTOR,

My pre-teen daughter has started showing signs of puberty. She has a strong body odour and also started ovulating. Could she have started puberty? How can I help her cope with the changes?

Leila

DEAR Leila, 

Puberty is the time between childhood and adulthood. In this phase, the body grows physically in size and changes occur due to increased levels of estrogens in girls and testosterone in boys.

The usual age of onset of puberty in girls is about 13 years, though it may be as early as 9 years or late as 16 years or so. The age for children to start puberty in girls has reduced in western countries, presumably due to better nutrition. 

Earliest sign of puberty is development of the breast buds. It begins as a sore painful swelling and prominence of nipple and may begin in one breast, followed by other. Later on these buds develop as breasts, due to deposition of fat, caused by hormone effect. Pubic hair also grows slowly at this time, followed by hair growth over armpits and over upper lip in some girls. The body grows in height, some weight gain occurs and hips become rounded.  Sweat glands grow in number, making the body sweatier.

Ovulation usually occurs 2 weeks after beginning of menstrual cycle or after some cycles. How did you ascertain that your daughter is ovulating? Was it through measuring serum progesterone levels or ultrasound of uterus? There may be rise of basal body temperature, thick discharge from the uterus and or leg cramps, and lower abdominal pain during ovulation.

Young growing girls have to be educated about puberty, to make them understand and accept the changes they are growing through.  A well balanced diet, rich in iron and calcium is helpful in making the body and bones strong. Regular physical exercise or activity keeps away obesity, which can occur otherwise due to the weight gain.

A parent, particularly mother, should freely discuss and explain about sex and subsequent risk of sexually transmitted diseases and pregnancy, to her daughter. 

Due to surge in hormone levels at this age, the libido is also enhanced.  Mentally she is too young to know the wicked world outside. A young growing girl can succumb to this sexual desire easily and fall prey to sugar daddies or make physical relations with adolescent/teenage boys.  Educating her about contraception is equally important.

She also has to be taught about menstrual cycles. Initially the cycles can be irregular for 6 months or so, and then become regular. So there is nothing to worry about irregular cycles, particularly in beginning. It is equally important for her to learn about keeping good menstrual hygiene. During menses, she should try to keep herself dry and clean to prevent infections.  

Dr Rachna Pande is a specialist in internal medicine