Female Puberty and Milestones

Normal Puberty

With Lynae Brayboy, M.D.

Learning Objectives

• You will learn the mechanism for normal

female sexual development.

• You will know the normal genetic, gonadal

and phenotypic sex differentiation.

• You will know the normal germ cell

migration.

• You will know the usual timing and stages

of puberty.
Genetic Sex Determination Definition

Genetic sex (XX, XY)

Gonadal sex
(testes, ovaries)

Hormone production Sexual differentiation in Hormone production

during fetal development the brain at puberty

Sexual differentiation of Secondary sexual

the external genitalia development

Sex of assignment and

Gender identity
rearing
Fritz, Marc A. & Speroff, Leon. Clinical Gynecologic Endocrinology and Infertility, Lippincott Williams & Wilkins, 8 th Edition, 2012
Genetic Sex Determination Definition

Sox9
Wnt4
+ +
Rspo1
Fgf9
Somatic precursor
XY XX
Sry
Sox9
Wnt4
+ +
Rspo1
Sox9 Fgf9
Wnt4
+ + Granulosa cell
Rspo1
Fgf9
Sertoli cell

Fritz, Marc A. & Speroff, Leon. Clinical Gynecologic Endocrinology and Infertility, Lippincott Williams & Wilkins, 8th Edition, 2012
Gonadal Development in the Embryo Definition

6 Oogonia
Number (millions)

5
4 Oocytes
3
Oogenesis
2 Follicle
begins
formation Birth
1
begins
4 8 12 16 20 24 28 32 36 40 Puberty Menopause
Weeks gestation

Fritz, Marc A. & Speroff, Leon. Clinical Gynecologic Endocrinology and Infertility, Lippincott Williams & Wilkins, 8th Edition, 2012
Development of Paramesonephros Etiology

Bruce White & Susan Porterfield. Endocrine and Reproductive Physiology, 4th Edition, 2013, p. 183, Mosby (Elsevier)
Phenotypic Sex Characteristics Etiology

Female Male

Jones & Lopez. Human Reproductive Biology, 4th Edition,2013, p. 94, Academic Press (Elsevier)
Sex Determination in the Fetus

Female development
1st trimester 2nd trimester 3rd trimester

Development of external genitalia

Gem cell Wolffian duct degeneration

migration Ovarian
Development of uterus
follicles
Development of vagina

6 8 10 12 14 16 18 20 22 24 36
Weeks of gestation
Fritz, Marc A. & Speroff, Leon. Clinical Gynecologic Endocrinology and Infertility, Lippincott Williams & Wilkins, 8 th Edition, 2012
Sex Determination in the Fetus

Male development
1st trimester 2nd trimester 3rd trimester

Testosterone synthesis

Leydig cell Growth of external genitalia

Spermatogenic development
cords
Descent of testes
Gem cell
migration Differentiation of external genitalia
Wolffian duct differentiation
Mullerian duct regression

6 8 10 12 14 16 18 20 22 24 36
Weeks of gestation
Fritz, Marc A. & Speroff, Leon. Clinical Gynecologic Endocrinology and Infertility, Lippincott Williams & Wilkins, 8 th Edition, 2012
Puberty

With Lynae Brayboy, M.D.

Development of the Hypothalamic-Pituitary-Ovarian Axis

Environment

Central nervous system

Hypothalamus
GnRH
Anterior pituitary
FSH LH
Ovary
Estrogen Progesterone
Uterus

Menses
Fritz, Marc A. & Speroff, Leon. Clinical Gynecologic Endocrinology and Infertility, Lippincott Williams & Wilkins, 8 th Edition, 2012
Sequence of Pubertal Milestones

Breast bud 10.5

Onset pubic hair 11.0

Maximal growth 11.4

High-yield
Menarche 12.8

Adult pubic hair 13.7

Adult breast 14.6

Age (years) 8 10 12 14 16 18
Fritz, Marc A. & Speroff, Leon. Clinical Gynecologic Endocrinology and Infertility, Lippincott Williams & Wilkins, 8th Edition, 2012
1st Signs of Puberty

• Thelarche (breast budding)

• Acceleration of growth High-yield

• Pubarche (appearance of pubic hair)

• Menarche (menses)
1st Signs of Puberty: Thelarche

Tanner 1 Tanner 2 Tanner 3

Prepubertal Breast bud Breast elevation High-yield

Tanner 4 Tanner 5
Areolar mound Adult contour
© by Lecturio
1st Signs of Puberty: Pubarche

Tanner 1 Tanner 2 Tanner 3

Prepubertal Presexual hair Sexual hair High-yield

Tanner 4 Tanner 5
Mid-escutcheon Female escutcheon
© by Lecturio
1st Signs of Puberty: Menarche

High-yield
Menarche on average 2.6 years
after onset of puberty
Normal Puberty Summary

Female sexual determination is not default.

Paramesonephric development happens in the

absence of AMH.

Germ cells migrate to the gonadal ridge and invade

gonads taking cues from somatic cells.

Impetus for puberty initiation is unknown.

Learning Outcomes

 You know the normal genetic, gonadal and

phenotypic sex differentiation.

 You know the normal germ cell migration.

 You know the usual timing and stages of

puberty.