It is really important that you understand menstrual physiology so that you can understand dysfunctional uterine bleeding, Polycystic Ovarian Disease, PMS, natural family planning methods, etc. It is unfortunate that the authors did not reproduce this chart in the 1998 edition. First sign is accelerated growth. Prior to puberty, GNRH is not pulsitile, LH and FSH are at very low levels and begin to rise and pulse with a GNRH pulse. This initially happens at night.
Reason is still unknown.
Skeletal growth rapidly increases as a Result of initial gonadal secretion of low levels of estrogen, which increases the secretion of growth hormone. Development of breasts Pubarche. Development of pubic and axillary hair Menarche. First menstrual period. Usually anovulatory for about a year.