Health Questions and Answers

Question: What are the physical signs of puberty, when do they occur, and in what order?


The first sign of puberty is often said to be breast budding (thelarche) around age 10. In fact, an increase in linear growth velocity can be appreciated 1-2 years prior to breast budding, heralding the onset of puberty. Thelarche is followed by pubic hair development (pubarche) at age 11, attainment of peak growth velocity (9 cm/year) at age 12, and menses (menarche) at age 13. The average age of menarche for U.S. girls has trended downward over the last century, presumably due to better nutrition and less stringent working conditions for minors. On average it takes 2.5 years from the onset of breast budding to the first period.

Pubertal Event                               Mean Age ± SD
Breast budding                               10.8 ± 1.1 years
Pubic hair                                         11.0 ± 1.2 years
Maximum growth rate                12.1 ± 0.88 years
Menarche                                         12.9 ± 1.2 years


  • Frisch R, Revelle R: Height and weight at menarche and a hypothesis of menarche. Arch Dis Child 46:695-701, 1971. Medline Similar articles
  • Harlan WR, Harlan EA, Gillo GP: Secondary sex characteristics of girls 12 to 17 years of age: The U.S. Health Examination Survey. J Pediatr 96:1074, 1980. Medline Similar articles
  • Marshall WA, Tanner JM: Variations in pattern of pubertal changes in girls. Arch Dis Child 44:291, 1969. Medline Similar articles
  • Mishell DR, Stenchever MA, Droegenmueller W, Herbst AL (eds): Comprehensive Gynecology, 3rd ed. St. Louis, Mosby, 1997

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