Delayed Puberty in Girls
📌 Definition
Girls are considered to have delayed puberty if:
- No breast development by age 13.
- No menstruation by age 15–16.
Puberty typically begins between ages 8 and 13 in girls :contentReference[oaicite:1]{index=1}.
🔍 Common Causes
- Constitutional delay: A normal variant (“late bloomer”), often familial, most common cause :contentReference[oaicite:2]{index=2}.
- Low body weight or excessive exercise: Seen in athletes, eating disorders; disrupts hormone production :contentReference[oaicite:3]{index=3}.
- Chronic illness: Diseases like celiac, diabetes, IBD, cystic fibrosis can delay puberty :contentReference[oaicite:4]{index=4}.
- Hormonal issues: Thyroid dysfunction, pituitary/hypothalamus disorders (e.g., hypogonadotropic hypogonadism, Kallmann syndrome) :contentReference[oaicite:5]{index=5}.
- Ovarian/gonadal failure: Conditions like Turner syndrome or gonadal dysgenesis leading to estrogen deficiency :contentReference[oaicite:6]{index=6}.
📝 Symptoms & Signs
- No breast growth by age 13 or absent menstruation by 15–16 :contentReference[oaicite:7]{index=7}.
- Short stature or growth significantly slower than peers :contentReference[oaicite:8]{index=8}.
- Delayed bone age compared to chronological age :contentReference[oaicite:9]{index=9}.
🧪 Evaluation & Diagnosis
- Complete medical & family history, physical exam :contentReference[oaicite:10]{index=10}.
- Blood tests: LH, FSH, estrogen, thyroid, etc. :contentReference[oaicite:11]{index=11}.
- Bone age X‑ray, pelvic ultrasound :contentReference[oaicite:12]{index=12}.
- Genetic testing, MRI if needed (e.g., suspected Turner, brain abnormalities) :contentReference[oaicite:13]{index=13}.
- Referral to pediatric endocrinologist if no signs by age 13–14 :contentReference[oaicite:14]{index=14}.
💊 Treatment Options
- No treatment: For self-limited constitutional delay, puberty may begin naturally :contentReference[oaicite:15]{index=15}.
- Weight gain & reduce stress: Especially useful if due to low body weight or exercise :contentReference[oaicite:16]{index=16}.
- Hormone therapy: Estrogen with or without progesterone to stimulate puberty and initiate menstrual cycles :contentReference[oaicite:17]{index=17}.
- Treat underlying conditions: Manage chronic illness, thyroid disease, or structural abnormalities :contentReference[oaicite:18]{index=18}.
🌟 Outlook & Prognosis
Most girls with constitutional delay eventually undergo normal puberty with no long-term effects. Others may need ongoing hormone replacement if due to ovarian failure or chronic illness :contentReference[oaicite:19]{index=19}.
“Many children with delayed puberty will eventually go through an otherwise normal puberty, just at a late age.” :contentReference[oaicite:20]{index=20}
Sources: Adapted from Ichhori article and supplemented by MedlinePlus, HealthyChildren.org, Pediatric Endocrine Society, NHS, MedlinePlus, Britannica, and other trusted medical references.