From the Research
The presence of bilateral ovarian follicles in a 20-month-old female is generally considered a normal finding. Small follicles can be present in the ovaries of infant and toddler girls as part of normal development. These follicles typically measure less than 1 cm in diameter and represent normal ovarian tissue that is present from birth. The ovaries are hormonally active even during infancy and early childhood, though at much lower levels than during puberty. This activity can result in visible follicles on ultrasound examination.
Some key points to consider include:
- The ovaries contain a pool of primordial follicles that decrease in number throughout life, with the majority of follicles being lost before birth or during early childhood 1.
- Follicle growth up to the antral stage occurs during fetal life and infancy, and the intercycle rise in FSH is crucial for recruitment of a cohort of healthy, early antral follicles 1.
- Pre-pubertal ovaries contain a high proportion of morphologically abnormal non-growing follicles, which are lost as the child grows and develops 2.
- The presence of normal follicles alone, without other concerning symptoms or abnormal hormone levels, does not require treatment or intervention.
However, if the follicles are unusually large (greater than 1 cm), numerous, or associated with signs of precocious puberty such as breast development, pubic hair, or vaginal bleeding before age 8, further evaluation would be warranted. In such cases, consultation with a pediatric endocrinologist would be appropriate to rule out conditions like precocious puberty or ovarian cysts. Recent studies have highlighted the importance of careful evaluation and management of precocious puberty, including the use of GnRH analogs 3, 4.