From the Guidelines
Delayed puberty in females is defined as the absence of breast development by age 13 or no menstruation by age 15, and it can be caused by various factors including genetic disorders, chronic illnesses, nutritional deficiencies, excessive exercise, stress, or hormonal imbalances. The diagnosis of delayed puberty is based on the absence of physical signs of puberty, such as breast development, by age 13, or if menstruation hasn't started by age 15 1. According to the evidence, the absence of initiation of puberty (Tanner stage 2 breast development) in girls 13 years or older or failure to progress in pubertal stage for $ 12 months is a key indicator of delayed puberty 1.
Causes and Risk Factors
The causes of delayed puberty in females can be categorized into several groups, including:
- Genetic disorders
- Chronic illnesses
- Nutritional deficiencies
- Excessive exercise
- Stress
- Hormonal imbalances Some of the risk factors for delayed puberty include a family history of pubertal delay, cognitive, psychological, and emotional maturity, concomitant growth hormone deficiency, and bone mineral density Z score 1.
Treatment and Management
Treatment for delayed puberty in females depends on the underlying cause, but often involves hormone replacement therapy (HRT) to initiate breast development and other secondary sexual characteristics. Transdermal 17βE is recommended as the first choice for pubertal induction in cancer survivor girls 1. The timing of pubertal induction may also affect the final height achieved by childhood cancer survivors, and it is recommended to be carried out over a period of 2 to 3 years 1.
Monitoring and Evaluation
Monitoring of growth and pubertal development and progression is recommended for at-risk pre- and peripubertal survivors, and laboratory evaluation of FSH and estradiol is recommended for prepubertal girls who experience a failure to initiate or progress through puberty normally 1. For postpubertal females who were treated with alkylating agents and/or radiotherapy to which the ovaries were potentially exposed, a detailed menstrual history and physical examination, with specific attention paid to POI symptoms, is recommended 1.
Importance of Timely Evaluation
Delayed puberty can impact bone density development and psychological well-being, so timely evaluation by an endocrinologist or gynecologist is recommended when puberty doesn't progress normally. Most cases can be successfully treated, allowing normal development of secondary sexual characteristics and fertility.
From the Research
Definition of Delayed Puberty in Females
Delayed puberty in females is defined as the lack of breast development by 13 years of age or the absence of menarche by 16 years of age 2, 3, 4, 5.
Characteristics of Delayed Puberty
The condition can be categorized into different types, including:
- Hypogonadotropic hypogonadism (congenital and acquired) 6
- Hypergonadotropic hypogonadism (congenital and acquired) 6
- Transient hypogonadotropic hypogonadism, which includes constitutional delay of growth and puberty (CDGP) and functional hypogonadotropic hypogonadism 6
Diagnosis and Treatment
Diagnosis of delayed puberty involves a comprehensive assessment, including history, auxological data, and pubertal development examination 4. Treatment options may include hormonal replacement therapy, such as estrogen and progesterone for female hypogonadism 6. Physiological induction therapy protocols, like human chorionic gonadotropin (hCG) monotherapy, hCG + follicle-stimulating hormone combined therapy, and gonadotropin-releasing hormone infusion, have also been recommended for the treatment of hypogonadotropic hypogonadism 6.
Key Facts
- Delayed puberty can have negative effects on self-esteem and may lead to psychosocial stress 2
- CDGP is the most common cause of hypogonadism in both males and females, accounting for 60% and 30% respectively 6
- Turner syndrome is a diagnostic condition that should not be forgotten due to its frequency 5