Delayed puberty in girls
Delayed sexual development - girls; Pubertal delay - girls; Constitutional delayed pubertyDelayed puberty in girls occurs when breasts don't develop by age 13 or menstrual periods do not begin by age 16.
Puberty changes occur when the body starts making sex hormones. These changes normally begin to appear in girls between ages 8 to 14 years.
Puberty changes
Puberty is when your body changes and you develop from being a girl to a woman. Learn what changes to expect so that you feel more prepared....
Read Article Now Book Mark ArticleWith delayed puberty, these changes either don't occur at the normal age, or if they do, they don't progress normally. Delayed puberty is more common in boys than in girls.
Causes
In most cases of delayed puberty, growth changes just begin later than usual, sometimes called a late bloomer. Once puberty begins, it progresses normally. This pattern runs in families. This is the most common cause of late maturity.
Another common cause of delayed puberty in girls is lack of body fat. Being too thin can disrupt the normal process of puberty. This can occur in girls who:
- Are very active in sports, such as swimmers, runners, or dancers
- Have an eating disorder, such as anorexia or bulimia
Anorexia
Anorexia is an eating disorder that causes people to weigh less than is considered healthy for their age and height, usually by excessive weight loss...
Read Article Now Book Mark ArticleBulimia
Bulimia is an eating disorder in which a person has regular episodes of eating a very large amount of food (bingeing) during which the person feels a...
Read Article Now Book Mark Article - Are undernourished
Delayed puberty also may occur when the ovaries produce too little or no hormones. This is called hypogonadism.
Ovaries
Premature ovarian failure is reduced function of the ovaries (including decreased production of hormones). Ovarian failure that occurs before the ag...
Read Article Now Book Mark ArticleHypogonadism
Hypogonadism occurs when the body's sex glands (gonads) produce little or no hormones. In men, these glands are the testes. In women, these glands ...
Read Article Now Book Mark Article- This can occur when the ovaries are damaged or are not developing as they should.
- It can also occur if there's a problem with the parts of the brain involved in puberty.
Parts of the brain involved in puberty
Hypogonadism is a condition in which the male testes or the female ovaries produce little or no sex hormones. Hypogonadotropic hypogonadism (HH) is a...
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Certain medical conditions or treatments can lead to hypogonadism, including:
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Celiac sprue
Celiac sprue
Celiac disease is an autoimmune condition that damages the lining of the small intestine. This damage comes from a reaction to eating gluten. This ...
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-
Hypothyroidism
Hypothyroidism
Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone. This condition is often called underactive thyroid....
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Diabetes mellitus
Diabetes mellitus
Diabetes is a long-term (chronic) disease in which the body cannot regulate the amount of sugar in the blood.
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Cystic fibrosis
Cystic fibrosis
Cystic fibrosis is a disease that causes thick, sticky mucus to build up in the lungs, digestive tract, and other areas of the body. It is one of th...
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- Anorexia
- Liver and kidney disease
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Autoimmune diseases, such as Hashimoto thyroiditis or Addison disease
Autoimmune diseases
An autoimmune disorder occurs when the body's immune system attacks and destroys healthy body tissue by mistake. There are more than 80 autoimmune d...
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Chemotherapy or radiation cancer treatment that damages the ovaries
Chemotherapy
The term chemotherapy is used to describe cancer-killing drugs. Chemotherapy may be used to:Cure the cancerShrink the cancerPrevent the cancer from ...
Read Article Now Book Mark Article - A tumor in the pituitary gland
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Turner syndrome, a genetic disorder
Turner syndrome
Turner syndrome is a rare genetic condition in which a female does not have the usual pair of X chromosomes.
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Symptoms
Girls begin puberty between ages 8 and 14. With delayed puberty, your child may have one or more of these symptoms:
- Breasts do not develop by age 13
- No pubic hair
- Menstruation does not start by age 16
- Short height and slower rate of growth
- Uterus does not develop
- Bone age is less than your child's age
There may be other symptoms, depending on what causes delayed puberty.
Exams and Tests
Your child's health care provider will take a family history to know if delayed puberty runs in the family.
The provider also may ask about your child's:
- Eating habits
- Exercise habits
- Health history
The provider will perform a physical exam. Other exams may include:
- Blood tests to check for levels of certain growth hormones, sex hormones, and thyroid hormones
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LH response to GnRH blood test
LH response to GnRH blood test
LH response to GnRH is a blood test to help determine if your pituitary gland can correctly respond to gonadotropin releasing hormone (GnRH). LH sta...
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Chromosomal analysis or other genetic testing
Chromosomal analysis
Karyotyping is a test to examine chromosomes in a sample of cells. This test can help identify genetic problems as the cause of a disorder or diseas...
Read Article Now Book Mark Article - MRI of head for tumors
- Ultrasound of ovaries and uterus
An x-ray of the left hand and wrist to evaluate bone age may be obtained at the initial visit to see if the bones are maturing. It may be repeated over time, if needed.
Treatment
The treatment will depend on the cause of delayed puberty.
If there is a family history of late puberty, often no treatment is needed. In time, puberty will begin on its own.
In girls with too little body fat, gaining a bit of weight may help trigger puberty.
If delayed puberty is caused by a disease or an eating disorder, treating the cause may help puberty to develop normally.
If puberty fails to develop, or the child is very distressed because of the delay, hormone therapy can help start puberty. The provider will:
- Give estrogen (a sex hormone) at very low doses, either orally or as a patch
- Monitor growth changes and increase the dose every 6 to 12 months
- Add progesterone (a sex hormone) to start menstruation
- Give oral contraceptive pills to maintain normal levels of sex hormones
Support Groups
More information and support to understand more about your child's growth can be found at:
The MAGIC Foundation -- www.magicfoundation.org
Turner Syndrome Society of the United States -- www.turnersyndrome.org
Outlook (Prognosis)
Delayed puberty that runs in the family will resolve itself.
Some girls with certain conditions, such as those with damage to their ovaries, may need to take hormones their entire lives.
Possible Complications
The estrogen replacement therapy may have side effects.
Other possible complications include:
- Early menopause
Menopause
Menopause is the time in a woman's life when her periods (menstruation) stop. Most often, it is a natural, normal body change that occurs between ag...
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Infertility
Infertility
Infertility means you cannot get pregnant (conceive). There are 2 types of infertility:Primary infertility refers to couples who have not become preg...
Read Article Now Book Mark Article - Low bone density and fractures later in life (osteoporosis)
When to Contact a Medical Professional
Contact your provider if:
- Your child shows a slow growth rate
- Puberty does not begin by 13 years of age
- Puberty begins, but does not progress normally
A referral to a pediatric endocrinologist may be recommended for girls with delayed puberty.
References
Haddad NG, Eugster EA. Delayed puberty. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 122.
Krueger C, Shah H. Adolescent medicine. In: Kleinman K, McDaniel L, Molloy M, eds. The Harriet Lane Handbook : The Johns Hopkins Hospital. 22nd ed. Philadelphia, PA: Elsevier; 2021:chap 5.
Styne DM. Physiology and disorders of puberty. In Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 26.
Review Date: 7/3/2022
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.