Early puberty mostly affects girls and often has no obvious cause. It's less common in boys and may be more likely to be associated with an underlying problem. Your GP may refer you to a specialist if they think there could be an underlying cause that needs to be investigated. Treatment with medication is usually only recommended if it's thought early puberty will cause emotional or physical problems, such as a very short stature or early periods in girls, which may cause significant distress.
It's not always clear what causes delayed puberty. Delayed puberty is generally more common in boys. Your GP may refer you to a specialist if they think there could be an underlying cause of delayed puberty that needs to be investigated. Tests that may be carried out include a blood test to check hormone levels, a hand X-ray to help determine likely adult height, and an ultrasound or MRI scan to check for problems with glands or organs. Treatment with medication is usually recommended if the lack of development is causing problems, such as significant distress.
Page last reviewed: 11 March Next review due: 11 March Philadelphia, PA: Elsevier; chap Updated by: Neil K. Editorial team. Delayed puberty in girls.
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 Are undernourished Delayed puberty also may occur when the ovaries produce too little or no hormones. 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.
Certain medical conditions or treatments can lead to hypogonadism, including: Celiac sprue Inflammatory bowel disease IBD Hypothyroidism Diabetes mellitus Cystic fibrosis Liver and kidney disease Autoimmune diseases , such as Hashimoto thyroiditis or Addison disease Chemotherapy or radiation cancer treatment that damages the ovaries A tumor in the pituitary gland Turner syndrome , a genetic disorder.
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. 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 LH response to GnRH blood test Chromosomal analysis 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.
The treatment will depend on the cause of delayed puberty. In girls with too little body fat, gaining a bit of weight may help trigger 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.
Outlook Prognosis. Delayed puberty that runs in the family will resolve itself. Possible Complications. The estrogen replacement therapy may have side effects. Other possible complications include: Early menopause Infertility Low bone density and fractures later in life osteoporosis.
At first Addison disease may be caused by an autoimmune reaction, cancer, an infection, or some A tumor that damages the pituitary gland or the hypothalamus can lower the levels of gonadotropins or stop production of the hormones altogether.
In boys, testicular disorders such as injury, for example, resulting from prior twisting of a testis testicular torsion Testicular Torsion Testicular torsion is the twisting of a testis on its spermatic cord so that the blood supply to the testis is blocked.
Testicular torsion causes sudden, severe pain and later swelling of the The infection may also affect the testes, brain, and pancreas, especially in adults. Mumps is caused Adolescents, particularly girls, who become very thin because of excessive exercise or dieting often have delayed puberty, including an absence of menstruation amenorrhea Absence of Menstrual Periods Having no menstrual periods is called amenorrhea.
Amenorrhea is normal in the following circumstances: Before puberty During pregnancy While breastfeeding read more. Chromosomal abnormalities, such as Turner syndrome Turner Syndrome Turner syndrome is a sex chromosome abnormality in which girls are born with one of their two X chromosomes partially or completely missing. Turner syndrome is caused by the deletion of part Klinefelter syndrome occurs when a boy has one extra X chromosome. Boys may One of these genetic disorders, Kallmann syndrome Diaphragms A contraceptive is something used for preventing pregnancy birth control.
Barrier contraceptives are a type of birth control that works by keeping sperm from getting to an egg. Barrier contraceptives Adolescents who have delayed puberty may be noticeably shorter than their peers, can be teased or bullied, and often need help coping with and managing social concerns.
Although adolescents are typically uncomfortable about being different from their peers, boys in particular are more likely to feel psychologic stress and embarrassment resulting from delayed puberty. The initial evaluation of delayed puberty should consist of a complete history and physical examination to evaluate pubertal development, nutritional status, and growth.
Doctors often take x-rays of one or more bones to see the level of bone maturity called a bone age x-ray. Doctors take blood samples and do basic laboratory tests to look for signs of chronic disease, hormone level tests, and possibly genetic testing.
Doctors usually evaluate boys who have no signs of puberty by age 14 years and girls who have no signs of puberty by age 13 years or who have not menstruated by age 16 years.
If these children otherwise appear healthy, they most likely have constitutional delay. The doctor may decide to re-examine these adolescents at 6-month intervals to ensure that puberty begins and progresses normally.
Girls with severely delayed puberty should be evaluated for primary amenorrhea Evaluation Having no menstrual periods is called amenorrhea. Magnetic resonance imaging Magnetic Resonance Imaging MRI In magnetic resonance imaging MRI , a strong magnetic field and very high frequency radio waves are used to produce highly detailed images. MRI does not use x-rays and is usually very safe The treatment for delayed puberty depends on its cause.
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