Delayed Puberty in Females

Adolescence has always been a tricky part of a person’s life. The body and hormonal changes that they go through when entering the teenage years are difficult. It is a vulnerable time for them as they experience constant mood swings. They have to deal with all the changes happening in their body and this might frustrate them. One thing that is common among growing teenagers is their moodiness and their growing distance from their parents. This is a delicate time in their lifethat may have lasting implications. Going through puberty is no picnic, but sadly all the preteens have to go through it.

Puberty is difficult for both boys and girls, but it is especially difficult for girls. It is when they start their periods. Girls go through puberty between the age of 8-14 years old. But not every girl’s body develops similarly. Some of them are early bloomers and some of them are late bloomers. Each of the two is not a good health sign and it may cause several health problems for the girls. Here we will discuss the problems when girls go through puberty late in their teenage years.

What is Puberty?

It is a process that every tween goes through. Your bodymatures into an adult one. Many changes occur not only physically but also psychologically. Girls go through this between the ages of 8 to 14 years old. Scientifically speaking puberty starts when the pituitary glands start making luteinizing hormone(LH) and follicle-stimulating hormone(FSH). These hormones produce estrogen, which results in all the physical changes girls go through. 

Changes a girl goes through in Puberty.

When puberty starts in a girl's body it drastically changes their appearance. It may be good or bad. Along with appearance, the hormones in their body changes their bodily functions. These are the changes:

• When they go through puberty they experience growth spurts.

• Most girls have their periods by the age of 12

• They start developing breasts

• They start getting pubic hairs, and hairs  in other places.

• Most of them start getting acne 

• They have mood swings.

Though puberty commonly happens between 8-12 years old, some girls go through delayed puberty. 

What Is Delayed Puberty?

When girls do not have their growth spurt, do not get their periods till 14, or their breasts do not develop by the age of 13, they are considered to be late bloomers or they experience a delay in their puberty. Delayed puberty is more common in teenage boys than in teenage girls.

If a girl’s body does not grow when it is supposed it maycause some health complications further in life. Though this happens rarely. Usually, if their body starts maturing later it progresses normally. 

How do you know you are experiencing delayed puberty?

With delayed puberty, you may have these symptoms:

• Breasts do not develop when you are 13

• Periods do not start till the age of 16

• Short height

• No pubic hair

• Your age does not equal bones age

Causes of the delayed puberty

Delayed puberty in girls happens because of several reasons. But once it starts it happens normally and there are rarely any complications. The reasons for delayed puberty are:

• The most common cause of late maturity is if your mother and father were also late bloomers. Normally, this pattern runs in families. So if your parents went through the same ordeal that might be the reason for your puberty kicking in late.

• Another common cause is girls who are thin and do not have the desired weight for their age. In short, another cause of delayed puberty in girls is lack of body fat. Thenormal process of puberty is disrupted if girls are underweight. This usually occurs in girls who:

▪ Are involved in sports they can be swimmers, runners, or dancers. Basically, girls involved in rigorous physical activity.

▪ Suffers from an eating disorder, like anorexia or bulimia. In this condition, girls think that they are fat and they need to lose weight even though they are not fat. It is a psychological issue and mainly they are conditioned to have these thoughts because of the society.

▪ Are malnourished. When a girl does not get proper food and diet which is required for hernormal growth process, she faces many health-related problems. One of them being delayed puberty.

• Delayed puberty is also a result of hypogonadism. Hypogonadism happens when the ovaries produce little or no hormones. This may result in the start of the late menstruation cycle. Causes of hypogonadism are: 

▪ The ovaries that are damaged and have not developed properly as they are supposed to. .

▪ If the parts of the brain that are involved in puberty have some problems.

There are certain medical conditions or treatments that can lead to hypogonadism, and they are:

▪ Celiac sprue: It is also called celiac disease, is an immune reaction that happens after eating gluten. Gluten is a protein in wheat, barley, and rye. It inflames the small intestine lining which leads to many health complications. 

▪ Hypothyroidism: It is a condition in which the thyroid glands do not produce enough hormones. They are mostly prevalent among the older ladies, but now young girls are also facing hypothyroidism. 

▪ Inflammatory bowel disease (IBD): This happens when there is an inflammation of the digestive tract. Generally, there are two types of IBD:

1. Ulcerative colitis: In this inflammation happens along the lining of the large intestine.

2. Crohn’s disease: In this inflammation happens along the lining in the deeper layers of digestive tract. 

▪ Diabetes: In this, the insulin level in a body is high or the body has high sugar levels. There are three types of diabetes: 

1. Type 1 diabetes: This is a chronic illness in which pancreas do not produce enough insulin.

2. Type 2 diabetes: In this, the body is not able to keep the blood sugar level normal because the body doesn't use insulin well.

3. Gestational diabetes: This type of diabetes happen to women during their pregnancywho never had any diabetes. 

▪ Cystic fibrosis: It is a genetic disorder that affects the cells producing mucus, sweat and digestive juices. It can severely damage the lungs, digestive system, and other body parts. 

▪ Liver and kidney diseases also lead to hypogonadism as they are unable to function properly. 

▪ Autoimmune diseases: In this the immune system of the body attacks the healthy cells inside the body. There are many types of autoimmune disease but hypogonadism may occur due to diseases like: 

1. Hashimoto thyroiditis 

2. Addison disease

▪ Cancer treatment in which chemotherapy or radiation is used can damage the ovaries.

▪ A tumor in a part of the brain is known as the pituitary gland.

▪ Turner syndrome: In this the females are born without or are missing the X chromosome.

How is Delayed Puberty Diagnosed?

Delayed puberty can be diagnosed when parents take their daughters to a health care provider. Where they will perform tests to diagnose the problem.

▪ Firstly doctor will take a family history to know if there is a pattern in the family.

▪ They also may ask about her::

▪ Eating habits

▪ Exercise routine 

▪ Health history

• The health care provider will do a thorough physical exam to see whether a girl has reached puberty or not. 

• Other testes and exams include blood tests to check the levels of some growth hormones, sex hormones, and thyroid hormones

• LH test which determines the luteinizing hormones in the body. 

• LH response to GnRH blood test is a test to see whether a pituitary gland can correctly respond to gonadotropin releasing hormone. 

• Chromosomal analysis helps to identify genetic abnormalities.

• A MRI of head to check for the tumours

• Ultrasound of ovaries and uterus

• An x-ray of the left hand and wrist to check whether bone age is less than the actual age of a female. 

How can it be treated?

Treatment method depends on the cause of delayed puberty. The doctor will first determine e the cause of delayed puberty and then start the treatment accordingly.

• If the problem is because of the family historythen usually no treatment is required. In time, puberty starts to happen on its own and progresses normally.

• If girls are thin and have too little body fat, then gaining a bit of weight may help in triggering puberty. 

• If any disease like brain tumor, hypogonadism are the causes for late puberty then starting their treatment may help to develop puberty normally.

• If it is caused by an eating disorder, in whichgirls lose excessive weight then treating that problem will also trigger the puberty.

• If all of the above methods fails and puberty does not develop then hormone therapy canbe started to trigger the puberty. The health care provider will:

1. Give estrogen  at very low doses. 

2. They will monitor the growth changes and may increase the dose every 6 to 12 months

3. Add progesterone another hormone to start menstruation

4. Giving contraceptive pills to maintain the levels of estrogen and progesterone.

When to Contact a Medical Professional?

In most cases, there is no need to contact medical professionals as delayed puberty dies not to cause any complications and once it is started it develops normally without any hiccups. Although if you want to you can contact your doctor if:

• Your daughter has a slow growth rate

• Breasts does not develop by 13 years of age

• Menstruation is delayed and does not start till the age of 16

• Puberty begins normally but it does not progress as it is supposed to.

Delayed puberty normally is not a cause for alarm. Especially if it runs in the family, there is no need to visit the doctor because it will resolve itself. But some girls with certain medical conditions like ovary damage may need to take hormones their entire lives.

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References: https://www.healthychildren.org/English/ages-stages/gradeschool/puberty/Pages/Delayed-Puberty-in-Girls-Information-for-Parents.aspx

https://medlineplus.gov/ency/article/007694.htm