Delayed puberty in girls is defined as the lack of any pubertal signs by the age of 13 years. The first sign of puberty in girls is breast bud development, accompanied by acceleration in linear growth.
Menarche usually occurs within 3 years of breast bud development, and is considered delayed if beyond this, or if menarche has not been reached by age 15 years.
Most patients seek medical advice because of slow growth, short stature and lack of periods.
Initial assessment should include:
- height and weight, plotted on growth chart, ideally with plotting of both parents’ height
- clinical examination for signs of pubertal development
- family history of pubertal timing where available
- Consideration of possibility of delayed puberty secondary to chronic disease
- Consideration of delayed puberty due to low BMI
- Consideration of dysmorphic features, such as those found in Turner syndrome.
Who to refer:
- Girls who do not have any breast development or growth acceleration by age 13 years
- Girls who have not reached menarche by age 15 years
- Suspected delayed puberty secondary to chronic disease (please indicate whether there is suspicion of this)
- If bloods are being checked prior to referral, as part of a work-up to exclude other chronic disease, please also include – LH, FSH, oestradiol, prolactin, TFTs and coeliac screen.
Who not to refer:
- Girls who are under the age of 13 years, unless there are other confounding factors in the history. In this case the team is happy to discuss.
How to refer:
Please refer via SCI Gateway to RHCYP à Endocrinology.
