Take 5: Delayed puberty

2 minute read

Late age of menarche due to constitutional delay requires reassurance, not hormonal therapy


Late age of menarche due to constitutional delay requires reassurance, not hormonal therapy.

The first occurrence of menstruation averages around 12 to 13 years, with differences between ethnic groups.

“We would be worried if a woman started developing secondary sexual characteristics before the age of eight years,” says Dr Yasmin Tan, a gynaecologist and laparoscopic surgeon at the Royal Hospital for Women in Sydney.

“It doesn’t necessarily mean something sinister is occurring but we would just want to have a look at that person.”

Dr Tan says she would like to see any patient who is 14 years who had not had her period with no secondary sexual development.

“If they’ve got breast development then we can wait till 16 years before we start to investigate them for lack of periods,” she says.

However, there is no cause for alarm in most cases, as lack of periods is usually just caused by constitutional delay.

“For hypothalamic hypogonadism, which is probably constitutional delay, reassurance – that’s the most important thing,” says Dr Tan.

Parents may insist on treatment but GPs should “sit on your hands, reassure and monitor the patient”, continues Dr Tan.

“It is sometimes really hard to get the mothers of the girls to accept this,” she says.

“They all want you to make them have their period, which in most cases you could. You could just give them the pill but it’s not the right treatment. The pill is very suppressive.

“If it’s their hypothalamic pituitary system that’s not mature yet, giving the pill is actually going to make it worse.”

In this video, Dr Tan discusses:

  • What is delayed puberty?
  • What is the normal pattern of puberty development in women?
  • Are there any variants to the normal patterns?
  • What is the average age of menarche?
  • What are the causes of delayed puberty?

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