Understanding Late Puberty in Girls
As the name suggests, delayed puberty is when the child experiences signs of puberty later than usual.
Puberty is the stage when a child develops into an adult. It starts when the pituitary gland begins to produce two vital sex hormones called the luteinizing hormone [LH] and follicle-stimulating hormone [FSH] to stimulate the development of ovaries and the production of estrogen. The first sign of puberty is thelarche or breast development; usually, the first menstrual cycle will follow 2–3 years later.
Read everything you need about puberty.
In normal cases, these changes begin between the ages of 8 and 14 for girls. A child is considered to have delayed maturation when the breasts haven’t developed by 13 or menstruation hasn’t begun by 16.
Signs of Delayed Puberty
The signs of delayed puberty include:
- Lack of breast development by 13
- Absence of menstrual cycle by 16
- Five or more years between the initial breast growth and the first menstrual period
- Lack of pubic hair
- Lack of bone maturity
- Slow growth rate or shorter-than-average height
- Inhibited uterine development
Causes of Delayed Puberty in Females
In most cases, puberty simply begins later than usual. Once it starts, it usually progresses normally. However, if the child doesn’t show any signs of puberty, it can be due to a variety of reasons. Some of the causes of delayed puberty in girls include:
A. Constitutional Delay of Puberty and Growth [CDPG]
Most often, delayed puberty is simply a result of the growth and development history of the family. A child may mature late if their parents, siblings, uncles, aunts, or cousins develop later too. This is known as constitutional delay or late blooming. A study published in 2022 found that CDPG was the leading cause of delayed puberty, as it affected 53% of adolescents. It was also understood that CDPG affected more boys than girls. In the case of constitutional delay, the child doesn’t require any treatment as puberty will normally begin, just later than others.
B. Low Body Fat
Lower-than-average body fat is another major factor in delayed puberty in girls. The body requires adequate fat reserves to commence puberty, especially menstruation. That’s why extremely active girls like swimmers, ballet dancers, runners, or gymnasts may experience delayed puberty. It can also be seen in unusually thin girls due to chronic illnesses that reduce body fat or participate in unhealthy habits like excessive dieting.
C. Malnourishment
Not getting adequate nutrients or following a poor diet can also lead to delayed puberty. Food scarcity or eating disorders can impact the growth and development of the child, thus leading to late maturation.
D. Functional Disorders
Delayed puberty can also be caused by a functional disorder called hypogonadism. Hypogonadism is when the ovaries produce little to no hormones due to ovarian damage or improper development. It can also occur when there are dysfunctions in the part of the brain that controls puberty. Often, delayed puberty is a side effect of hypogonadism which is caused by other medical conditions, including:
- Autoimmune Diseases
- Anorexia
- Chemotherapy or exposure to radiation [which damages the ovaries]
- Celiac Sprue
- Cystic Fibrosis
- Diabetes Mellitus
- Hypothyroidism
- Inflammatory Bowel Disease [IBD]
- Liver or Kidney Diseases
- Sickle Cell Disease
- Tumor in Pituitary Gland
- Turner Syndrome
Other medical illness that causes low body fat can also cause delayed puberty.
E. Other Causes
Other causes of delayed maturation include asthma, hypopituitarism [underactive pituitary gland], abnormal development of the reproductive system, androgen insensitivity syndrome, or too much exercise.
Diagnosis of Delayed Puberty in Females
Fortunately, late maturation is easy to spot. Once the cause is identified, doctors can treat the child to develop normally. If you’re concerned that your daughter is experiencing delayed puberty, consult a specialist in your area. In addition to understanding your family’s and child’s medical history, they may also request
- Blood Tests: To measure hormone levels and detect chromosomal problems and other illnesses that can cause delayed puberty in females.
- Hand X-Rays: To evaluate if the bones are maturing normally. Usually, an X-ray is done on the left hand and wrist bones to understand bone maturity. Although X-rays are commonly recommended, it is typically delayed by 2+ years to give adequate time for additional growth.
- CT Scan: To scan internal organs, bones, and muscles for better understanding.
- MRI: To evaluate the brain for tumors.
- Ultrasound: To evaluate the uterus and ovaries for abnormalities or restrained growth.
Treatment of Delayed Puberty in Females
A vast majority of delayed puberty cases usually resolve once the underlying problem is addressed.
Girls that inherit delayed maturation don’t require any treatment as puberty will eventually start on its own. Giving small doses of estrogen for 4-6 months may be recommended to initiate breast development and assist the process of puberty.
If the doctor finds an issue, they might send the teen to a pediatric endocrinologist or other specialists for further treatment.
How to Help Your Daughter
Without a doubt, it can be frustrating for your daughter to watch her peers grow and develop. It’s natural for her to struggle with confidence and self-esteem issues as she compares herself with her friends. In these situations, it’s important you adopt an empathetic role and reassure your daughter positively. Answer her questions and let her know that she will eventually catch up.
Additionally, enroll your daughter in activities suitable for her body type and encourage her to follow a healthy lifestyle.
During these confusing times, it’s our responsibility to help our children to the best of our abilities. Be their friend, listen to their concerns patiently, and uplift them tirelessly.
If your child is struggling in school or suffering from depression, it’s best to arrange a meeting with a counselor or therapist so she can comprehend her emotions better.
When to Seek Help?
It’s advised to seek medical attention if her breasts haven’t developed by 13 or she hasn’t started her period by 16. Also, consult a professional if your daughter had an abrupt stop in signs after entering puberty.
Common Q&A
Q1. What are the consequences of late puberty?
Some of the potential consequences of delayed puberty are:
- Physical Consequences: As aforementioned, late puberty can affect the growth and development of several physical traits, including breast development, widening of hips, and the start of menstruation. Girls with delayed puberty may also be of shorter adult height compared to their peers. Finally, it can also impact bone development and lead to lower bone density.
- Fertility Issues: Delayed puberty can potentially cause fertility problems in the future. If puberty is significantly delayed or the underlying condition is left untreated, it may be difficult to conceive and carry pregnancy later. However, many girls with delayed puberty have successfully conceived after adequate medical intervention.
Q2. What are the psychological or emotional effects of late puberty in females?
Girls experiencing late puberty may suffer from emotional and psychological challenges. Feeling self-conscious or anxious about oneself is common, especially when your peers have reached puberty. This, in turn, leads to social isolation, self-esteem issues, body image problems, and depression.
Q3. Does masturbation delay puberty?
No, masturbation does not interfere with a child’s growth and delay puberty.
