Published October 2016
Current Opinion in Obstetrics and Gynecology

Delayed puberty in girls can have major implications for their physical and emotional health. In a review paper, Gylynthia Trotman, MD, MPH, provides an overview of where current research stands and how it can inform future studies.

“Puberty is an important time of physical and social maturation. Providers caring for adolescent girls should be aware of the common causes, recommendation for initial evaluation, and indications for referral,” Trotman says. “Initial evaluation and careful counseling should be tailored to the patient in an effort to avoid both costly and often unnecessary testing, and patient and family anxiety.”

Delayed puberty has many negative implications, including bone health and psychosocial impact associated with lack of pubertal development.

The exact factors that prompt the onset of puberty remain unknown, but recent research has demonstrated that the emergence of Kisspeptin activation is important in triggering it. Kisspeptin is a regulator of the reproductive axis, and is thought to work by stimulating the release of hypothalamic gonadotropin-releasing hormone.

In girls where that does not occur, there are generally four causes: constitutional delay of growth and puberty (the most common), hypergonadotropic hypogonadism, permanent hypogonadotropic hypogonadism, and transient/functional hypogonadism.

Research indicates a strong genetic predisposition, with 50 percent to 75 percent of patients reporting a family history of delayed puberty. Maternal inheritance seems to be a leading factor. Two treatment options are sex steroid therapy and hormone replacement.

“Therapy should be started at very low doses and increased gradually before reaching maintenance,” Trotman says. “This will allow for proper development of estrogen-dependent secondary sexual characteristics.”