Causes of delayed puberty

Puberty depends on coordinated signals from the brain, pituitary gland and ovaries. A later start can run in families and may simply represent an individual pattern of development. It can also occur when the body does not have enough available energy because of restricted eating, intense training or another nutritional problem.

Long-term inflammatory, digestive, kidney or thyroid illness may slow development. Less commonly, the hypothalamus or pituitary does not release the hormones that start puberty, or the ovaries cannot respond normally. Turner syndrome is one possible ovarian cause and may be accompanied by short stature or other characteristic features, although delayed puberty alone does not establish that diagnosis.

Arrange a routine medical assessment if breast development has not begun around the expected stage, development starts but then stalls, or periods have not started despite other pubertal changes. A clinician will review growth over time, family puberty patterns, eating and exercise, medicines, and symptoms of chronic illness.

The examination may include height, weight and pubertal development. Depending on the findings, testing can include thyroid and reproductive hormone blood tests, assessment for chronic disease, a bone-age X-ray, pelvic imaging or chromosome testing. Treatment is matched to the cause and may involve nutritional support, care for an underlying illness or carefully supervised hormone therapy.

Seek prompt medical advice if delayed development occurs with severe headaches, new vision changes, fainting, marked weight loss, persistent abdominal symptoms, excessive thirst, or a clear slowing of growth. These features can point to a health problem that needs earlier assessment. Get urgent help for sudden severe headache, loss of vision, confusion or collapse.

Ask whether the growth pattern suggests a family tendency or an underlying condition, which tests would change management, and whether nutrition, exercise or medicines could be contributing. You can also ask whether referral to a paediatric endocrinologist or adolescent health specialist is appropriate and what changes should trigger an earlier follow-up.