When to worry about delayed puberty with hypothalamic amenorrhoea

Hypothalamic Amenorrhoea occurs when the brain reduces reproductive hormone signalling. This can happen with inadequate energy intake, intense exercise, emotional stress, or a combination of factors. Most people with Hypothalamic Amenorrhoea notice delayed puberty when hormone signalling remains low during the expected development of puberty.

Delayed Puberty can involve no breast development, no first period, or development that begins and then stops. Other causes can affect the thyroid, pituitary gland, ovaries, nutrition, or normal variation, so an assessment should consider the whole picture.

Arrange an appointment with a GP, adolescent health clinician, or gynaecologist. Prepare details about growth, exercise, eating patterns, stress, symptoms, medicines, and family timing of puberty. Do not deliberately increase exercise or restrict food while waiting for advice.

Assessment may include a physical examination, blood tests, and sometimes imaging. Care commonly focuses on restoring adequate energy availability, addressing stress or disordered eating, and protecting bone health. Support from a dietitian or mental health professional may be part of the plan.

Seek prompt care for severe headache, vision changes, fainting, repeated vomiting, rapid weight change, severe weakness, or symptoms suggesting another hormonal problem. Arrange routine assessment when puberty has not started, has stalled, or periods remain absent after they began.

Mention bone pain or a history of fractures, because low reproductive hormones and low energy availability can affect bone strength. A clinician can decide how quickly testing is needed.

Ask: Could low energy availability or stress be affecting hormones? Which tests are needed? How can I support bone health? Should exercise or nutrition change, and who can help me make that change?