Delayed Puberty in Females: Why It Happens and What to Do About It

    Published 07 April 2020
    Fact Checked
    Reviewed by Olga Adereyko, MD, Primary Care Physician, General Practitioner, Medical Consultant
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    While every young woman matures differently, if your daughter hasn’t developed breasts by 13 or gotten her period by 16, it could be a sign of delayed puberty. The underlying causes of delayed puberty range from mild to severe. Read on for more info on how to handle delayed puberty in girls. 

    What is delayed puberty?

    Puberty is when your body starts to produce sex hormones and undergoes a number of related changes. Typically, girls enter puberty between the ages of 8 and 14 years. Delayed puberty in females means that breast development hasn’t occurred by 13 or menstruation hasn’t begun by 16. If and when these processes do start, delayed puberty might prevent them from progressing normally. 

    Symptoms of delayed puberty

    Common symptoms of delayed puberty in girls include:

    • Lack of breast development by the age of 13
    • Absence of menstruation by the age of 16
    • Having no pubic hair
    • Shorter than average height and a slow rate of growth
    • Inhibited uterine development 
    • Lack of bone maturity
    • A gap of four years or more between initial breast growth and the first period

    Note that the symptoms of delayed puberty in females can also point to other medical conditions, so be sure to consult your doctor for proper diagnosis. 

    Causes of delayed puberty

    In some cases, sexual maturation is simply beginning a little later than usual and doesn’t necessarily indicate delayed puberty. Eventually, your daughter should enter this phase and make the transition normally. 

    But what are the exact causes of delayed puberty? They might include:

    Constitutional delayed puberty

    Research shows that delayed puberty is more likely in adolescent girls whose parents experienced the same thing at their age. This is known as constitutional delayed puberty.

    Low body fat

    Another contributing factor for delayed puberty is a lower than average amount of body fat. Your body requires adequate fat reserves to initiate puberty, especially when it comes to menstruation. That’s why extremely active girls, such as swimmers, runners, gymnasts, or dancers, may be slightly more prone to experiencing delayed puberty. 

    Eating disorders

    Lastly, disorders like anorexia or bulimia could offer an answer to the question of what causes delayed puberty. The fact that they might be undernourished and lacking body fat affects their ability to produce or maintain a monthly menstrual period, leading to delayed puberty.

    Hypogonadism and other medical issues

    Hypogonadism occurs when the ovaries produce little to no hormones, due to ovarian damage or improper development. Hypogonadism is also triggered by dysfunctions in the part of the brain which controls the process of puberty. Delayed puberty is an occasional side effect of hypogonadism which, in turn, is caused by: 

    • Diabetes mellitus
    • Liver or kidney disease
    • Celiac sprue
    • Hypothyroidism
    • Cystic fibrosis
    • Inflammatory bowel disease (IBD) 
    • A tumor in the pituitary gland
    • Turner syndrome
    • Certain autoimmune diseases (e.g., Addison’s disease or Hashimoto’s thyroiditis)
    • Radiation cancer treatment or chemotherapy (which damages the ovaries)

    Other health complications that create a shortage of body fat could also be responsible for delayed puberty. 

    Diagnosis of delayed puberty in females

    Signs of delayed puberty are naturally easy to spot if a young woman doesn’t start developing between the ages of 8 and 14. If you suspect your daughter may be experiencing delayed puberty, reach out to your family doctor for help. 

    Initially, they’ll perform a physical examination and take a complete medical history to gain a better understanding of their diet and exercise habits, etc. Additionally, they might recommend performing: 

    • Blood Tests

    These will check current levels of sex, growth, and thyroid hormones while also searching for diabetes, chromosomal abnormalities, and anemia. For example, very high levels of FSH and LH could be a sign of ovarian dysfunction that would cause delayed puberty.  

    • X-rays

    Invisible beams project an internal image of bones, tissues, and organs onto film. Typically, the X-ray is done on their left hand and wrist bones to determine bone maturity. 

    • CT Scan

    A computed tomography scan, also known as a CAT scan or CT scan, is a diagnostic imaging procedure. A combination of X-rays and computer technology produce images of the internal organs, bones, and muscles, providing greater detail than a standard X-ray. 

    • MRI

    A magnetic resonance imaging (MRI) machine utilizes magnetic fields and computer-generated radio waves to create extremely detailed images of organs and tissues. In fact, MRI scans of the head can be very effective at detecting tumors. 

    • Ultrasound

    An ultrasound offers your doctor a closer look at internal organs and is helpful in scanning the uterus and ovaries for abnormalities or inhibited growth. 

    Dealing with delayed puberty in girls

    Delayed puberty treatment is based on its root cause, and there’s a good chance that puberty can proceed normally if the underlying problem is addressed.

    If the causes of delayed puberty are thought to be genetic, perhaps no action is needed. Your daughter will eventually enter puberty and make the transition on her own. 

    If the causes of delayed puberty are thought to be genetic, perhaps no action is needed.

    When delayed puberty is the direct result of low body fat, treatment focuses on boosting overall body fat percentage through higher caloric intake. This is sometimes challenging for those struggling with an eating disorder. 

    In certain instances, your doctor may prescribe hormone therapy to stimulate the development of secondary sexual characteristics like widened hips and larger breasts. In rare cases, surgery is another option for correcting any anatomical issues. 

    When to see a doctor

    It’s wise to take your daughter to the doctor if her breasts haven’t developed by 13 or she hasn’t gotten her first period by 16. It’s equally important to seek medical help if your daughter began entering puberty, then abruptly stopped. 


    Signs of delayed puberty in your daughter can be very concerning, especially when everyone else her age is maturing. Keep an eye out for the symptoms of delayed puberty outlined above. Treatment will vary depending on the specific reasons behind delayed puberty and may occasionally point to a completely unrelated medical issue.

    History of updates

    Current version (07 April 2020)

    Reviewed by Olga Adereyko, MD, Primary Care Physician, General Practitioner, Medical Consultant

    Published (07 April 2020)

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