Early Puberty and Delayed Puberty

Puberty is the name for that time in your life when you’re between childhood and adulthood, when your secondary sexual characteristics start to develop and you experience growth spurts. Girls normally go through puberty between the ages of 8 and 14.

We talk about early puberty when the sexual characteristics in girls start to develop earlier than the age of 8. The first sign of puberty in girls is when their breast buds develop. Early puberty generally occurs when the sex hormones that control puberty are activated too early. In other words, the same thing happens as in normal puberty, but at an earlier age.

Early puberty is much more common in girls than in boys. In most cases, we don’t know what causes early puberty in girls (the fancy word for describing these cases is idiopathic), although it’s always a good idea to go and see your doctor as, even though it’s not that common, it can sometimes be due to medical problems such as tumours on the ovaries, the adrenal glands, the pituitary gland or the brain. Or something might not be right with the central nervous system, the condition might run in the family or it could be due to certain genetic syndromes, which are quite rare.

The main problem with early puberty is that it can restrict your height. Less commonly, it can lead to psychological and social problems when girls develop early and start comparing themselves with their friends or classmates. Sometimes, the feeling of being different, along with the changes in their mood caused by hormonal changes, can be quite a big thing for girls to deal with.

Although it doesn’t always need to be, early puberty can be treated, but the treatment will depend on the type and the main cause of the condition, if known. The general idea of the treatment is to delay and, if possible, reverse the symptoms of early puberty.

As we said earlier, puberty normally starts between the ages of 8 and 14. So we talk about delayed puberty when there are no secondary sexual characteristics by the time girls reach the age of 14, or when they haven’t had their first period by the time they are 16. By no secondary sexual characteristics, we mean that at these ages the breast buds haven’t started to develop and no pubic or underarm hair has grown.

A delay in the start of puberty can be caused by lots of things, of all different kinds, but in a nutshell, we can talk about delayed puberty when there’s an increase in hypophyseal hormones and delayed puberty when there are low levels of hypophyseal hormones.

In delayed puberty with increased levels of hypophyseal hormones, the hormonal stimulus from the hypothalamus (a part of the brain) and the pituitary gland to trigger puberty is working properly, but there’s something not right with the organ that the hormone is targeting, the ovary, which is not working as it should and is not releasing enough sex hormones.

The reasons for this condition could be:

• An ovary condition that’s due to a chromosome disorder which is stopping the ovary from working properly and oestrogens from being released. The most common of these conditions is called Turner syndrome.
• Damage to the ovaries for different reasons (surgery, radiotherapy, etc.), which is stopping them from producing enough hormones.
• Enzyme deficiencies, such as 17-alpha-hydroxylase deficiency.
• Autoimmune diseases, such as Addison’s disease.

Cases of delayed puberty with low levels of hypophyseal hormones can be described as:

• Simple delayed puberty: in this case, there’s a delay in the start of puberty and also a delay in growth. This very often runs in the family and in most cases will right itself over time.
• Delayed puberty that is secondary to a chronic disease: various chronic illnesses can cause delayed puberty, such as cardiac disorders, kidney disease and intestinal, blood or nutritional disorders. In these cases, it’s the illness itself that’s causing a delay in puberty. If we look at malnutrition in particular, the most common cause of this in girls is anorexia nervosa, a psychological disorder where the sufferer refuses to eat. If anorexia nervosa occurs before or during puberty, it will cause a delay in puberty; if it occurs after puberty, it will cause secondary amenorrhea (the absence of periods).
• Hypothalamic causes: this group includes a series of disorders of the central nervous system that affect the hypothalamus, causing a lack of hormones that stimulate puberty.
• Hypophyseal causes: these include conditions affecting the pituitary gland that lead to a decrease in the production of its hormones, which are necessary for triggering and maintaining puberty.

If the specialists find out what condition is causing the delayed puberty, that condition will be treated and, in doing so, the delay will also be treated. In certain cases, hormone treatment is necessary, using oestrogens and progesterone to bring on puberty artificially. In all cases, the treatment needs to be supervised by a specialist, either an endocrinologist or a gynaecologist.