Girls usually start menstruating or get their first period at 13 or 14 years of age. This is the sign that their body is maturing. In some cases, girls mature later than usual (Late bloomers). Their menstruation progresses normally afterwards. Delayed menarche runs in families. It is the common cause of late maturity. In the majority of the cases, almost 98% of teens start their periods by age 15. Some girls don’t get their first period even after crossing 15 to 16 years of age. In such cases, an appointment with the gynaecologist becomes indispensable because it could be a sign of an underlying health issue that could be of concern.

What causes late menarche in girls?

Factors responsible for delayed puberty in girls are genetic disorders, binge eating or exercise disorders, certain infections, hormonal disorders, certain tumours, radiation therapy and chemotherapy that damages the ovaries.

Lack of body fat: Girls who are too thin or lack body fat progress late to puberty. This happens due to undernourishment or due to bulimia or anorexia (eating disorders) or if they are actively involved in certain intense training sports for long periods.

Problems with the Ovaries: When ovaries produce very little hormones, they may delay puberty. This is called hypogonadism.

This can happen when ovaries are damaged or when there is a problem with the parts of the brain involved in puberty.

Causes of Hypogonadism

The health conditions that can lead to hypogonadism include liver and kidney disease, diabetes mellitus, hypothyroidism, inflammatory bowel disease (IBD), celiac sprue, cystic fibrosis; genetic disorders (Turner syndrome), Kallman’s, tumour of the pituitary gland; and Addison disease, Hashimoto thyroiditis – an autoimmune disorder.

Other causes of Delayed Menarche

Obesity can also delay periods in girls as for a smooth menstrual cycle, the body requires a normal range of fat levels. Too little or too much body fat can lead to delayed periods.

Excess stress can also delay periods in girls.

Medications: some drugs used to treat allergies, depression and cancer can delay periods in girls.

Anatomical causes such as imperforate hymen, Mullerian agenesis cause absent menstruation.

Diagnosis of Late Menarche

Gynaecologists perform initial evaluation by a comprehensive physical examination and by taking into account the complete history, growth and nutritional status of the girl to evaluate pubertal development (Tanners staging). The doctor may also recommend some basic laboratory tests – such as hormonal tests to detect any chronic disorders. In some cases, genetic tests and bone-age X-rays may also be ordered to see the level of bone maturity and to look for the signs of genetic disorders. Sometimes, magnetic resonance imaging may also be recommended to know the central cause of the delay.

Bottom line

When girls don’t have any signs of puberty by age 14 years or have not menstruated by age 16 years, they are most likely to have constitutional delay. Gynaecologists decide to re-examine these girls at 6-months intervals with the anticipation that their periods would begin and proceed normally. However, girls with severely delayed puberty should be evaluated for primary amenorrhea (Genetic conditions are the most common causes of primary amenorrhea).

If your girl has not yet started her first period, then make an appointment with me for further examination and evaluation to figure out the exact cause of delayed menarche.