Dear Doctor, My daughter made 16 and she’s never gotten her period. She developed breasts two years ago although they are rather small. I started worrying when she was 14 but I was told it delays some times. But 16? Is she normal? Should I be worried? Rita
As children grow, they attain puberty, due to influence of hormones. These hormones are released by the pituitary gland, adrenal glands and testes and ovaries. These help in attaining secondary sexual characteristics, which clearly differentiate between a boy and a girl. Some of these secondary sexual characteristics include growth of facial hair in boys and deepening of the masculine voice. In girls it includes development of breasts, rounding of hips, softening of voice. In girls, one of the most significant change is the initiation of the menstrual cycle. The inner lining of the uterus becomes thick and laden with rich blood supply in preparation for receiving a fertilised ovum. When fertilisation does not occur, the blood vessels are broken down, causing visible blood loss. This cycle occurs due to balance of estrogen and progesterone.
Usually puberty sets in and menstrual cycles are started around 12 to 14 or 15 years. But 16 is also not late. Like any other delayed growth parameter of a child, there can be delayed puberty.
Puberty may be delayed due to being physically very active, as happens with girls training as athletes. Delayed puberty can be due to being underweight or obese as well, as this disturbs the hormonal equilibrium. Malnutrition, particularly zinc and or iron, vitamin A deficiency, can cause delayed menarche (onset of menses). Hormonal disorders or diseases like those of the pituitary, thyroid glands or ovaries can delay onset of menses and other signs of puberty. Mental stress can also lead to delayed signs of puberty. A young girl exposed to alcohol in the mother’s womb or as a small child, can have disruption of hormonal balance and delayed menses. Genetic factors also play a role. A girl having an elder female relative (like mother/aunt or elder sister) with history of delayed menarche is more likely to have a delayed menarche.
Apart from these reasons, medical disorders like malabsorption syndrome, inflammatory bowel disease, brain tumor, and etcetera, can cause delayed or no puberty as one of the manifestations.
Chromosomal birth defects like turner’s syndrome are also responsible for delayed or disturbed puberty. Other normal secondary sexual characters also do not develop in these conditions.
If your daughter is developing other signs of puberty normally, she is sure to start having menstrual cycles as well. Encourage her to have a nutritious diet, remain relaxed and avoid alcohol or any abusive substance. You can get anxious when she is 18 years old. If any suspicion of an underlying disease exists, the disease can be identified by suitable investigations and treated.
Dr. Rachna Pande is a
specialist in internal medicine.