What causes delay of menarche?
Absent periods and delayed puberty can be caused by many things. The patient’s work-up is done step by step. The first step in the evaluation is to check if the girl has begun to show other signs of puberty. Does she have some breast development? Has she undergone a growth spurt recently? Does she have armpit and pubic hair? If no signs of puberty are present by age 13, the girl’s doctor will probably refer her to a hormone specialist (endocrinologist) for evaluation. If, however, pubertal development has been otherwise normal, a pediatrician, gynecologist, family doctor, or pediatric endocrinologist can usually sort out the situation. (In different parts of the United States, different specialists have this expertise.) If your child’s primary doctor isn’t comfortable with doing the work-up, he can refer you to another physician. The doctor who is doing the work-up will ask about eating habits, exercise, and growth pattern up until that point. Are there other family members who started
