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2.1
Delayed Menarche
Menarche Delayed

Presentation

Hypopituitarism may present with loss of anterior or posterior pituitary hormones. [aippg.net]

uterus present - Hypothalamic dysfunction; pituitary lesion; PCOS; ovarian insufficiency Breasts present, uterus absent - Müllerian agenesis; complete androgen insensitivity Breasts absent, uterus present - Hypogonadotropic hypogonadism; gonadal dysgenesis [emedicine.medscape.com]

Research presented by: R.L. Matchock - University of Pennsylvania The prenatal environment of the human fetus is now known to have lasting physiological and behavioral effects into childhood and adulthood. [handresearch.com]

A companion Website includes a Student Study Guide, Laboratory Manual, Instructor's Guide, Brownstone Test Generator, PowerPoint presentations, and images from the book. [books.google.de]

The peak growth spurt and other changes such as voice breaking, muscle bulking and facial hair growth are not usually present for another two years. [gponline.com]

Entire Body System

  • Fatigue

    […] adults -TSH deficiency: isolated TSH deficiency is very rare secondary hypothyroidism - sensitivity to cold, dry skin, physical and mental sluggishness, coarseness of hair -ACTH deficiency: decreased skin pigmentation poor apetite, nausea, vomiting, fatigue [aippg.net]

    […] history can provide clues as to the cause of delayed puberty. [8] Delayed growth and puberty can be the first signs of severe chronic illnesses such as metabolic disorders including inflammatory bowel disease and hypothyroidism. [8] Symptoms such as fatigue [en.wikipedia.org]

Skin

  • No Pubic Hair

    The appearance of pubic hair is commonly next. [pamf.org]

    ACTH deficiency: decreased skin pigmentation poor apetite, nausea, vomiting, fatigue, muscle weakness, loss of axillary and pubic hair in females -Prolactin deficiency: failure of lactation in post-partum patients Loss of posterior pituitary hormones [aippg.net]

    Pubic hair distribution is used to stage puberty, along with breast size and contour in girls and testicular volume in boys. [aafp.org]

    My child has developed pubic hair and body odor, but still no breast development. Should I be concerned? Your child could have pubic hair and body odor but still meet the definition for delayed puberty, so she should be evaluated. [childrenshospital.org]

    In most boys, physical changes of puberty start between the ages of 10 and 13 years, with the first change being enlargement of the testes, followed by pubic hair and penile growth, and subsequent growth at peak height velocity. [pedsinreview.aappublications.org]

Urogenital

  • Amenorrhea

    The dancers with scoliosis had a slightly higher prevalence of secondary amenorrhea (44 percent vs. 31 percent), the mean (+/- SD) duration of their amenorrhea was longer (11.4 +/- 18.3 vs. 4.1 +/- 7.4 months; P less than 0.05), and they scored higher [ncbi.nlm.nih.gov]

    We report here on 89 young ballet dancers among whom there was a high incidence of primary amenorrhea, secondary amenorrhea, irregular cycles, and delayed menarche — an incidence correlated with excessive thinness. [dash.harvard.edu]

    primary amenorrhea (diagnosis), Amenorrhoea primary, amenorrhea primary, Amenorrhea, primary, Primary amenorrhoea (finding), Primary Amenorrhea, Delayed Menarche, Primary physiologic amenorrhea, Primary amenorrhea, Primary amenorrhoea, Primary physiologic [fpnotebook.com]

    In a study of 89 female ballet dancers, while 1/3 of the women reported normal cycles, 15% reported secondary amenorrhea and 30% reported irregular cycles. [agris.fao.org]

    Definition Amenorrhea is the medical term for the absence of menstruation. There are two types of amenorrhea, primary and secondary. [healthofchildren.com]

  • Dysmenorrhea

    Dysmenorrhea may be either primary or secondary. [emedicine.medscape.com]

    […] diagnosis細胞診 cytoreductive surgery腫瘍細胞削減(減少)手術 d deceleration一過性徐脈 delayed puberty遅発思春期 delivery分娩、出産 diaphragm1.横隔膜 2.避妊ペッサリー dilatation and curettage(D&C)子宮内容除去術 discharge帯下 dominant follicle主席卵胞 Douglas pouchダグラス窩 dysfunctional uterinebleeding機能性出血 dysmenorrhea [tokyo-med.ac.jp]

    When to call the doctor Girls who have not had a menstrual period by age 16 or who have not shown any signs of breast development or other indications of puberty by age 14 should be examined for causes of primary dysmenorrhea. [healthofchildren.com]

  • Cesarean Section

    […] a abdominal cesarean section腹式帝王切開術 abdominal distention腹部膨満 abortion流産 adenomyosis子宮腺筋症 adjuvant chemotherapy補助的化学療法 adnexectomy付属器摘出術 adnexitis子宮付属器炎 amenorrhea無月経 amniocentesis羊水穿刺 amniotic fluid羊水 amniotic fluid embolism(amniotic embolus)羊水塞栓 anamnesis [tokyo-med.ac.jp]

  • Vaginal Bleeding

    STIs can also cause irregular vaginal bleeding due to inflammation of the genital tract, [35] including the cervix and endometrium, which can be fragile and shed irregularly. [14] Exogenous hormone administration, in the form of combined estrogen-progestin [emedicine.medscape.com]

  • Metrorrhagia

    […] history of a bleeding disorder, or a history of a bleeding disorder after a hemostatic challenge, such as a tooth extraction or delivery. [34] Intermenstrual bleeding As the name indicates, AUB–intermenstrual bleeding (IMB), previously referred to as metrorrhagia [emedicine.medscape.com]

Workup

This item is withdrawn What is the workup of delayed menarche? - WITHDRAWN 2018 (hdl:10355/7394) This item is restricted. If you have a login to access this item: Proceed to the login screen and log in. [mospace.umsystem.edu]

These can be ruled out by means of blood tests (see Workup ). Finally, endometrial malignancy, though rare in women younger than 40 years, should also be on the differential diagnosis for adolescents with irregular menses. [emedicine.medscape.com]

[…] healthy physical development. [2] Delay of puberty may also occur due to various causes such as malnutrition, various systemic diseases, or defects of the reproductive system ( hypogonadism ) or the body's responsiveness to sex hormones. [2] Initial workup [en.wikipedia.org]

Treatment

Does my child need treatment for delayed puberty? What are the options for treatment? What are the risks and benefits of each treatment option? How long will my child need treatment? Edited: November 2017 [hormone.org]

[…] nodules; and new coverage of when and when not to use radioiodine in the treatment of patients with thyroid cancer. [books.google.de]

However, treatment with sex hormones according to the sex of the individual (testosterone or estrogen) can help to boost the hormone levels and induce puberty. [news-medical.net]

Treatment options include monthly depot testosterone esters or daily oral capsules. Transdermal testosterone is under evaluation in this age group. [gponline.com]

Treatment of cause Hormone therapy The treatment for delayed puberty depends on its cause. When an underlying disorder is the cause of delayed puberty, puberty usually proceeds once the disorder has been treated. [merckmanuals.com]

Prognosis

Despite an obvious cause, pubertal assessment is necessary as active treatment of the delay in growth and puberty can improve the growth prognosis, reduce long-term risk of osteoporosis and boost self-esteem, so a referral is beneficial. [gponline.com]

Prognosis The prognosis of either primary or secondary amenorrhea depends on the underlying cause. [healthofchildren.com]

Prognosis and outcome Long-term prognosis In individuals with premature ovarian failure as a cause of delayed puberty, amenorrhea is likely permanent and the possibility of spontaneous pregnancy is Overall treatment of the predisposing cause of pubertal [clinicaladvisor.com]

[…] premature ovarian failure早発閉経(早発卵巣機能不全) premature rupture of themembranes前期破水 premature separation ofnormally implanted placenta常位胎盤早期剥離 premenstrual syndrome月経前症候群(月経前緊張症) presentation胎位 preterm早期 primordial follicle原始卵胞 primordial germ cell原始生殖細胞 prognosis [tokyo-med.ac.jp]

Etiology

[…] associated with ambiguous genitalia, hyperandrogenism, and Cushing syndrome. [11] Yet another method of categorizing the etiologies of primary amenorrhea involves evaluating the components of the hypothalamic-pituitary-ovarian (HPO) axis as well as the [emedicine.medscape.com]

The primary distinction should be made between those etiologies that result in permanent disruption of hormonal function and those that will be transient or modifiable. [clinicaladvisor.com]

Treatment depends on the etiology. McCune-Albright Syndrome. [aafp.org]

Osteoporosis in children and adolescents: etiology and management. Paediatr Drugs 2005;7:295-323. 52. Nichols JF, Rauh MJ, Lawson MJ, Ji M, Barkai HS. Prevalence of the female athlete triad syndrome among high school athletes. [redorbit.com]

] Although serum growth hormone levels are low in constitutional delay of puberty, they increase after treatment with sex hormones and in those cases, growth hormone is not suggested to accelerate growth. [8] Subnormal vitamin A intake is one of the etiological [en.wikipedia.org]

Epidemiology

OBJECTIVES: To assess how much of the epidemiologic association between PFAS and delayed menarche can be explained by the correlation of growth and maturation with PFAS body burden. [ncbi.nlm.nih.gov]

Collaborative Group on Hormonal Factors in Breast Cancer: Menarche, menopause, and breast cancer risk: Individual participant meta-analysis, including 118,964 women with breast cancer from 117 epidemiological studies. [ascopost.com]

Another study, published in Cancer Epidemiology, Biomarkers & Prevention, found that ovarian cancer patients whose age of first menstrual cycle was younger than 12 were associated with higher mortality rates—they were 51 percent more likely to die from [splinternews.com]

"Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms". Human Reproduction Update (Review). 20 (4): 582–93. doi : 10.1093/humupd/dmu007. [en.wikipedia.org]

Pathophysiology

As noted (see Pathophysiology ), cycles are not consistently ovulatory for the first few years after menarche, especially if menarche occurs at a later age. [emedicine.medscape.com]

The pathophysiology is largely unknown. Iatrogenic - hormones used for contraception or hormone replacement therapy (HRT) or management of other conditions. [patient.info]

Prevention

The occurrence of menarche after an injury preventing dancing supports the hypothesis that a change in fatlean ratio and the accompanying changes in metabolic and hormonal levels characteristic of hard physical exercise may be involved in the delay of [bisp-surf.de]

If the goal is to prevent inbreeding, having sex with a half-sibling who shares 50 percent of your genes might also seem like a bad idea. [livescience.com]

[…] from sending the “start puberty” signal conditions that prevent the ovaries or testes from being able to respond to the “start puberty” signal certain genetic conditions, such as Klinefelter’s syndrome in boys and Turner syndrome in girls 3. [childrenshospital.org]

Prevention Amenorrhea related to pregnancy, the female athletic triad, drug or alcohol abuse, or eating disorders is preventable insofar as these are lifestyle choices. [healthofchildren.com]

Various disorders, such as diabetes mellitus, inflammatory bowel disease, kidney disease, cystic fibrosis, and anemia, can delay or prevent sexual development. [merckmanuals.com]

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