How to treat delayed puberty in girls?

1. Constitutional delay of puberty

Because patients with this disease will eventually experience the onset of puberty, generally no treatment is required. However, necessary consultation should be provided to relieve the concerns and worries of patients and parents, eliminate inferiority complex, and conduct regular evaluation of the patient's sexual characteristics and relevant hormone tests. If some patients experience mental stress due to their development lagging behind their peers, or even mental, psychological and behavioral abnormalities, appropriate drug treatment can be given if necessary. Short-term hormone therapy is used to stimulate the appearance of sexual characteristics. Before taking the medicine, the patient and his family must be informed in detail of the expected purpose of the drug treatment and the possible side effects, and try to let the patient and parents choose whether to use drug treatment or continue observation. Girls take ethinyl estradiol or conjugated estrogen (pregnant estrogen) orally for 3 to 6 months, and regularly check the patient's sexual characteristics and body development. After treatment, patients with constitutional delayed puberty will spontaneously start puberty, especially when the bone age reaches 13 to 14 years old. Otherwise, pathological causes should be considered.

2. Pathological delayed puberty

(1) Elimination of the cause: If the cause can be eliminated, the treatment is mainly based on the cause. For example, surgical removal of the tumor, active treatment of systemic diseases, and improvement of nutritional status. Once the cause is eliminated, the condition can be relieved. For patients whose cause cannot be eliminated, sex hormone replacement therapy is required. For patients with high gonadotropin, the cause is often unable to be eliminated. Hormone replacement therapy is mainly used to promote the development of sexual characteristics, menstruation or growth. However, for those with Y chromosomes in the karyotype, gonadectomy should be performed. For patients with functional low gonadotropin, since puberty delay is secondary to other diseases, in principle, the primary disease is treated, nutrition is strengthened, weight is improved, or the amount and method of exercise are adjusted. These patients do not need exogenous hormone treatment. After the above conditions are improved, sexual development will occur spontaneously.

(2) Hormone replacement therapy: Whether estrogen therapy can accelerate epiphyseal closure is a common concern. It has been confirmed that only superphysiological doses of androgens have this effect. Generally, ethinyl estradiol 5 μg/d has no effect on promoting epiphyseal closure. It has a mild effect on promoting bone growth, and long-term use can slightly develop the breast. Patients with primary hypogonadism require long-term hormone replacement therapy, with a small initial dose, similar to the treatment of constitutional delayed puberty. After 2 to 3 years, it is gradually increased to adult replacement doses to simulate the hormone levels after the onset of normal puberty. The initial dose is ethinyl estradiol 5 μg/d or conjugated estrogen (pregnant estrogen) 0.3 mg/d, and then gradually increased to ethinyl estradiol 10-25 μg/d or conjugated estrogen (pregnant estrogen) 0.6-1.25 mg/d in the next 2 to 3 years. The maintenance dose should be able to reach withdrawal bleeding. If withdrawal bleeding occurs or within 6 months of starting treatment, a progestogen (such as medroxyprogesterone 5 mg/d) should be added from the 12th day of oral estrogen.