Delayed Puberty: Impact on Female Fertility
Puberty is the period of life that leads to adulthood through complicated and sometimes painful physiological and psychological changes. The hypothalamic-pituitary-gonadal axis undergoes an active phase during foetal and neonatal development and then ente
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Martin Birkhaeuser
11.1 Introductory Remarks Puberty is the period of life that leads to adulthood through complicated and sometimes painful physiological and psychological changes. The hypothalamic- pituitary-gonadal axis undergoes an active phase during foetal and neonatal development and then enters a resting phase that lasts for the rest of childhood until puberty. Puberty begins with an activation of the hypothalamic-pituitary-gonadal system. It occurs today earlier than a century and even earlier than 20 years ago. Delayed puberty may have a dramatic impact on the mental and social development of an adolescent. In the literature, different definitions for “delayed puberty” can be found and there are no guidelines indicating when in the absence of pubertal signs an investigation should be started. Usually, in girls, a first evaluation should be done not later than at the age of 13. However, the initiation of a first evaluation has to be earlier in some cases: it depends on the psychosocial pressure exerted on a child by her personal delay when it is compared to the pubertal development of the pair group of schoolmates and friends. One aspect that quite often worries the patient and her parents the most is the impact of delayed puberty might have on later fertility. This chapter intends to give a short overview for non-specialized endocrinologists over normal puberty, the practically most important forms of delayed puberty and the measures to be taken.
M. Birkhaeuser Gynaecological Endocrinology and Reproductive Medicine, University of Berne, Gartenstrasse 67, Basel 4052, Switzerland e-mail: [email protected] © International Society of Gynecological Endocrinology 2017 C. Sultan, A.R. Genazzani (eds.), Frontiers in Gynecological Endocrinology, ISGE Series, DOI 10.1007/978-3-319-41433-1_11
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11.2 Normal Puberty 11.2.1 Clinical Aspects The clinical onset of external pubertal development is announced by the appearance of secondary sex characteristics. In females, these signs are the appearance of breast buds and of pubic and axillary hair. The development of secondary sex characteristics is rated into five stages according to Tanner’s criteria [1–5]. They evolve progressively over several years until adulthood is reached and are designated as Tanner stages B1 through B5 for breast development and PH1 through PH6 for pubic hair growth (Figs. 11.1 and 11.2). A detailed description of the Tanner stages can be found in standard textbooks of paediatrics and paediatric or gynaecological endocrinology [1–3]. In girls, pubertal growth spurt occurs during Tanner stages 2 and 3. In girls, it occurs 2 years earlier than in boys. Girls do not show the same slowing down of growth velocity as boys before puberty and increase their growth velocity to 6 cm/year during the first year of puberty, and to 8 cm/year on average during the second year [6]. Menarche A variety of environmental and genetic factors are involved in the regulation of menarche. The first menstrual period (menarche
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