Q My daughter is 15 years old.

She weighs 55kg and is 1.66m tall.

Till now, she has not started her periods. She had a blood test and ultrasound scan at a hospital. Everything is all right.

What is the cause of the delay in her menses? Should we go for further check-ups?

A Puberty is a process of sequential physical transformation, and there are variations in its onset, tempo and duration.

It usually proceeds in a fairly predictable pattern, starting with breast enlargement, followed by a growth spurt, body fat distribution, vaginal discharge which is initially random before becoming cyclical, and, finally, menstruation.

For girls, breast development can start from as young as seven years old, with the "late bloomers" starting their pubertal changes as late as 13.

Girls can expect to have their first period about two to three years after they start developing breasts. The cause of delay in menses may be due to several reasons, and some of them may include the following:

FAMILY HISTORY

It is important to remember and know when you had your first period as your daughter may follow your pattern.

Often, the most common reason for delayed menses is a family history of late blooming or constitutional delay.

NUTRITION AND CHRONIC MEDICAL CONDITIONS

Eating disorders, intensive exercises, stress and other chronic medical conditions may lead to delayed menses.

Your daughter is growing proportionately at 50 to 75 per cent for both height and weight.

It is important to know if she has any history of chronic medical problems, such as severe asthma, gastrointestinal disease, diabetes and thyroid disease.

HORMONES

Some girls may have conditions affecting their hormonal production from the pituitary gland or ovaries, or may even have structural problems in their pelvic organs that affect menstruation.

Blood investigations and ultrasound scans which can detect such conditions will help to evaluate the cause for delayed menses.

I understand that your daughter had been evaluated with a blood test and scan, and I am happy to hear that the results are normal.

Her physician would be able to advise on the likely cause for her delayed onset of menstruation.

As she is now 15, it is advisable for your daughter to undergo further evaluation.

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