Going through puberty

Puberty is an important time when you are growing as it is the time that you grow quickly and at the end of puberty several years after starting is when you stop growing. Doctors will therefore be watching for when you go into puberty. Sometimes in young people with conditions affecting the hypothalamus and pituitary gland it can happen at the right age, sometimes it can happen a little too early so needs stopping for a short while and sometimes it cannot happen at all and then you need to take hormones to help you go through puberty.

Why can some young people have a problem going through puberty?

Two of the hormones, called gonadotrophins, Luteinizing hormone and follicle stimulating hormone, LH and FSH for short, from the pituitary gland control whether you go into puberty or not. These hormones drive the ovaries to make the hormone oestrogen and it is this hormone that causes the changes to your body seen in puberty and gives you periods.

This means that if the pituitary gland starts producing the hormones too early driving your ovaries to make oestrogen you have an early puberty and if the pituitary gland cannot produce the hormones to drive your ovaries to make oestrogen you will not go into puberty or have periods by yourself.

Mostly your ovaries are healthy it is just the hormones from the pituitary gland that are wrong. One possible exception to this is in young people who have had treatment for leukaemia or a tumour with radiation treatment or chemotherapy which might have damaged the ovaries as well as the hypothalamus and the pituitary gland.

How will I know if I am going to have a problem with my puberty?

Girls go into puberty at different times so you may notice that other girls at school are developing even from the age of 8. The first sign is starting to develop breasts. If you develop breasts before the age of 8 that is too early. Most girls have started puberty by the age of 13 so if there are no signs by the age of 12 the doctors may do some blood tests to see if it shows any signs of going into puberty.

What if my puberty starts too early?

There are two reasons to stop puberty if it starts too early. The first is you won’t be developing at the same time as other girls at school and you may even start your periods before you have left primary school which might make you feel a bit different and uncomfortable. The second reason is that towards the end of puberty you stop growing so if you start early the earlier you will stop growing. The easiest way to stop puberty is to have an injection that puts the hormones (LH and FSH) from your pituitary gland back to sleep until the right time which is usually just before you are a teenager.

What will help me go through puberty?

The easiest way is to give you the oestrogen back that your ovaries aren’t making to help you go through puberty, it often comes as a small tablet that has to be taken every day or maybe a patch. The doctors try and do exactly what the body would do and start at low doses and increase them very gradually over several years until you are mostly through puberty.

At some point when you are on a higher dose of oestrogen they will add in progesterone (another hormone also normally made by the ovaries) or start you on a tablet that has both oestrogen and progesterone in it. This will give you periods. The tablet with both might either be the oral contraceptive pill and hormone replacement therapy, sometimes later on you may be offered a patch.

Try and find ways to make it easy for you to remember. Your doctor will check the dose is right for you by seeing how you are progressing through puberty and whether you are having periods and how you feel (so tell them). Later on they may check with a scan that your uterus or womb has grown or that your bones are healthy.

How long will I need to take oestrogen medication for?
Oestrogen is also important for keeping your bones healthy and stopping you breaking bones and making you feel good. Therefore as your ovaries won’t start working if your pituitary gland doesn’t make gonadotrophins you need to stay on oestrogen medication until at least the age of 50.  This is the age that most women stop producing as much oestrogen and their periods stop (called the menopause) and therefore it makes sense for you to stop your oestrogen medication then too.

Questions you could ask your doctor or nurse

  • Do you think I will have problems going into puberty?
  • Which would you recommend – the oral contraceptive pill or HRT, the patch or tablets, having periods or not having periods?
  • I have had chemotherapy and/or radiotherapy as part of my treatment – could that have damaged my ovaries as well as my pituitary gland?