Female hypogonadism

Lack of gonadal hormone secretion in a female, from pituitary or ovarian deficiency.

Principles

• Replacement is with oestrogen. If the uterus is intact, add a progestin to prevent endometrial hyperplasia/cancer from unopposed oestrogen.
• When fertility is needed with pituitary dysfunction, gonadotrophins must be stimulated or replaced.

Delayed puberty in girls

Delayed if there are no signs of sexual maturation (e.g. breast development) by age 13.

• Constitutional delay — ~30% of cases.
• Underlying conditions (other endocrinopathies, poor nutrition, chronic illness) — ~20%.
• No known cause — the remaining ~50%.

Exclude underlying causes first, interpreting constitutional delay in the context of family and developmental history. Review over ~6 months; if no development, specialist-initiated oral oestrogen (then adding progestin) may be started.

Related topics

• Primary and secondary amenorrhoea — see the womens-health amenorrhoea page.
• Menopause, POI and MHT — covered in womens-health: Overview, Symptoms, Diagnosis & Assessment, Menopause Treatment, and premature ovarian insufficiency. (The former endocrinology “Menopause” note has been retired in favour of those canonical pages.)