Fifteen-minute consultation: Delayed puberty in girls

Delayed puberty in girls most commonly presents as absent breast development by age 13 years and occurs less frequently than delayed puberty in boys. Constitutional delay of growth and puberty (CDGP) is the most common individual diagnosis but pathological causes collectively account for a substantial proportion of cases. For the general paediatrician, a practical assessment framework should include focused history, auxology, Tanner staging, first-line investigations, recognition of red flags and timely referral to paediatric endocrinology. Girls with absent thelarche by age 13 years, absent menarche by age 15 years or no menarche more than 3 years after thelarche require specialist assessment. This article provides a structured clinical guide for general paediatricians assessing girls with delayed puberty.