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What causes delayed periods?

Q: My 24 years old daughter weighs 60 kg. Till now her periods have not started. She has undergone various tests suggested by various gynaecologists. Her MRI, ultrasound, prolactin level, urine tests and blood tests are normal. Her pituitary gland is not fully developed, which was diagnosed by one of the gynaecologist. She took Novelon for three months. During all three cycles, she had normal bleeding. What causes delayed periods?

A:She will need to be treated by a gynaecologist along with an endocrinologist. Replacement hormones for the pituitary abnormality along with Novelon cyclical may bring about the menses. However, she will need to be followed up to see if the cycles are accompanied by egg formation as well - this would be done by serial mid cycle ultrasound. In case, egg formation too is possibly achieved after having the normal menses, she may achieve a pregnancy later on. At this point it is not possible to predict or tell - however effect of treatment and her response in terms of regular menses may be achieved. In case all these fail, marriage is always possible to someone, not desiring babies or already having them. Adoption also is always an option. First we need to define normal life - if she is working, studying and having an occupation, she is normal already.

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