How do You initiate Oestrogen Therapy in a Girl Who has Not Undergone Puberty?

Peter C. Hindmarsh

Disclosures

Clin Endocrinol. 2009;71(1):7-10.

Aims of Pubertal Induction

The aims of pubertal induction include:

Attainment of secondary sexual characteristics including induction of menses
Generation of the pubertal growth spurt
Acquisition of bone mineral mass
Uterine development sufficient for assisted reproductive interventions.

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Cite this: How do You initiate Oestrogen Therapy in a Girl Who has Not Undergone Puberty? - Medscape - Jul 01, 2009.

Abstract and Introduction
Normal Puberty
Aims of Pubertal Induction
Process of Pubertal Induction
Pubertal Induction in Special Situations
Conclusions and Areas of Uncertainty
References

Table 1. Pubertal induction programme
Using ethinyloestradiol
Start ethinyloestradiol	2 μg per day for 6 months
Ethinyloestradiol	4 μg per day for 6 months
Ethinyloestradiol	6 μg per day for 6 months
Ethinyloestradiol	10 μg per day for 6 months
Ethinyloestradiol	15 μg per day for 6 months
At this point introduce progestagen to cycle
Finally use either oral or transdermal hormone replacement depending upon patient preference and titration of dose against symptoms, uterine growth and bone mineral density
Using oestragel (Divigel; Orion Pharma, Newbury, UK)^[9]
0·1 mg for the first year
0·2 mg for the second year
0·5 mg for the third year
1·0 mg for the fourth year
1·5 mg for the fifth year
Monitoring of progress
6 monthly
Height velocity
Pubertal staging
Blood pressure
12 monthly
Bone age
Pelvic ultrasound to assess uterine growth
Lipid profile
Bone mineral density (perhaps more reserved for later stages of pubertal induction when rapid growth is completed)
Routine annual review for girls with Turner syndrome

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