Estrogen Treatment in Children

Abstract

Estrogen treatment is rarely indicated during childhood. A limited number of patients requires either topical or systemic estrogens in selected cases. Labial adhesions in which the labia minora fused over the vestibule is the most common indication for topical estrogen treatment in children. Although the most accepted theory of labial adhesions is low estrogen levels, the use of topical estrogen treatment is still controversial. The systemic application of estrogen is used in girls with hypogonadism. Either in hypo or hypergonadotropic hypogonadism, low doses of estrogen treatment is initiated at pubertal age as a replacement treatment, to mimic normal puberty. In Turner syndrome, which is an example of hypergonadotropic hypogonadism, estrogen treatment should be also initiated at pubertal age in addition to growth hormone replacement. Although in girls, 'constitutional growth and pubertal delay' is not observed as frequently as in boys, very low doses of estrogen therapy for a short duration can be considered to induce normal puberty. Another indication of systemic estrogen treatment is for tall stature in carefully selected cases to fuse epiphysis. Though topical estrogen treatment in labial adhesions is preferred and used by many practitioners, systemic use of this hormonal therapy is only constituted by pediatric endocrinologists. In this chapter, our aim is to discuss the estrogen treatment in children with special emphasis on indications, treatment doses and results.