Why are young girls starting their periods so early?
-Dr.Vaishnavi
Menarche is a phase in puberty when a young girl starts having her periods. We know that across the world the age of menarche is decreasing. The normal age of menarche varies between 8-13yrs. Starting one’ s period before the age of 8 and after the age of 13 is taken seriously. In majority of these patients this triggers a referral to the gynaecologist and further investigations. But what about the girls who start their periods at 9yrs and 10 years of age? What support do they get?
First of all, is this normal?
There has been a decreasing trend in the age of menarche. The normal age is around about 12 years of age. But, frequently we come across children starting their periods at age 9 and 10 years of age. Some researchers believe that this is a part of evolution and that it is attributed to the lack of disease,better nutrition and socioeconomic status in these young girls. Genetic, environmental, ethnic and nutritional factors are believed to be contributory.
So while this phenomenon raises all kinds of questions, it seems to be the new norm.
What are the causative factors?
Obesity and sudden weight gain areassociated with early menarche.
It is frequently noticed when these children go through a phase of reduced physical activity such as at present as the result of the Covid pandemic, sometimes due to the work loads from school and academics,and quite often due to change in attitudes and interests that come with adolescence.
Exposure to pesticides and other environmental polluters seem to interfere with the person’s hormonal milieuand bring on early menarche. Phthalates found in plastic and bisphenolA and DDT that are pesticides used commonly in agriculture have been implicated in precocious and early puberty. Large Human studies are however required to establish a causal relationship.
High risk social back ground such as addiction to alcohol, drugs, exposure to domestic abuse, conflict in households, lack of proper parenting, are factors thought to be associated with early menarche and acts by increasing the levels of the stress hormone.
Studies are required to look into various other factors such as steroid in meat and hormones in various foods such as eggs and milk.
What are the effects?
With early menarche there tends to be sexual maturation that is out of sync with cognitive or mental maturation. This causes high-risk behaviour,possibly due to engagement with older adults, and as a consequence of the sudden hormonal surge. A French study published in 2010 confirms this theory.
Heavy irregular periods are common due to lack of maturity of the Hypothalamo-Pituitary Ovarian Axis.Iron deficiency anaemia might set in due to heavy and prolonged periods.
Urinary tract infections and vaginal,vulval infections are common due to inability to care for themselves at a young age especially during menstruation.
Obesity is commonly seen due to low levels of peer acceptance and decreased physical activity levels.
What are the long-termeffects?
Diabetes and Obesity seem to be more prevalent in children that go through menarche at an early age. In fact, the high BMI may be a causal factor in early menarche. The exposure to a longer duration of estrogen levels is clearly implicated in multiple studies in causing an increase in the incidence of breast and ovarian cancer in these individuals.
Coronary artery disease is commonly observed in these women due prolonged exposure to estrogen too.
There is also an observed increase in the incidence of sexual and physical abuse in these young girls.
How can one prevent early menarche?
It might not be possible to completely avoid early menarche as it is multifactorial and not entirely under one’s control.
However it might help to maintain an ideal body weight and engage in regular physical activity. Children should be encouraged to develop an interest in sports, take long walks and regularly run/jogor cycle.
Avoiding junk food, takeaways and resorting to home-cooked healthy meals and including at least five fruits and vegetables in their diet is a must.
Avoiding pesticides and contaminants in food might help to delay age of menarche.
In conclusion, it is clear that girls who start menarche early need constant support and meaningful input both from their family and doctors to sail through this difficult period. Lifestyle modifications at an early age will help prevent difficulties at a later stage.
