At 14, Rhea Khan lied to her five closest girlfriends about getting her first period. Khan would actually get her first period more than two years later, when she was well into her 16.
"I just felt left out and frustrated...It was like they all shared an experience but I couldn't. They used to tease me about how they are all women now, but I wasn't yet," Khan, who is now 23, and pursuing post graduation in a Mumbai college, told FIT.
When she was 15, Sameera (name changed), on the other hand, would tie a dupatta around her stomach – hoping that the pressure would make her get her first period.
"From my relatives to friends, everyone knew I was not menstruating. My cousin told me to tie a dupatta around my stomach at night, so that I would get my periods. So I tried it without realising how stupid it was.They would tell me that I was very lucky to not experience any period pain, or change travel plans. If anything, I felt extremely unlucky."
In a country like India, more and more girls are hitting puberty earlier than before. Read here on what experts have to say about that. That makes Rhea and Sameera the exceptions, say endocrinologists and gynaecologists.
What Is Causing Delayed Puberty?
The age of menstruation was 16 in the mid-19th century and declined to 13 by the late 1980s. In India, and most parts of the world, the age of menstruation, since then has hovered between 12 to 13 years of age – until now, says Dr Ruchi Bhandari, consultant gynaecologist, infertility specialist & cosmetic gynaecologist at Mishka IVF Centre.
Dr Alok Sardesai, Consultant, Paediatric Endocrinology, PD Hinduja Hospital & MRC, Mahim, explains that delayed puberty, on the other hand, is considered to be the lack of breast development till the age of 13, and no onset of menstruation for three years following.
"In most cases it is due to family history – the teenager has a mother or an aunt who did not hit puberty till they were 15. It could be because of endocrine factors."
For instance, delayed puberty also may occur when the ovaries produce too little or no hormones. This is called hypogonadism, Dr Bhandari explains.
"Or, it could be due to disorder of the system – like a long-term illness. But, these cases are quite uncommon in present day India, as we see many cases of early but not delayed puberty," Dr Sardesai tells FIT.
Being Underweight, Excessive Exercising May Cause Delayed Puberty
Unlike early puberty, which is caused by obesity, one of the predominant causes of delayed puberty is lack of nutrition, or excessive dieting or exercising.
"Obesity causes delayed puberty to a lesser extent as one needs a certain degree of fat volume for the onset of puberty," Dr Sardesai says.
Fourteen-year-old Prerna (name changed), from Jaipur, was diagnosed with anorexia when her parents took her to the gynaecologist for delayed puberty.
"Until then, we did not realise that Prerna had body image issues, and thus an eating disorder. We took her to understand why she had not gotten her period yet. She has been taking treatment for anorexia, and is getting better at developing healthy eating habits," her mother told FIT.
"Weight is one of the most important factors we consider before diagnosing delayed periods. Another factor is excessive exercising for their age. Many early teens are spending time at gym, or are working out to train for a sport. This can influence the hormone levels."Dr Ruchi Bhandari
'I Was Depressed'
While it may not be common, delayed puberty takes psychological toll on girls.
"She sees a lot of her friends having a normal puberty, and she feels left out. It could lead to anxiety and depression. They need proper care from a healthcare provider so that the cause can be identified, and two, they need emotional support from both counsellor and their parents. They need to be assured that this is not a disease, and it can be fixed with the right care," Dr Bhandari says.
Sameera, who is now a 20-year-old student, is addressing what she went through due to delayed puberty, in therapy.
"It was not long ago, and the one thing I cannot let go of was the shame. Everyone and their aunt were asking my mother about it. I did everything, from eating dates to consuming thousands of sesame seeds barfis. Nothing helped, because I was so anxious about just seeing that blood. One morning, when I was 15, it just happened. I now realise I was depressed during that entire phase."Sameera to FIT
Rhea, on the other hand, remembers how she was anxious about her friends finding out that she actually had not gotten her periods yet.
"I have been made fun of for being thin and scrawny all my life. But people would advise me that eat more, it would make your breasts grow. Things are not black and white like that. For almost one year, I avoided getting my friends home because I was too afraid that my grandmother would tell them about it."
How to Treat Delayed Periods?
According to experts, if there is an endocrine issue – the patient is evaluated accordingly, and a treatment plan is made
If there is an eating disorder like anorexia or bulimia, it is to be identified and stopped immediately through counselling – before addressing the endocrine issue
If the child is undergoing undergoing excessive exercise, is training for a sport, then that has to be altered according to hormone levels
Otherwise, a clean diet with lots of green vegetables and protein is encouraged.