In January 2023, when seven-year-old Maya got her period for the first time, her parents rushed her to the hospital.
"It did not even strike us that it could be her period. We thought she was bleeding due to some health issue. But panicking about it, we ended up really scaring her. At seven, I am not sure my daughter understands what is happening to her body," says Maya's mother, who lives in Faridabad.
In Bengaluru, Juhi's parents had similar concerns, when she started menstruating barely a week after her eighth birthday in November 2022.
"We were somewhat prepared because but had not had the conversation with her until she got the period. It is unsettling because I got my first period when I was 12, and I remembered a myriad of emotions I went through. Not sure how my eight-year-old will handle," Juhi's mother Krishna tells FIT.
Maya and Juhi are far from being exceptions. Endocrinologists and gynaecologists in India have been for some time now witnessing a trend of girls hitting puberty earlier than before. However, this has been pronounced since 2016, and may be more so after the pandemic, say experts.
What's In An Age?
The age of menstruation was 16 in the mid-19th century and declined to 13 by the late 1980s. American scholar Marcia Herman-Giddens was one of the first people to speak about this phenomenon when she published a study of more than 17,000 girls, revealing that they started developing breasts around the age of 10 – much earlier than before.
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. But what is striking is that the number of precocious or early puberty cases have increased significantly.
"Precocious puberty is defined as the development of pubertal changes among children earlier than what is considered normal. It is usually considered 8 for girls and 9 for boys," she explains.
According to Dr Sachin Kumar Jain, Head, Department of Endocrinology, Amrita Hospital, Faridabad,
"It could be due to genetic syndromes, a family history of the disease, central nervous system problems, and tumors or growths on the ovaries, adrenal glands, pituitary gland . Or it could be due to a host of lifestyle issues – which is what we often see in patients," he tells FIT.
What's Causing Early Puberty?
According to a peer-review study published way back in 2013, precocious puberty affects up to 29 per 100,000 girls per year. But in 90 percent of these cases, the study points, that a single factor cannot be ascertained as the cause.
However, one of the common factors noticed by endocrinologists and gynaecologists on ground are obesity, coupled with lack of sleep, stress and anxiety, exposure to hormone-disrupting chemicals, among others.
"There is a definite relationship between raised BMI and early puberty. There have been at least 10 studies, with over 12,000 girls and 13,000 boys worldwide. Obesity leads to insulin sensitivity, and hyperinsulinemia – which again disrupts hormones. This is a predominant cause of early puberty."
"Excessive consumption of processed food – from packets of chips, to highly processed dairy also contribute to obesity, which intern contributes to disrupting endocrine glands," says endocrinologist Dr Sachin.
Another possibility could be the excessive exposure to Bisphenol A (BPA) – a chemical that is predominantly used in various plastic products like windows, eyewear, water bottles, among others.
Both Dr Ruchi and Dr Sachin emphasise on the the role of sleep deprivation and anxiety.
"Children have access to gadgets, blu-ray emitters such as phones, iPads, televisions. They do not sleep till late night, this in turn increases anxiety levels. One of the hormone which is secreted in the dark light is melotinin – and this is the hormone which controls our development... Due to sleeplessness, this may get secreted more, leading to early development," Dr Sachin adds.
The Impact Of Pandemic
A paediatric endocrinologist, at a leading hospital in Delhi, tells FIT:
"If we were seeing 20 cases of girls hitting early puberty pre-pandemic, we are now witnessing almost 10 times more cases. Girls in class two and class three, who are not yet mature enough to understand why they are growing breasts, or the process of menstruation are hitting puberty. Early puberty right now is also a phenomenon seen more in girls – almost a 1:10 ratio between boys and girls."
A study published in the National Institutes of Health (NIH) also points to this.
During COVID-19 lockdown in India, 155 of 3,053 girls who were studied had precocious puberty while pre-lockdown only 59 of 4,208 girls hit puberty before than age of 10.
Similar patterns were also seen in other countries including US, UK, Germany, Italy, among others.
For instance, a study published in January of 2021 surveyed children across Italian centers of pediatric endocrinology found that 328 girls were referred for suspected precocious puberty between March and September 2020. But the number was only 140 during the same period in 2019. The study also concluded that a similar incidence was not observed among boys.
The study concluded that there was an association between “the complex lifestyle changes related to the lockdown” as reasons precocious puberty in Italian girls.
How It Affects the Little Girls
While studies are underway to establish exact causes, this should not be ignored in the present, says the Delhi-based paediatric endocrinologist.
Eighr-year-old Sukrita's (name changed) parents in Delhi first thought she was hurt by someone, when she complained of stomach ache, and parents spotted blood stains in her school uniform. While they took her to an endocrinologist, who suggested an abdominal scan, her mother realised Sukrita had just had her first period.
"We have tried to explain to her that this happens to everyone, and that she has just gotten it slightly early. She is embarrassed to tell any of her friends, she refuses to go to school on the days she has her period. She is very scared, and I just want her to feel better, but I am helpless."
Juhi's mother Krishna, meanwhile, is concerned about how her daughter has withdrawn herself from her friends group.
"My daughter is what society would consider chubby. Her classmates make fun of her already, but now she has had a significant growth in her chest – so they whisper behind her back. She is very conscious and is generally withdrawn from her peers."
"Parents are undeniably concerned, especially parents of girls. Menstruation is not the only mark for attaining puberty in girls. Many medical professionals are not equipped to handle such cases – and this tends to increase anxiety among parents. There needs to be be more conversation about this. Yes, girls are hitting puberty earlier. Yes, this needs to be spoken about, and made easy for people to reach out for support."
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