Samantha Lipton* was seven when her mom Rachel first noticed she was growing little breast buds. “It seemed so early to me,” Rachel says. “All of the other girls in her class were completely flat. I had to buy her little lined tank tops to wear under her shirts to school.” Still, she remained relatively unconcerned, until a year later, when Samantha had developed pubic hair, acne and body odour. “I was terrified that she was starting puberty, and would be getting her period in Grade 3. She just wasn’t ready to deal with that yet.” Nor, quite frankly, was Rachel.
Rachel’s GP referred them to a pediatric endocrinologist to determine whether Samantha was going through precocious puberty (PP) – the onset of puberty before age seven or eight in girls, and age nine in boys. In general, girls are now developing earlier than they did a generation ago; numerous studies have shown that breast development in particular is starting younger. Contrary to popular belief, the reason is not excessive hormones in food we eat, or chemicals in our air, water or textiles. It’s largely attributed to better nutrition, greater consumption of animal protein and higher levels of body fat. Girls who are taller and heavier tend to develop earlier than their diminutive counterparts.
But many children who appear to be developing early don’t, in fact, have clinical PP. To diagnose PP, a doctor will do blood and urine tests to detect elevated levels of sex hormones and will X-Ray your child’s hand, to detect her ‘bone age,’ and see if her bones are also maturing early. Precocious puberty is much more common in girls than boys, but when it does occur in males, the cause is far more likely to be an underlying problem such as a tumour. In a small number of girls, the cause can also be a tumour in the brain or ovary, an infection (such as meningitis) or a problem with the thyroid gland. But in most cases it happens spontaneously.
What are the risks? Other than the social and emotional ramifications of developing before your peers, precocious puberty is associated with a higher risk of breast and reproductive cancers in later life, because of longer exposure to sex hormones such as estrogen. Girls who go through early puberty have higher rates of anxiety, depression and early sexual experimentation. In addition, despite initially being much taller than their peers, children who have PP may not reach their full height potential, since the onset of menstruation signals bones to stop growing, and growth in height stops when puberty ends.
For children diagnosed with PP, the doctor may suggest monthly injections of a synthetic hormone that will block production of the sex hormones that are bringing on puberty. These hormones are safe, have no side effects and virtually halt puberty in its tracks. When the child stops the hormone therapy, puberty resumes right where it left off.
As it turned out, Samantha Lipton, did not, in fact have precocious puberty. While her bone age is about a year ahead, she had no estrogen in her blood at the time of her test. “The doctor told us she was in a pre-puberty phase, and was at least a year or 18 months from getting her period, which was what I was most worried about,” says Rachel. “She may look like a teenager, but she’s still my little girl. I wasn’t ready for her to grow up just yet.”
Period talk still hush hush
Most women have vivid memories of their first period – whether they were 11 and terrified or 16 and relieved, the moment is probably preserved in their brain (not to mention chronicled in a diary). Kathleen O’Grady thought those stories were worth sharing; she collected more than 500 of them in her book Sweet Secrets.
“There are girls who knew nothing and thought they were dying, and girls who were proud and bragged about it, and everything in between,” says Kathleen, a research associate at the Simone de Beauvoir Institute at Concordia University in Montreal. “What we found was that most young women had a mixed experience. It was rarely all good or bad. So we tried not to paint the first menstruation as wholly positive or negative, but to give girls the whole gamut of the experience.” The book, which is geared to young girls, also includes need-to-know facts and information about menstruation.
What Kathleen found in collecting the stories is that, despite the open nature of sex and sexuality in western culture, there is still a certain taboo around menstruation. “I was shocked at how few women, even in the most liberal of households, had frank and open discussions with their parents about menstruation. In fact, regular menstruation is a sign of good health – parents need to focus on that, and how absolutely ordinary the process is. And they need to start the discussion early, so there is no trauma for the girl when it happens. Nothing about it should be traumatic.”
Originally published in ParentsCanada magazine, December 2012.