|
|
|
|
|
|
|
|
|
Menarche or onset of menstruation is an important developmental milestone in a girl's life. It heralds the sexual maturity from the medical as well as the social point of view. Menarche usually occurs between 12-16 years of age. When menarche occurs before the age of 12 years it is called early menarche. In modern days we commonly hear these phrases that "age of menarche is falling "or "girls are attaining menarche earlier than ever". Let's see whether this is true and what are the implications of early menarche on the girl and her family. It is very alarming for the parents to discover early onset of menses, especially if this happens before the age of nine years. If menarche occurs that early it is called precocious puberty and needs medical advice. Average age of menarche varies with race and ethnicity. In USA and Europe girls attain menarche at an average age of 12 years and three months and in Russia at 13 years. In India the average age is 13-15 years. Poor socio-economic status and nutrition have been associated with delayed onset of menarche. A study on socio-economic variables affecting menarche was reported by Al Saheb and group in 2010. They found that income and family composition were the most important variables which had an impact on the age of menarche. Girls born in high-income groups had better nutritional status and a strong link was found with the age of menarche. In families with single parents higher psychological and physical stress was observed. This was again found to have a strong association with early menarche and sexual maturity. In USA approximately 16 per cent of girls attain puberty (early signs of sexual development e.g. development of genital hair and breasts) by the age seven and almost 30 per cent by the age of eight years. Early menarche raises a number of health issues related to the wellbeing of affected young girls, especially those who are less than 10 years of age and are not emotionally and psychologically mature to handle puberty. It is even difficult to train them to maintain menstrual hygiene. Suddenly from a carefree child she suddenly becomes an adolescent who fails to understand the changes happening in her body, the anxiety of parents and also the restrictions imposed upon her. These vulnerable kids may face problems like depression, anxiety, eating disorders, smoking and even drug abuse. Early menarche has been linked to anaemia, irritability, loss of school days and negative impact on school performance. It has also been linked with higher incidence of breast carcinoma because of early exposure to the hormone oestrogen. A girl starts thinking herself as a mature adult. This feeling may lead to her early sexual initiation and she may get entrapped in sexual harassment and abuse. She also becomes vulnerable to increased risk of teenage pregnancy and the consequences attached with it. The onset of menarche is determined by a complex interplay of genetic, environmental, neurological and hormonal factors. One of the strongest predicator of menarche is the age of menarche of the mother. Only the environmental factors are modifiable to certain extent. The most important of these factors is obesity. There are numerous studies which have linked obesity or high BMI (body mass Index) with early menarche. Decreased level of activity also triggers certain signals in brain which affect the onset of puberty. Even in normal-weight girls increased intake of non-vegetarian diet, animal protein intake, consumption of soft drinks, increased used of processed and fast food, have association with early menarche. These substances contain many chemicals called EDCs (Endocrine Disrupting Compounds). In animals EDCs are hormonally active compounds which mimic or antagonise natural hormones. These can alter or interfere with the body's endocrine signals. These compounds keep on accumulating in the body and may lead to early menarche. Increased use of plastics e.g. water bottle, cups, cosmetics etc also contributes to the exposure to EDCs. Other factors include socio-economic status, stressful life events, family relationships and whether the girl was born with a lower birth weight. Increased television viewing and computer use have also been implicated in the causation of early menarche. It has been hypothesised that the light emitted by the screens inhibits melatonin, a hormone which is responsible for nocturnal sleep patterns. Melatonin is an important hormone responsible for the initiation of puberty. Decreased levels of melatonin can lead to early onset of menses. The million-dollar question is "Can we do something about early menarche?" The answer is yes but to a certain extent. We can control environmental factors. Children should be actively encouraged to follow a healthy lifestyle and have healthy and balanced diet which should include fresh fruits and vegetables, less of animal protein and fast and processed food. Children should be encouraged to play outside in the open and limiting exposure to television and computers. Growing children need lot of parental guidance, support and supervision. It is the duty of parents that young girls enter menarche with an optimal weight and healthy lifestyle. — The writer is a Chandigarh-based gynaecologist
|
|||
|
|
|||
