Why girls who start menstruation early may be short – Paediatric endocrinologists

Angela Onwuzoo 

Numerous myths and misconceptions about the growth in height of girls who begin menstruation early have always created significant anxiety among parents.

In as much as girls start puberty at different times and genetics largely determines growth patterns, paediatricians say most girls will stop growing in height about two and a half years after they begin to menstruate.

The child health specialists noted that a girl’s largest growth spurt is typically just before she starts her period.

According to them, a girl may grow slightly after she starts menstruating, but her major growth spurt is finished before the first period.

The start of the menstrual period, known as menarche, happens on average around age 12, which child health experts describe as a milestone event of pubertal development in girls since it represents the onset of the female reproductive capacity.

The paediatric endocrinologists stated that on average, a girl’s first period is two years after breast development begins.

They explained that if breast development starts earlier, she may start her period earlier and if breast development is late, she may start her period later.

The United Nations Children’s Fund says menstruation is a normal and healthy part of life for most women, adding that on average, women menstruate for about seven years during their lifetime.

UNICEF states that a lack of information about menstruation leads to damaging misconceptions and discrimination, which can cause girls to miss out on normal childhood experiences and activities.

“Stigma, taboos, and myths prevent adolescent girls — and boys — from the opportunity to learn about menstruation and develop healthy habits.

“The first period can be met with either celebration, fear, or concern. For every girl, this signifies an important transition to womanhood – a time when they would benefit from the support of family and friends”, the international organisation states.

The Paediatric Endocrinologists, who spoke exclusively with PUNCH Healthwise said the whole process of early menstruation varies from girl to girl, stressing that menarche is a complex phenomenon that is influenced by genetic and environmental factors.

A Professor of Paediatric Endocrinology, College of Medicine, University of Lagos, Abiola Oduwole, told our correspondent that early menstruation might affect the growth of girls.

The Head of Paediatrics Department, Lagos University Teaching Hospital, Idi-Araba, said, “Every girl child will go through puberty usually between the age of 10 and 11. Some a little bit earlier than nine years is still normal.

“Now, when you enter puberty, your body begins to change and prepare to be an adult. So, if you start developing breasts now, some hair in the armpit, some in the private parts, by another two and half years, you will start to see your period.

“When you see your period, the hormones that are being produced will also affect the growth plates in your joints. This is where we grow taller. Those growth plates are called epiphyses; they will cease and close up.”

The consultant paediatric endocrinologist noted that the closure of the epiphyses is a normal body response.

Epiphyses are the cartilaginous layers at the end of long bones at the joints responsible for growth.

“One and half years after you have seen your menses, your joints will close up and you can’t grow taller again. So, the earlier you see your period, whatever height you are at that time, you will just grow some little inches more and within one and half years, your epiphyses will close. You will not be able to grow more.

“That is why some girls who see their periods between the ages of 14 and 15 grow much taller because they still have two years more to grow after seeing their menses.

“But if you have a child with precocious puberty – that is earlier than it should be, and the child starts seeing her menses at the age of five; by the time the child is seven, the epiphyses will close. And a child that the epiphyses close by seven will be short.

“So children who see their periods at a very early age will not be tall. That is what happens,” she explained.

Mayo Clinic says precocious puberty, also known as premature puberty, is a condition in which a child’s body begins to change into that of an adult too soon.

It states that precocious puberty usually occurs before the age of eight in girls and before the age of nine in boys.

Meanwhile, Oduwole said early menstruation could be caused by environmental factors such as increased subcutaneous fat, a high body mass index, and sugar-sweetened beverages as well as genetic factors.

She, however, noted that health education can prevent early menarche by reducing the consumption of fructose, high concentrations of which are present in sugar-sweetened beverages.

The don advised parents to avoid feeding their children with foods that predispose them to obesity.

Another Paediatric Endocrinologist at the Lagos University Teaching Hospital, Dr Elizabeth Oyenusi, who spoke on some of the causes of early puberty, said girls with early breast development should be evaluated by child specialists.

The specialist, who is the President, African Society for Paediatric and Adolescent Endocrinology, told our correspondent that it is not normal for a girl to develop breasts before the age of eight, which precedes menstruation.

She said, “Any pubertal development, meaning breast development, pubic hair development, or axillary hair development before the age of eight years in a girl is abnormal. It is precocious puberty.

“So apart from the development of breasts, the development of pubic hair, the development of axillary hair, and also having adult body odour and body shape, are some of the things you can see. It is not normal.

“The things that can cause it are varied. There is one called idiopathic, you may not be able to find any cause. That one most times may run in families.”

Oyenusi, a senior lecturer in the Department of Paediatrics, Faculty of Clinical Sciences, University of Lagos, also listed some other causes of early puberty, which she said are more dangerous.

She added, “Things like having a tumour in the brain, in the ovary, or the adrenal gland; all these things can cause a child to start developing earlier than normal.

“And so, if a child gets breast or any of that pubertal development before the age of eight, then you are required to see a doctor, specifically, a paediatric endocrinologist.

“Sometimes, when they are around seven years old and you check them out, it may just be that they are starting earlier and there is no other problem.

“But because there are many other problems, which if you don’t solve, can cause that, it means that you must investigate the child.”

She also pointed out that early puberty could expose children to psychological distress and also impact their growth by making them have a small height in adulthood.

Experts say early puberty will cause a child’s body and moods to change much sooner than that of friends and classmates, adding that this may make a child feel self-conscious and embarrassed or be teased by other children.

Apart from tumours, Oyenusi said there are some other genetic diseases too, such as enzyme deficiency and hormonal imbalance that could make children have puberty too early.

On how early puberty could be managed and treated, Oyenusi said, “If we see a child that has precocious puberty and we investigate, if there is a life-threatening cause, it has to be treated. But if it is just that they are starting too early and they can’t handle the progression, we stop puberty by giving them puberty-blocking drugs.

“When parents notice abnormal puberty signs in their children, they should go and see the doctor. The child must be seen and evaluated by a paediatric endocrinologist who decides whether there is nothing to worry about or there is.”

She advised parents to ensure that their children who go into puberty too early are evaluated and treated.

In a 2023 article published in BMC Paediatrics, titled, “Analysis of risk factors of precocious puberty in children”, the authors said in recent years, studies have pointed out that the incidence of precocious puberty in children is increasing year by year.

BMC Pediatrics is an open-access journal that publishes peer-reviewed research articles in all aspects of health care in neonates, children, and adolescents.

“Precocious puberty in children will lead to increased hormone secretion, which will affect their psychology, height, nervous system tumours, etc., seriously endangering children’s physical and mental health, and may also advance the time of bone maturity in children, resulting in short adult height”, the authors stated.




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