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General Practice 2023

Early menarche: what é, symptoms and main causes

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Early menarche: what é, symptoms and main causes
Early menarche: what é, symptoms and main causes

Menarche corresponds to the girl's first menstruation, which usually occurs in adolescence, between 9 and 15 years of age, but which can vary according to lifestyle, hormonal factors, presence of obesity and history of menstruation of women of the same family. It is classified as being:

  • Early menarche: when it appears before age 8,
  • Late menarche: when it appears after 14 years.

More than half of Brazilian girls have their first period by the age of 13, and by age 14 more than 90% of girls already have their period. However, when the girl menstruates before age 8, the parents should take the girl to the pediatrician to investigate what is happening, as there may be illnesses involved.

Signs and symptoms of early menarche

The first signs and symptoms of early menarche are the appearance, before age 8, of:

  • Vaginal bleeding;
  • Slight body swelling;
  • Pubic hair;
  • Breast enlargement;
  • Increase the hips;
  • Pain in the abdominal region and
  • Psychological signs such as sadness, irritation or increased sensitivity.

The girl may also notice a whitish or yellowish discharge coming out of the vagina a few months before menarche.

Causes of early menarche

The first period has come earlier and earlier. Before the 1970s, the first period came between the ages of 16-17, but lately girls have menstruation much earlier, from the age of 9 in many countries, and the causes are not always clear.Some possible causes of 1st period too early are:

  • Without defined cause (80% of cases);
  • Mild to moderate childhood obesity;
  • Exposure to plastic containing bisphenol A is suspected since birth;
  • Central nervous system injuries such as meningitis, encephalitis, cerebral cyst or paralysis, for example;
  • After radiation to the central nervous system;
  • McCune-Albright Syndrome;
  • Ovarian lesions such as follicular cysts or neoplasia;
  • Estrogen-producing adrenal tumors;
  • Severe primary hypothyroidism.

Also, when a girl is exposed to estrogen hormones from an early age, the chances of early menarche can be increased. Some situations in which the girl may be exposed to estrogens include taking the contraceptive pill by the mother during pregnancy and/or breastfeeding, and the use of ointment to separate the labia minora, in case of female phimosis, for example.

Required exams

When the girl has her first period before the age of 8, the pediatrician may suspect some change in her he alth, and therefore usually evaluates the girl's body by observing the growth of the breasts, armpit hair and groin. In addition, the doctor may order tests such as LH, estrogen, TSH and T4, bone age, pelvic and adrenal ultrasound.

When the first period comes before the age of 6, you can still request tests such as magnetic resonance imaging of the central nervous system to check for serious changes that may be causing menstruation so early.

Treatment for early menarche

The main consequences of early menarche are psychological and behavioral disorders; increased risk of sexual abuse; short stature as an adult; increased risk of obesity, hypertension, type 2 diabetes, cardiovascular disease, stroke, and certain cancers, such as breast cancer, due to early exposure to the hormone estrogen.

Thus, the pediatrician may suggest that the parents carry out the treatment, delaying the girl's menarche until the age of 12, using monthly or quarterly injections of a hormone that causes puberty to regress. When the first period comes too early and is caused by an illness, it must be treated, and the period disappears, then returns when treatment is stopped.

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