Preparing girls for puberty

Girls in the United States are getting their first menstrual period about six months earlier than girls in the 1950s and 60s did, according to a new study published in JAMA Network Open. The study is based on more than 71,000 women enrolled through the Apple Research App on their iPhones.

And that’s just the average. A higher percentage of girls are getting their period at even younger ages than ever before. Researchers have found that the percentage of girls who begin menstruating before the age of 11 grew from 8.6 percent to 15.5 percent and the number of girls who began before age 9 doubled.

Many girls that young may not be given information about menstruation because their parents don’t suspect that they are old enough to need it. That can leave girls embarrassed and unprepared. Some girls even try to hide symptoms of early puberty, according to pediatrician Lori Zito, MD, at Bass River Pediatric Associates in South Yarmouth.

Dr. Zito watches for the Tanner Stages of puberty in her patients so she can advise them and their parents what to expect as their body changes. Adolescents go through five Tanner Stages. The ones that girls experience include:

• Stage I - before puberty begins.
• Stage II - when girls develop breast buds and downy pubic hair.
• Stage III - when breast tissue expands a little around the nipple and pubic hair turns coarser.
• Stage IV - when the breasts appear to have a “mound on mound” appearance where the nipple is separate from the breast tissue. Pubic hair is a full triangle and arm pit hair appears. This is when girls typically get their period.
• Stage V - when a girl is fully developed.

“The very earliest sign of puberty is body odor,” Dr. Zito said. “The other thing we see before a period for most girls is a big height growth spurt. Girls will still grow for two years after their period but at a much slower rate, depending on the child. If it’s already a tall child, they might get three or four inches. If it’s a short child, they might only get one inch.”

Begin Talking at Stage II

The time between Stage II and the onset of menstruation is usually two years, Dr. Zito said. Stage II is when she suggests that parents begin to talk to their daughters about the body changes that are coming. Dr. Zito recommends two books for parents to give to their daughters. Both are published by the American Girl company. The first book is The Care and Keeping of You 1: The Body Book for Younger Girls.

“This book is perfect because it’s at their developmental level,” Dr. Zito said. “It really just talks about the changes in the body. It doesn’t talk about sex. It doesn’t talk about babies. It just talks about the changes like the breast tissue, the hair, hygiene, deodorant, showering, acne, and then it ends with the period and how to use pads and tampons. It’s a great little book.”

For older girls, she recommends The Care and Keeping of You 2: The Body Book for Older Girls. The movie Inside Out 2, is also a great way for parents to talk about the emotional changes caused by puberty. The main character, Riley, is going through puberty and four new emotions (Anxiety, Envy, Embarrassment and Ennui) join her childhood emotions of Joy, Anger, Fear, Disgust and Sadness.

Both American Girl books can be found at local libraries, but Dr. Zito recommends buying the first book, if you can afford to, because a lot of girls are embarrassed and don’t want to look at it at first. If it is in a drawer in their nightstand, they can look at it when they are ready.

When Supplies Should Be Ready

When girls are between Stage III and Stage IV, Dr. Zito recommends that her female patients prepare by making sure they have the supplies they will need, especially while they are at school.

“It’s a good idea to have a little cosmetic case that has all your supplies in it - pads, fresh underwear, a rolled-up pair of leggings - and you have it in your backpack,” she said. “And I say to them, ‘If you don’t need it, one of your friends will, so it’s a nice thing to have.’”

These days, pads are smaller and more absorbent than they used to be, and even though most girls start with pads, they can start using tampons even with their first period, Dr. Zito said. She cautions patients to use a lesser absorbent tampon on light period days to allow ease of removal and to prevent toxic shock syndrome.

Early puberty is more common in girls who are overweight because obesity leads to high estrogen and androgen levels, which kick-starts puberty. Some girls have what is called “precocious puberty” which is puberty that begins before the age of 8. If Dr. Zito sees a girl under the age of 8 with breast buds, she refers her to an endocrinologist, so she can start taking puberty blockers to slow things down until she is 11 years old.

There are a lot of theories why puberty is starting earlier. Some scientists think it is being caused by stress or by endocrine-disrupting chemicals in our food supply or even pollution.

“There are a lot of different theories but no one really knows why it happens,” Dr. Zito said. “Parents just need to prepare them for when it occurs and be open to talking about it very early on.”