When Mother Nature knocks early...

She is a manager at a private bank,not unfamiliar with in-ordinate amounts of stress and pressure. Yet last week has left her besides herself with anxiety after her daughter had her first menstrual period. Her daughter is in Class III.

"She took a long time to toilet-train and barely a year ago began to go potty by herself. And now she has hit puberty. I don't know what to do," weeps the 35-year-old. The gynecologist reassures her there is nothing wrong medically with the eight-and-half-year-old.

A 2015 study titled 'Age of Onset of Puberty in Apparently Healthy School Girls from Northern India' (authored jointly by Departments of Endocrinology and Metabolism and Biostatistics at AIIMS; and Sur Homeopathic Medical College, Hospital and Research Centre and International Life Sciences Institute of Delhi) found the average age of menarche to be 10.3 years and showed that pubertal onset occurs earlier in overweight and obese. Yet this girl is neither, so the mother is not pacified.

"These are all easy things for medical practitioners to say," she says agitatedly, "I'm the one who will have to talk to her about menstrual hygiene and sanitary pads. Even that is easy. Imagine telling her about the male gaze and the wrong kind of touch. It's criminal that she's robbed of her childhood innocence so early."

The awkward years

Dr Kiran Coelho, who heads the gynaecology department at Lilavati hospital and consults at Hinduja hospital in Khar, confirms that the onset of puberty in young girls has been pulled back by two to three years in the last decade. "I think the discomfort of conservative families, who don't want to even talk about sex from a biological point of view, is the bigger problem," she says. "It is parents of girls from such families who find it more difficult in talking to the daughter." She advises mothers to get over their own awkwardness and talk to the child. "If you feel that you're unable to cross that bridge, take the child to a gynaecologist. Often girls can be more receptive to an authoritative third person like a teacher or doctor who can explain the whole phenomenon in a way easy to process and understand."

Psychiatrist Dr Pavan Sonar echoed her views. "A non-preachy, non-judgmental approach will help the child articulate her feelings better as she copes with not only the physical changes but also experiences a whole spectrum of new emotions and attractions which she may not fully comprehend herself," he said, "This will help raise awareness about the dangers of abuse, sexually transmitted diseases and even unwanted pregnancies."

Need to know

Dr Coelho feels, better nutrition and heightened awareness due to films and media contributes to the early onset of puberty. She advised parents to use Internet resources or Know-Your-Body books to help explain to young girls the process of menstruation. "Explaining that her menstrual cycle is linked to the rise and fall of hormones is important because this will remove fear and doubts. You should be able to emphasize how it is normal that this cycle thickens the lining of the uterus and results in growth of an egg, which is released from an ovary around14 days later. This unused thickened lining which would provide the embryo nutrition in case of pregnancy is what is thrown out by the body through menstruation."

Arming the child with scientific knowledge will equip her to understand that the process is normal and also help her withstand curiosity or estrangement from her peers. Getting to puberty early than classmates could start off conversations that the parents of the other children may not be ready for. There might be social stigmatization as she excuses herself from physical activities during her period, or finds herself embarrassed due to staining.

Early development of the body could also cause discomfort and embarrassment.

While the norm is to silence or only allow hushed talk about menstruation, many like sociologist and cultural historian Dr Meghana Kashyap feel the onset of early menarche makes it all the more imperative that society starts talking about the gender politics. "When a girl reaches puberty, she finds herself forced into menstrual etiquette. This leads to its complete invisibilization, first by the male members of her own family, which soon might extend to the whole world outside. Most of the silence that girls are socialised into when it comes to sexual and reproductive health has its roots in this taboo. We need to change that. The early onset of puberty among girls actually offers us an opportunity to change the gender paradigms of socialisation on this taboo subject which can then become something to talk about openly like any other health and wellness issue."

Precocious Puberty

Precocious puberty is the undesirably early onset of puberty which may be caused by problems in the functioning of either the hypothalamus or the pituitary gland. Investigations need to also rule out any infection, trauma, or irradiation-related damage to the inhibitory system of the brain; hypothalamic haemartoma (non-cancerous tumour) which produces pulsatile gonadotropin-releasing hormone (GnRH), Langerhans cell histiocytosis or any genetic disorders like McCune–Albright syndrome.

Dos & Don'ts

1) Don't panic or act anxious. Your child will pick up that vibe and imagine the worst.
2) Be a friend. Talk to the child. Listen to her.
3) Don't get preachy or judgmental.
4) Don't act awkward when bringing up sex, STDs or unwanted pregnancies.
5) Seek out a gynaec/ counsellor to talk if you aren't able to.
6. Sound out the teachers who will be able to assist the child at school with staining or changing.
7. Sound out other parents so that they are prepared to answer questions from their children who are curious about your child's new experience.