Since 2014, the Association Française de Pédiatrie Ambulatoire (AFPA) and the Association Française des Pédiatres Endocrinologues Libéraux (AFPEL) have been warning and informing the public about the increase in cases of early puberty.

In 2017, an analysis presented by Santé publique France recorded 1,173 cases of precocious puberty in young girls between 2011 and 2013. The report shows that some regions are more affected by this phenomenon than others. On average, 2.68 cases per 10,000 girls were identified, but these numbers are significantly higher in the Midi-Pyrénées and Rhône-Alpes regions. Why do children growing up near large cities like Toulouse and Lyon have a higher risk of developing early signs of puberty?

To better understand this phenomenon and protect yourself from it, Sisters Republic explains everything about the causes, risks, and treatment options for early menstruation.

Early Puberty and Menstruation: How Does It Work?

In young girls, the first signs of puberty usually occur at the age of 9 to 12 years. Puberty begins when the hormonal system matures. This phenomenon is controlled by the brain at the level of the hypothalamus and the pituitary gland. These two glands release hormonal messengers to stimulate the gonads. In young women, these gonads are the ovaries, which produce estrogen. This hormone causes the sexual characteristics to develop in young women:

• bone growth
• The adrenal glands secrete androgens: onset of hair growth (pubic hair, armpits, etc.), changes in the skin (oilier, acne...) and sweat (more odorous).
• Activation of the breast glands: The breasts grow
• A functioning uterus: Start of menstruation

Typically, the first menstruation occurs two years after the onset of breast development. Early puberty is more common in girls than in boys. An early menstruation is referred to when the first menstruation occurs before the age of eight.

What are the causes and symptoms of precocious puberty?

Certain signs that indicate hormonal changes before the age of eight can help you recognize early puberty:

• A rapid growth spurt
• Mood swings that may indicate an "adolescent crisis"
• The pressing of the breasts

Medical factors and environmental causes

The cause of an early menstruation can be medically related. The pituitary gland can be responsible for an early menstruation if it has an anomaly such as:

• A cyst
• A deformity
• A progressive lesion

The early menstruation is most commonly associated with environmental factors such as:

• overweight
• Endocrine Disruptors

Pediatricians have found that daily sugar consumption can disrupt the ovaries. This is associated with a gradual weight gain in childhood, which is often blamed for early puberty.

Endocrine Disruptors

Since the 1990s, health authorities have been aware that there are many substances that can disrupt the human hormonal system. There are three different types of them:

• Phytoestrogens, which naturally occur in soybeans, chickpeas, beans, wheat, corn, etc.
• Synthetic estrogens that originate from contraceptives and menopause replacement therapies and are now found in wastewater and rivers.

The third type of endocrine disruptors are xenoestrogens, which are found in pesticides and industrial pollutants , such as:

• Bisphenol A, found in plastic bottles and canned goods
• Phthalates used in the production of toys, food packaging, and cosmetics.

These substances disrupt the body because they mimic the hormone estrogen. They activate puberty prematurely and trigger an early menstruation. Since 2013, Bisphenol A has been banned in the production of items intended for children under 3 years old. It has also been banned in the manufacturing of coatings for boxes, cans, and ticket stubs since 2015. Unfortunately, these measures are not enough to protect children.

What risks and treatments are there for early puberty?

"If you suspect that your child is entering puberty early, you should consult a pediatrician. To make an accurate diagnosis, the pediatrician analyzes several data:"

• The course of the growth curve in the health book
• The bone age of a child through an X-ray of the left hand and left wrist.
• A pelvic ultrasound to measure the maturation of the sexual organs (uterus, ovaries...).
• A blood test
• An MRI of the brain

A pediatric endocrinologist then assesses the risks of precocity in order to initiate an individualized treatment.

What risks does early puberty entail?

An early menstruation can lead to complications in some women in adulthood. An early menstruation can result in a premature growth stop and prevent little girls from surpassing 150 cm. Early puberty can also be the cause:

• Painful or irregular menstruation
• Type-2-Diabetes
• Premature menopause
• The occurrence of depression or behavioral disorders before the age of 30.

How is early puberty treated?

There is a treatment that stops the activity of the pituitary gland and pauses the development of puberty signs. Thanks to this treatment, precocious girls can grow psychologically at the same pace as other children their age and continue their growth normally. The treatment is based on the injection of GnRH-like hormones, which can be administered at home on a monthly or quarterly basis. Psychological support may be recommended to help cope with the physical and psychological upheavals.

This treatment tends to increase appetite. Therefore, it is often accompanied by careful monitoring of the child's weight. It is about controlling the intake of fast sugars and increasing physical activity. At the same time, it is important to limit the child's exposure to endocrine disruptors.

The treatment ends at the age of eleven years, so that puberty can begin. The first menstruation occurs approximately two years after the last injection. The treatment has no significant long-term side effects, neither on fertility nor on the risk of breast cancer in adulthood.