Precocious puberty in girls: the risks and how to treat it

Puberty is a stage that can already be very difficult in the lives of girls. If it happens too soon, the teenager has to deal not only with changes in body and behavior, but with a series of health risks.

But at what age can puberty be considered precocious? What causes this problem and what can be done to combat it?

Puberty is the maturing of the body to prepare for procreation, explains physician Marta Francis Benevides Rehme, president of the National Commission Specialized in Child Pubertal Gynecology at Febrasgo (Brazilian Federation of Gynecology and Obstetrics Associations). It happens in stages and is a different process in girls and boys.

“In girls, first there is the growth of breasts, then the appearance of hair on the body and then the first menstruation, which marks the end of this process”, explains Rehme.

The age at which girls go through puberty has been falling over the years: the average age for first menstruation today is much lower than it was at the beginning of the last century, says the doctor. Researchers still cannot say for sure why, but there are a number of hypotheses, including changes in diet and environmental stimuli.

Today, the average appearance of the first signs of puberty is around 10 years old and the first period between 11 and 12 years old, explains Rehme.

When the appearance of hair or breasts occurs in girls under 8 years of age, they are considered to be going through a process of precocious puberty, explains endocrinologist Sonir Roberto Rauber Antonini, professor at the USP School of Medicine in Ribeirão Preto and chairman of the Department of Pediatric Endocrinology of the Brazilian Society of Endocrinology and Metabology (SBEM).

In addition to the appearance of breasts and hair, other factors that can appear in precocious puberty are very rapid growth in very small girls, skin becoming oily and acne-prone, and even the presence of underarm odor and changes in behavior.

In these cases, explains Antonini, it is extremely important that this girl undergoes a pediatric consultation and is referred to a pediatric endocrinologist for examination and diagnosis. If it is positive, that is, if the girl is really going through precocious puberty, this process usually needs to be stopped.

But why is this intervention necessary and what problems can precocious puberty bring?

The risks of precocious puberty

During puberty, the body starts creating certain hormones in greater amounts.

A region of the brain called the hypothalamus produces more of the hormone GNRH, which acts on the pituitary gland, a gland located at the bottom of the brain, and increases the production of the hormones LH and FSH.

These hormones, in turn, travel through the bloodstream and affect the ovary, causing it to mature and produce the hormone estradiol (a type of estrogen), which in turn causes breast development, increases the rate of growth, and causes changes in body conformation—hips get wider, for example. This hormone also acts on the brain, which can affect mood and behavior. The first period is the last phase of this process, when the body increases production of the hormone progesterone.

When a girl goes through puberty early, all these hormones are being produced ahead of time, generating a series of consequences for her life and health.

“This child will grow very quickly, but it will stop growing fast, because menstruation, which is the last phase of puberty, slows growth a lot”, explains pediatric endocrinologist Sonir Antonini. “So a girl who should grow up to be 11, 12 years old will have her period earlier and stop growing until she’s 8 years old, getting a shorter stature.”

In addition, explains gynecologist Mara Mendes, director of the department of patient protection at the CMBA (Brazilian Medical College of Acupuncture), changes in the body ahead of time increase the risk of the girl being sexualized early. “We cannot ignore the risk of pregnancy if she has menstruated early and suffers sexual abuse”, says the doctor. At this age, pregnancy can even put the child’s life at risk.

Exposure to so many hormones ahead of time can also cause major emotional changes, explains Mendes. “There are the effects of hormones on the brain, but also other more subjective factors. There may be a shortening of childhood, she may not accept herself in front of her colleagues, who will still take a long time to go through the process.”

“Precocious puberty can lead to depression and risky behavior in adult life — there are several studies that link precocious puberty to these problems”, explains Antonini.

There are also some studies that show a correlation between early exposure to puberty hormones and an increased risk of certain cancers in adulthood — although this is something that still needs to be studied further, according to Antonini.

Risk factors and causes of precocious puberty

There are several possible causes for precocious puberty, explains Antonini — from a genetic cause, that is, a tendency to the problem inherited from the parents, to the presence of diseases such as tumors, problems with the adrenal glands or the ovaries.

More commonly, however, it has what doctors call a central cause, which is when the brain — for a variety of reasons that aren’t always clear — is releasing hormones ahead of time.

There is also a risk factor, which can increase the chances of puberty being delayed: childhood obesity.

Endocrinologist Maria Edna de Melo, president of the Child Obesity group at SBEM, explains that obese girls tend to have early puberty.

“What usually happens is a girl who would menstruate at 11, 12 and end up menstruating at 9 or 10. Childhood obesity usually causes this advance, but usually does not cause precocious puberty, that is, before 8 years”, explains Mel.

According to Antonini, it is not yet known exactly why obesity causes this advance, but it is probably related to the production of leptin, an important hormone for the body to produce puberty hormones.

“Leptin is produced by adipose tissue”, explains Antonini, “so excess leptin is probably one of the factors that causes obesity to generate this advance.”

“The amount of fat in the body is closely related to puberty. So just as a girl with excess can anticipate, a very thin child may not enter puberty”, says the endocrinologist.

Melo explains that it is important for parents to consult the pediatrician if they are in doubt about the proper weight of their children. “Obesity in children is not calculated in the same way as in adults, there is a specific index for them indicated by the WHO (World Health Organization).”

How is precocious puberty treated?

The treatment that will be indicated depends on the cause of the problem.

In the case of early but not technically early puberty (before the age of 8), where the cause is obesity, puberty does not need to be stopped — the treatment of obesity is indicated, which can lead to other health risks in the future. .

“In 95% of cases of childhood obesity, the cause is inadequate nutrition and little physical activity, so these are the factors that need to be changed”, explains Antonini.

“Today there is a lot of pressure from the food industry, it is very easy to obtain ultra-processed foods. And sometimes they are even cheaper than fresh foods”, explains Melo.

“Parents are often judged — and they themselves sometimes blame themselves — when there is childhood obesity, but people forget that parents are also victims of this strong pressure from the food industry”, says the doctor.

Treatment for childhood obesity, she says, involves behavior change, dietary reeducation and medical monitoring of health indicators.

When there is indeed a precocious puberty with a central cause, that is, caused by the advance of the release of hormones by the central nervous system, the process needs to be interrupted with the use of hormone blockers, explains Antonini.

“Usually, injections of GNRH analogues are used every 1, 3 or 6 months”, he says. “The process needs to be accompanied by a pediatric endocrinologist, who will monitor the child’s growth, weight and adjust dosages.”

Blockers are generally taken by girls until they are around 10 or 11 years old.

“Within a few months or a year after stopping taking the blockers, the girl enters puberty. There are about 30 years of studies showing that they are very safe drugs, which do not have serious side effects”, explains the doctor. “When the girl stops taking it, enters puberty and menstruates, she will have normal fertility capacity.”

In cases where precocious puberty is a symptom of a disease — such as a tumor or problems with the adrenal glands — the treatment will focus on solving this original problem, explains the doctor.