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Very early puberty boosts risk of psychological problems

It also increases risk of sexual abuse and early pregnancy, says study

Caroline White

Friday, 27 April 2012

Girls who start puberty very early are more likely to have psychological problems and be at risk of sexual abuse and early pregnancy, than other girls of their age, suggests a review published today in The Obstetrician & Gynaecologist.

Normal puberty usually starts from around the age of 10 years, with breast development the first sign. In Europe, the lower end of the normal range for the onset of puberty is 8 years in girls, although there are ethnic variations.

In girls, early or precocious puberty is defined as the development of secondary sexual characteristics, such as the development of breasts or pubic hair before the age of 8 years.  

The condition warrants referral to a paediatric endocrinologist for evaluation and management, say the authors.

Girls who start puberty early can be affected both physically and psychologically, they say. For example, although the child may initially be tall thanks to faster maturation of the bones, growth may stop early, so final height may be compromised.

Levels of sex steroids normally seen in older girls can prompt adolescent behaviour and further problems if the child is expected to behave according to their physical maturity rather than their age. These girls are at increased risk of sexual abuse and early pregnancy as a result, say the authors.

Treatment will depend on the type of puberty and its underlying cause, which is not always known. But most children can be treated effectively with gonadotrophin-releasing hormone analogues (GnRHa), which controls the release of the hormones responsible for the development of secondary sexual characteristics.

But side effects can include headaches, hot flushes, mood swings, and rashes.

This treatment is normally stopped when it is time for normal puberty to begin. The decision to discontinue treatment should be taken jointly by the endocrinologist, the child and the parents, says the review.

But the decision to provide treatment or not is a difficult one, in particular, for girls who start puberty between the ages of 6 and 8 years.

Sakunthala Sahithi Tirumuru, specialist registrar, at the Department of Obstetrics and Gynaecology, Alexandra Hospital, Redditch, and co-author of the review said:

“Starting puberty early can have a significant impact both psychologically and socially on both the child and her family.

This all needs to be considered by the healthcare team and further studies are needed to evaluate the effects of hormone treatment on quality of life and long-term impact.”

Tirumuru SS, Arya P, Latthe P. Understanding precocious puberty in girls. The Obstetrician & Gynaecologist 2012; 14:121–9.

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