Causes and Solutions for Early Onset of Menstruation Compared to Typical Age

When Gabby was six years old, she began to develop hair in various parts of her body. That same year, her menstruation started. Alarmed about what was happening to her daughter, her mother took her to see a doctor. “The team of pediatric health specialists had never encountered such a case before, so further investigation was necessary,” said Gabby, now 26, while speaking with the World Health Organization. “They had to refer me to other hospitals for treatment.” Gabby has a condition called Central Precocious Puberty (CPP), which means her puberty began much earlier than usual. In such cases, children show signs of sexual maturation before the typical ages of nine in girls and eight in boys. The prevalence of this condition varies by country but affects girls more frequently. Each year, between 0.2 and 26 out of 10,000 girls worldwide, and 0.02 to 0.9 percent of boys, face this issue. Early puberty not only poses immediate health concerns but may also increase the long-term risk of cancer and cardiovascular diseases.

Gabby doesn’t remember much about the onset of her early puberty, but she recalls the painful moments. “I would sit on the floor clutching my stomach in pain,” she recounted. After about a year of tests, although her brain MRI scan showed no clear abnormalities, she was diagnosed with Central Precocious Puberty. She was then prescribed the hormone-suppressing drug gonadotropin-releasing hormone agonist (GnRH). “I felt as if I was from a completely different planet because I was continuously undergoing tests and receiving injections every three weeks,” she explained. The GnRH injections work to halt puberty progression, allowing children to develop according to their actual age.

There are two types of early onset puberty: Peripheral Precocious Puberty (PPP) and Central Precocious Puberty (CPP). PPP occurs when the ovaries or testes begin producing sex hormones independently of the hypothalamic signaling in the brain. This form is usually caused by an underlying condition, such as ovarian or testicular tumors, adrenal gland disorders, or exposure to external sex hormones. CPP refers to the early activation of the normal puberty process in the brain’s hypothalamus, leading to a progression that follows the typical sequence but starts prematurely. CPP is the most common type of early puberty and often has no identifiable cause.

A study conducted in Denmark from 1998 to 2017 involving 8,596 children found that each year, 9.2 girls and 0.9 boys per 10,000 were diagnosed with CPP. Over 20 years, the incidence among girls tripled and among boys doubled. Similarly, an analysis of insurance claims in South Korea from 2008 to 2014 showed CPP rates of 26.28 per 10,000 girls and 0.7 per 10,000 boys, indicating earlier onset of puberty in the population.

Researchers have yet to fully understand why CPP rates are higher in girls than boys but suspect that environmental and biological factors play a significant role. A 2025 meta-analysis of 44 studies reveals that from 1977 to 2013, the average age at breast development in girls decreased by about three months per decade. Boys have also shown some earlier puberty onset, although the change is less pronounced and slower compared to girls.

Dr. Yana Pinheiro Machado, an endocrinologist at the University of São Paulo in Brazil, treats children with this condition. She noted that brain injuries or tumors in the hypothalamus may be involved. Researcher Canton and her team also propose environmental and dietary factors as contributors. “High obesity rates in children must be carefully monitored, as obesity accelerates puberty development,” she emphasized.

Studies demonstrate that increased body fat can raise levels of sex hormones like estrogen and hormones such as leptin, which influences bone growth. These hormonal changes are believed to contribute to early puberty onset. Genetics also play a role. A 2013 study led by Harvard professor Anna Claudia Latronico identified a mutation in the MKRN3 gene linked to Central Precocious Puberty. This mutation was found in sisters, Lara and Beatriz, who showed early breast development at ages eight and ten, respectively.

“I was very scared because Lara was only five years and ten months old, which is extremely young for puberty onset,” the girls’ mother said. Canton’s team traced the mutation to the father’s family. Beatriz, the younger sister, also has a strong chance of developing CPP, so early signs at age seven prompt immediate treatment. “I was very afraid because we felt like we lost our childhood,” said Lia.

Canton warned that untreated CPP can pose significant risks to both physical and mental health. “Imagine what happens when a child’s breast development starts at seven years old—she looks different from her peers, which is challenging socially,” she pointed out. Sex hormones contribute to bone maturation, so early puberty accelerates bone maturity and can halt growth prematurely, potentially resulting in shorter adult height.

Large population studies link early puberty to increased risks of heart disease, breast cancer, and uterine lining cancers. However, timely diagnosis and treatment can mitigate these risks. “The treatment we use has been in practice for three to four decades and is effective,” she stated.

Despite initial fears, Lia and Bruno, the parents of the girls, now feel relieved that their daughters could enjoy a happier childhood. “When Lara showed signs of early puberty, she wondered why she was different, why she was alone in this, and why she had to take medication,” Lia shared. They hope their experience raises awareness among other parents and encourages them to seek help early. Gabby also wishes to speak openly about the condition and support others on social media. “I was angry because there is so little information about this,” she said. “Seeing many people approach me with questions made me realize sharing my experience was the right thing to do.”