I remember an instance where an unsuspecting, unprepared 9-year-old was reduced to tears as she noticed her clothes stained through with blood. This was coupled with stares and muffled laughs from both boys and girls in a mixed school. These were the days when there was very little education at home and in school on these matters. Fast forward, 30 years later. You have young people and their parents inundated with information.

Puberty begins typically with breast development, followed by underarm and pubic hair growth, and finally, the beginning of periods. The average age of starting periods is variable, between 9-15 years. Its not uncommon to see girls start their period before the age of 10.

A survey in India showed that 71% of girls were unaware of menstruation till they had their first period.

Breast development alone may occur in girls. Typically breast development starts around 11 years of age. If it begins before the age of 8, you should see your doctor.

A Danish study showed that 2 out of every 1000 girls had early puberty.

In the large majority of cases, the cause of early puberty is simply the early maturation of the glands in the brain. Hormones from these glands make the ovary produce the female hormone, oestrogen. Oestrogen initiates the changes of puberty. In many cases, early puberty may run in families.

Other rare causes are:

Make an appointment to see your doctor if there are signs of puberty before the age of 8:

Girls with early puberty grow tall very quickly. They stop growing very soon and may achieve an adult height shorter than their peers. Their bones mature early because of hormone exposure. If you start treatment early, they may attain a normal height.

Girls who develop early are self-conscious. You need to watch out for signs of depression and anxiety.

If the cause is early maturation of the brain glands, doctors will monitor at 4-6 monthly intervals or treat with hormones.

If there is a brain tumour, you will have surgery or radiation treatment. Surgery is used to treat tumours of the ovary.

If you notice breast development, it may be a good idea to talk to your daughter about puberty. Prepare her to expect a period and equip her physically and mentally to deal with it.

If you notice signs of puberty before the age of 8, explain that her body has matured a little early. Be honest about what to expect when you visit your doctor.

Avoid making comments on her appearance. There is nothing that young people desire more than to fit in. Focus on positive aspects, be it sport, academic achievements, or other hobbies.

Remember that doctors can treat this in most cases, and medication can reverse some effects like rapid growth and stop others like breast enlargement.

In the small number of cases, where the cause is a tumour of the brain, ovary, or adrenal gland, there is a higher risk due to surgery and its sequelae.

Keep the conversation going with your daughter. Bear in mind that depression, eating disorders, early sexual behaviour, and substance abuse are common.

There are support groups and charities that you can contact. Talking to people in similar situations helps ease the problem and come up with solutions.

Period poverty

A discussion about periods would not be complete without addressing global period poverty. The problem is present in developed countries as well. Schools in Scotland made menstrual products available to all recently.

Spare a thought for people less privileged than you who need to choose between food and buying menstrual sanitary products.

One of the dilemmas for Muslim parents is if prayer becomes compulsory. Most parents teach their children to pray from an early age. However, if periods start very early before the age of 8, the child may not have the maturity and responsibility to observe all the obligations which come with attaining puberty.

Aim to be patient and encouraging.