While most ten-year-olds in her age group were exchanging stickers, collecting toys or meeting up with friends, Milly Watmore was hunched over in pain for days every month because of her period.
While the average age at which girls in the UK get their first period is 12, Milly is one of a growing number of girls who are getting their periods at a young age.
She was ten when they started, which caused problems, especially at school – and not just because of her painful cramps.
“I couldn’t concentrate all the time in lessons because I was worried I would leak through my clothes,” says Milly, now 17, from Worcester.
And such experiences are becoming more common. According to research, girls are increasingly starting to menstruate at a younger age.
“I couldn’t concentrate all the time in lessons because I was afraid to get up because I was afraid I would leak through my clothes,” says Milly Watmore, pictured 10 but now 17
A study published in May found that women born between 1950 and 1969 had their first period at an average age of 12.5 years. For women born between 2000 and 2005, the average age was 11.9 years, the journal JAMA Network Open reported.
Researchers from Harvard University who conducted the study found that the percentage of girls who first menstruated before the age of 11 had increased from 8.6 percent to 15.5 percent.
And while the percentage of women who menstruated before age 9 was still small (less than 2 percent), this percentage more than doubled over the same period, from 0.6 to 1.4 percent.
They said childhood obesity – “a growing epidemic in the US” – could be a contributing factor, as could “diet, psychological stress and environmental factors such as hormone-disrupting chemicals and air pollution”.
Although these are US figures, experts say the same trend is also occurring in the UK, which they say is causing a lot of problems for girls.
According to a new report, 11 percent of teenage girls in the UK said they felt like ‘life wasn’t worth living’ during their period.
A survey of 3,000 British girls aged 12 to 18 by Wellbeing of Women, a women’s reproductive health charity, found that 20 percent said they were “bedridden” because of their periods and 43 percent were unable to eat or sleep.
Even more worrying, the Harvard study found that early menstrual cycles are linked to negative health outcomes, “such as heart disease, cancer, miscarriage and premature death.”
So why do girls get their periods earlier?
There are several factors involved, says Dr Tania Adib, a gynaecologist at Lister Hospital in London.
“It really comes down to diet and nutrition. People are eating more high-calorie foods and eating more overall, which is why they’re gaining weight,” she says.
Fat tissue produces the hormone estrogen. High levels of this can trigger the pituitary gland in the brain to produce hormones that stimulate the ovaries to begin the menstrual cycle earlier.
“During the war, when food was scarce, young girls had less body fat and started menstruating later,” Dr. Adib said.
But that’s not the whole story – and it doesn’t explain cases like Milly’s, since she is not overweight.
According to Dr. Adib, there is research showing that certain hormone disrupting substances in the environment may be involved, such as phthalates or bisphenol-A.
“These chemicals are used in the production of plastics and are thought to have an estrogen-like effect,” she says. “They are also in furniture, children’s toys, fabrics and cosmetics.”
Genetics are also a factor, says Dr Shazia Malik, gynaecologist and medical director of UK gynaecological health company DAYE.
“Mothers who get their periods early often have girls who also get their periods early,” she says.
‘These genetic influences cause the brain to signal earlier than normal to release sex hormones.’
Genetics may have played a role in Milly’s case, as her mother also started her period at age 10. Still, Milly was shocked to find herself bleeding while staying with her father (her parents are divorced).
“I saw the blood and I panicked,” she says. “I didn’t learn much about it in school. I was also at Dad’s house, and he didn’t have any pads.”
According to Dr Adib, it can be “traumatic” for a girl to get her period while she is still in primary school, often before her parents or teachers have talked to her about what to expect.
“Bleeding is quite traumatic for a young girl, and nine-year-old girls are often not mentally mature enough for those physical changes,” she says.
‘I didn’t start until I was 14, so I was completely prepared for it. But if I had started when I was nine, I think I would have found it annoying.’
Back home, Milly’s mother told her what to expect and went to school to talk to her teachers. Still, navigating school while on her period wasn’t easy.
“There were no bins in the girls’ toilets, so I had nowhere to put my pads,” Milly says. “I had to go to the teachers’ toilet, which was embarrassing at that age.”
Milly’s periods became heavier and once – when she was ten and in the sixth grade – she leaked through her summer dress. She didn’t notice it until someone told her.
“I had to get a spare dress from the lost and found,” she recalls. “It was humiliating, especially since no one else in my year group had started.”
At night, Milly had to sleep on a towel to prevent her bedding from leaking. But as time went on and her periods became heavier, leaks in her bedding and clothing became more frequent.
Her GP prescribed tranexamic acid, a medication used to treat heavy menstrual bleeding. It works by reducing the breakdown of blood clots, making the blood flow slower and less heavy.
“I was told the medication would help reduce my bleeding, but it would also make my periods last longer,” says Milly.
Dr. Adib says there are other options to help girls with painful periods, such as mefenamic acid, a nonsteroidal anti-inflammatory drug. “Because it’s quite mild, it will help with some of the pain, but it won’t necessarily make your periods lighter,” she says.
According to Dr. Adib, very heavy, painful periods, which are very debilitating and difficult to manage for young girls still in school, may need to be treated with the contraceptive pill.
“But GPs are a bit hesitant to prescribe the pill to young girls,” she says.
‘In young girls taking the contraceptive pill, it seems that depression and mental health problems are slightly more common than in older women.’ Dr Malik added: ‘The pill should not be our first line of defence against period pain or heavy bleeding, as it carries an increased risk of blood clots, weight gain and mood swings.
‘There is also an association between adolescents taking the combination pill and lower bone density as adults.
‘It is therefore very important to discuss these risks with a healthcare provider before starting the pill or other medications, especially in very young girls.’
While older women with menstrual problems may be offered an IUD, which releases a form of the hormone progesterone that helps thin the uterine lining, Dr. Adib says, “You don’t want to put IUDs in young girls.”
She believes that GPs should be made ‘more aware of the onset of menstruation in young girls’ and of the treatment options for them.
Milly took tranexamic acid tablets daily from the age of 13. That was when the bleeding was at its heaviest, and it eventually became lighter.
“I was no longer bleeding through towels on my bed,” she says. “The bleeding time did get longer, up to ten days, but I didn’t mind.”
The longer periods lasted about six months, and then they became six days. Still, her period ruined her life.
“Holidays are a problem,” she says. “If I have to go on vacation, we can get a period delay tablet from the chemist, which I take to delay my period for a few days.”
She also downloaded an app so she knows when her period is coming so she can prepare.
Dr. Malik says it’s important for parents to talk to their children about menstruation.
‘Parents should consider preparing their daughters earlier for the changes that come with puberty. Open communication can help girls understand, accept and cope with the changes.
“It’s essential to have these conversations with both boys and girls. It can make a huge difference, especially for a young girl, if she doesn’t feel like there’s anything wrong with her. This is nature at work, after all.”