While most ten-year-olds in her peer group were trading stickers, collecting toys or hanging out with friends, Milly Watmore spent days each month hunched over in pain from her period.
While the average age for starting menstruation in the UK is 12, Milly is one of a growing number of girls starting their periods young.
He was ten when they started, which created problems for him, especially at school, and not just because of his painful cramps.
“I couldn’t concentrate all the time in class because I was worried about having to stand up in case something spilled through my clothes,” says Milly, now 17, from Worcester.
And these kinds of experiences are becoming more and more common. According to research, girls are starting to have their periods at an increasingly younger age.
“I couldn’t concentrate all the time in class because I was worried about standing up and something might leak through my clothes,” says Milly Watmore, pictured aged ten but now 17.
A study published in May found that while women born between 1950 and 1969 started their periods at 12 1/2 years on average, for those born between 2000 and 2005 the average age was 11.9 years, the journal JAMA Network Open reported.
Harvard University researchers behind the study found that the proportion of girls who start getting their periods before age 11 has risen from 8.6 percent to 15.5 percent.
And although the proportion of women who began menstruating before age nine was still tiny (less than 2 percent), over the same period it had more than doubled, from 0.6 to 1.4 percent.
They said childhood obesity – “a growing epidemic in the US” – could be a contributing factor, as well as “diet, psychological stress and environmental factors such as endocrine disruptors and air pollution”.
While these are US-based figures, experts say the same trend is occurring in the UK and it is a trend, they say, that brings with it a host of problems for girls.
According to a new report, 11 per cent of teenage girls in the UK found that their periods made them feel like “life wasn’t worth living”.
The survey of 3,000 UK girls aged 12 to 18 by Wellbeing of Women, a women’s reproductive health charity, found that 20 per cent said their period left them “bedridden” and 43 per cent unable to eat or sleep.
Even more worrying, the Harvard study found that earlier onset periods are associated with adverse health outcomes, “such as cardiovascular disease, cancer, miscarriage, and premature death.”
So why do girls get their periods earlier?
There are multiple factors involved, says Dr Tania Adib, a consultant gynaecologist at Lister Hospital in London.
“This is largely due to diet and nutrition: specifically, people are eating higher-calorie foods and eating more in general, and as a result, they are more overweight,” she says.
Fat tissue produces the hormone estrogen, high levels of which can cause the pituitary gland in the brain to produce hormones that stimulate the ovaries to start the menstrual cycle earlier.
“During the war, when food was scarce, girls did not have as much body fat, so their periods started to come later,” explains Dr. Adib.
But that is not the whole story and does not explain cases like Milly’s, since she is not overweight.
Dr. Adib says there is research to suggest that some hormone-disrupting chemicals in the environment could be involved, such as phthalates or bisphenol A.
“These chemicals are used in plastic production and are thought to have an estrogen-like effect,” she explains. “They are also found in furniture, children’s toys, textiles and cosmetics.”
Genetics is another factor, says Dr Shazia Malik, consultant gynaecologist and UK medical director of gynaecological health company DAYE.
“Mothers who start menstruating early tend to give birth to girls who also start menstruating early,” she says.
‘These genetic influences mean that the brain sends signals for the release of sex hormones earlier than usual.’
Genetics may have played a role in Milly’s case, as her mother also started menstruating at age ten. Still, Milly was shocked when she saw that she had started bleeding while at her father’s house (her parents are divorced).
“I saw the blood and I panicked,” she says. “I hadn’t learned much about it in school. Plus, I was at Dad’s house and he didn’t have any sanitary pads.”
It can be “traumatic” for a girl to start having periods while still in primary school, often before her parents or teachers have talked to her about what to expect, says Dr Adib.
“Bleeding is quite traumatic for a little girl, and nine-year-old girls are usually not mentally mature enough for those bodily changes,” she says.
“I didn’t start until I was 14, so I was pretty ready for it. But if I had started at nine, I think I would have felt bad.”
Back home, Milly’s mother explained what to expect and she went to school to talk to her teachers. Still, it wasn’t easy adjusting to school while on her period.
“There were no waste bins in the girls’ toilets, so I had nowhere to put my pads,” says Milly. “I had to use the teachers’ toilet, which was embarrassing at that age.”
Milly’s periods became heavy and once, when she was ten and in sixth form, she leaked milk through her school summer dress, not realising until someone told her.
“I had to go look for a spare dress in the lost and found,” she recalls. “It was mortifying, especially since no one else in my group had started.”
At night, Milly had to sleep on a towel to avoid leaks on her bedding, but as time went on and her periods became heavier, leaks on bedding and clothing became more common.
Your GP prescribed you tranexamic acid, a drug used to treat heavy bleeding during your period. It works by reducing the breakdown of blood clots, making your flow slower and less heavy.
“I was told the medication would stop me from bleeding as much, but it might make my periods last longer,” Milly says.
Dr Adib says there are other options to help girls with painful periods, such as mefenamic acid, a non-steroidal anti-inflammatory drug. “Because it’s quite mild, it will relieve some of the pain, but it won’t necessarily make the periods lighter,” she says.
Very heavy and painful periods that are quite debilitating and difficult to control in girls still in school may need to be treated with the contraceptive pill, says Dr Adib.
“But there is a slight anxiety on the part of GPs about prescribing the pill to young girls,” she says.
“There appears to be a slightly higher incidence of depression and psychological problems in young girls taking the contraceptive pill, something we don’t see in older women,” adds Dr Malik: “The pill should not be our first line of defence against period pain or heavy bleeding as it carries a higher risk of blood clots, weight gain and mood swings.
‘There is also an association between teenagers taking the combined pill and lower bone density in adulthood.
‘That’s why it’s crucial to discuss these risks with a doctor before starting the pill or any other medication, especially in very young girls.’
While older women with problematic periods may be offered an IUD, which provides a form of the hormone progesterone to help thin the lining of the uterus, Dr Adib says: “You don’t want IUDs in young girls.”
She believes GPs need to “be more aware of younger girls starting to get their periods” and the treatment options available to them.
Milly took tranexamic acid tablets daily from the age of 13, when her bleeding was heavier, and then became lighter.
“I was no longer bleeding through the towels on the bed,” she says. “The bleeding time was extended to about ten days, but I didn’t mind that.”
The longest periods lasted about six months and then dropped to about six days. Still, her period has ruined her life.
“Holidays are a problem,” she explains. “If I have to start taking them during the holidays, I can buy a pill at the pharmacy to delay my period for a few days.”
She also downloaded an app that helps her know when her period is coming so she can be prepared.
Dr. Malik says that for parents, conversations with their children about periods are important.
‘Parents should consider preparing their daughters for the changes associated with puberty earlier. 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 little girl, if she’s not made to feel like there’s something wrong with her. After all, that’s nature in action.”
This week: Dermatologist Dr. Thivi Maruthappu and collagen
Collagen is the most abundant protein in the skin, but as its levels decline over time, the skin loses elasticity. And evidence from clinical trials seems to support the theory that supplements could be beneficial in combating skin aging.
A 2021 review looking at the effects of collagen supplements found that nearly all were shown to improve skin elasticity, hydration and reduce facial wrinkles, the International Journal of Dermatology reported.
However, it should be noted that most of the published studies were funded by supplement manufacturers, so the results should be taken with a grain of salt. However, I have tried the supplements myself and found that they do improve my skin’s hydration.
Look for one that contains type 1 collagen with dipeptides (e.g. proline-hydroxyproline), as these seem to show faster results.
Collagen drinks are expensive and research doesn’t show they offer any benefits. To produce collagen, the body needs iron and vitamin C, so include these in your diet.
SUGGESTED DOSE: According to studies, the most useful is to take between 5 and 10 g per day.