From the Guidelines
Exposure to endocrine-disrupting chemicals, such as bisphenol A and phthalates, is a significant cause of premature menstruation, as these chemicals can alter hormonal development and lead to early puberty. The relationship between these chemicals and premature menstruation is supported by studies such as [@15@], which found an association between phthalate and bisphenol A exposure and pubertal development in girls. Other factors that may contribute to premature menstruation include:
- Genetic predisposition, where family history plays a role in determining the age of menstruation onset
- Obesity, which can increase estrogen production and trigger early puberty, as seen in studies such as [@3@]
- Certain medical conditions, such as congenital adrenal hyperplasia, hypothyroidism, or pituitary tumors, which can cause hormonal imbalances leading to early menstruation
- Psychological stress and trauma, which have been linked to earlier puberty onset
- Central nervous system disorders affecting the hypothalamus or pituitary gland, which can trigger premature hormonal signals It is essential to note that the evidence suggests that exposure to endocrine-disrupting chemicals is a significant and preventable cause of premature menstruation, and reducing exposure to these chemicals can help mitigate this risk. Studies such as [@24@] and [@30@] provide further evidence of the link between chemical exposure and premature menstruation. If a child shows signs of puberty before age 8 in girls or 9 in boys, medical evaluation is recommended to rule out underlying conditions. Treatment depends on the cause and may include GnRH analogs like leuprolide acetate to temporarily halt puberty progression if necessary, as supported by studies such as [@6@].
From the Research
Causes of Premature Menstruation (Early Menarche)
The causes of premature menstruation, also known as early menarche or precocious puberty, can be attributed to various factors. Some of the possible causes include:
- Genetic disorders, such as constitutive activating mutations in the human LH-receptor gene and activating mutations in the Gs protein a-subunit gene 1
- Central nervous system (CNS) disorders, such as CNS tumors 2
- Gonadotropin-dependent precocious puberty (GDPP), which results from the premature activation of the hypothalamic-pituitary-gonadal axis 1
- Gonadotropin-independent precocious puberty (GIPP), which is the result of the secretion of sex steroids, independently from the activation of the gonadotropic axis 1
- Environmental factors, such as alterations in energy balance and exposure to endocrine-disrupting chemicals 3
- Improvement in nutritional and socioeconomic conditions, which has been associated with a secular trend in earlier pubertal onset 3
Types of Precocious Puberty
There are two main types of precocious puberty:
- Central precocious puberty (CPP), which is caused by the early activation of the hypothalamic-pituitary-gonadal axis 4
- Peripheral precocious puberty, which is caused by the secretion of sex steroids, independently from the activation of the gonadotropic axis 1
Diagnosis and Treatment
The diagnosis of precocious puberty involves a comprehensive assessment, including hormonal evaluation and image studies 1, 4. The treatment of precocious puberty depends on the underlying cause and may include: