With such early onset of menses, the child’s diagnosis is probably precocious puberty, but there are several other issues and concerns that deserve a gynecologist’s attention sooner than you might think. For the youngest girls, it’s most likely to be vaginal discharge, itching or a concern about anatomical abnormalities. These patients will typically be referred to a gynecologist by their pediatrician. For older girls, painful periods are the leading complaint.
“In some young women, period pain is so severe that it limits their activity. So we talk about how to manage that,” Dr. Brophy says.
The most complex or concerning cases that Dr. Brophy sees have to do with precocious or delayed puberty.
“In such cases, we frequently rely on the support of a pediatric endocrinologist,” she says.
When should a parent or guardian be concerned that something is not “normal?”
“Any discharge that is smelly. Any itching or burning. These things should be evaluated,” Dr. Brophy says. “Also, bleeding that is so heavy a girl needs to change her pad or tampon every hour or so. And periods that are too painful for the girl to attend school.”
In such cases, and in the case of any matter that concerns you as a parent or guardian, Dr. Brophy recommends talking to the child’s pediatrician. When you have that conversation, “be open about everything,” she says.