The average age when girls experience their first menstruation, known as menarche, is decreasing by three months every decade, gynaecologist Therese Galea Testa said.

In an interview with The Malta Independent on Sunday, Galea Testa said that at the turn of the century, in 1900, the average age for menarche stood at 16 or 17, while  now girls are getting their periods as early as 11 or 12, and in some cases even as young as nine.

She explained that nowadays children start to be given the puberty talk from the age of 10 to better prepare them for their bodily changes.

She said that the early onset of puberty is hitting the developed world because of several factors mainly because of better access to food sources.

She added that because of this we are also seeing more incidents of obesity and fat deposition “which may lead to early periods and breast development because of hormone production”.

She said that there is a theory that states that certain chemicals that are found in plastic packaging “might mimic the oestrogen hormone and thus stimulate breast and period development”.

The gynaecologist explained how some of her patients, who are still of secondary school age, “some as young as 12 and 13”, have missed school days on occasion as apart from feeling tired and weak, they are fearful that they are going to bleed through their pants “because at that age they don’t know how to handle periods”.

She also added that it is not the first time she had to admit such young girls to hospital because they end up fainting after developing anaemia, thus requiring blood transfusions.

Galea explained that in the first two years after a girl gets her first period, sometimes the blood flow is heavy, the reason being that “even though they (the girls) get a period, since they do not ovulate regularly the hormones are still imbalanced”, which leads to what is known as an ovulatory bleeding.

Because of this, some of these affected girls end up bleeding for around 10 days a month instead of the average four to five days.

“There is a significant morbidity associated with the problem of early periods,” she said, adding that therefore these girls end up having to take several medications, vitamins and sometimes they are also placed on the contraceptive pill to control period irregularity and symptoms.

However, although beneficial to control irregular periods, prescribing the contraceptive pill at such a young age can stop the girls from reaching their “full potential growth”.

Asked whether the pill can affect psychological development, she said that she is in the know of no study which showed this result.

Despite these consequences, the gynaecologist said that one needs to consider the pros and cons for which the contraceptive pill is being prescribed, given that some girls are also sexually active at such a young age.

There are also other pregnancy contraceptive methods such as placing an Intrauterine Device (IUD), which is a small T-shaped plastic and copper device that's put into a womb (uterus) by medical professionals.

It releases copper to stop you getting pregnant and protects against pregnancy for about five to 10 years. It's sometimes called a "coil" or "copper coil".

Galea Testa confirmed that these would have fewer effects as a contraceptive method, however implanting an IUD is a very intrusive process.

“There needs to be a lot of cooperation from the patient’s side,” she said.

She said that given the psychological effects of such an intrusive process and the high need of co-operation, young girls are not ready for it mentally “although they might look physically mature”.

“You have to pay attention not to traumatise them,” she said.

Proposed menstrual leave

Asked about the number of women diagnosed with polycystic ovary syndrome (PCOS) the gynaecologist said one in every four women in the country suffers from the condition which causes few, unusual or very long periods.

Another common condition which affects a women’s reproductive system is also endometriosis, which enables cells similar to the lining of the uterus, or endometrium,  to grow outside the uterus.

Galea Testa said both medical conditions can be the cause of very painful periods.

But she stops short of saying that because of this menstrual leave should be introduced.

Last month PL MP Rosianne Cutajar called for a national discussion about menstrual leave. The particular leave, according to Cutajar, would only be granted to women who, while having their menstrual cycle, go through a lot of pain because they suffer from certain medical conditions such as endometriosis, ovarian cysts and others.

With reference to the proposed discussion on menstrual leave, Galea Testa said: “I believe that as gynaecologists we should reach out to all our patients, to help them cope with their life.”

Asked about her opinion on what medical conditions should be included and covered by “menstrual leave” if it were ever to be passed as law, she said she hadn’t given it much thought.

However “there is always that 10% who are affected a lot by their periods”, she said, adding that among them “you will have that 1% of women that whatever you do, as a gynaecologist to help them, they will still be affected or else they might have other medical problems which do not allow them to take certain amounts of medicine”.

Galea Testa explained how once she had a patient who got pregnant and was scared to tell her employer, “because she was convinced that as soon as he finds out about the pregnancy he was going to find an excuse with her work performance and fire her”. If women were to use menstrual leave on a monthly basis they would be facing similar consequences, she said.

Cutajar’s suggestion has not found much support.

In comments to this newspaper, employers’ organisations had said that the proposal for a national discussion on menstrual leave was “not practicable” and “unjustified”.

The Malta Chamber of Commerce and the Malta Chamber of SMEs were not too keen on the possibility of introducing this leave, with questions arising such as to who will be paying for such leave, which would likely fall upon the employer.

In comments to The Malta Independent, the CEO of the Malta Chamber of SMEs Abigail Agius Mamo had said that there is no justification for the introduction of menstrual leave.

When asked on the suggestion, the GWU said that it would welcome such a discussion. The UHM Voice of the Workers, on the other hand, said that it is more of a question of whether the number of sick leave days allotted should be increased, as the issue is of a medical nature.