From irregular bleeding to unsafe sex, women of this age group grapple with several issues that need to be addressed in a timely manner
Irregular periods, obesity and excess body hair are common among girls as they attain puberty, affecting their physical and mental well-being.
A study published in 2018 found that by late adolescence, 75% of girls worldwide were found to experience menstrual disorders such as delayed, irregular, painful and heavy menstrual bleeding. Polycystic ovarian syndrome (PCOS), a relatively common hormonal disorder, is often the cause.
It can lead to dysfunctional bleeding, endometrial cancer, obesity, diabetes, dyslipidemia, hypertension and theoretical increased risk of cardiovascular disease if left untreated.
One 2011 study suggests as much as 9-13% prevalence of PCOS amongst Indian adolescent girls.
One of the major causes of PCOS is lifestyle.
“I believe 4S to be responsible for many of the problems faced by girls today—salt, sugar, stress and sleep,” says Dr Priyanka Mehta, Obstetrician-Gynaecologist at Apollo Women’s Hospital, Chennai.
Higher intake of salt and sugar, stress due to academic as well as social pressures, and lack of sufficient sleep are becoming very common, affecting the health of the girls in this age group, and will continue to play havoc if not corrected in time.
Many lifestyle diseases are passed on genetically. While the previous generation suffered from diabetes and the like in their sixties, the current generation is facing it as young as in their thirties and forties, and the next may suffer even earlier.
Taking cognisance of this risk, thyroid screening is being done right on Day 4 of new born child.
The thyroid gland is important for maintaining the metabolism of the body.
“When this gland does not produce enough hormones, the condition is called hypothyroidism, one of the causes for irregular period cycle,” explains Dr Mehta.
Hypothyroidism also causes delayed development, fatigue, obesity and infertility. Stress is one of the factors that causes hypothyroidism, and it in turn is one of the triggers for PCOS.
Eating out as a family or with friends was a weekend activity, once a month or to celebrate special occasions.
But today, with the availability of food apps, greater choice of restaurants and access through mobile phones, ordering food has become easy—often at the cost of health.
Restaurant food is one of the major sources of high-salt, high-sugar diet, and fast food has no nutritional value.
The combination of fat, sugar and lots of sodium (salt) is what makes fast food tasty, but the high intake of sugar, salt and fat increases the risk of obesity, diabetes, hypertension and cardiac problems.
“Parents need to ensure a balanced diet for their adolescent daughters for good health,” Dr Mehta stresses.
Increased mobile usage is itself becoming a health problem, not just physical but mental as well.
Girls are spending longer hours on the phone, tracking their social media pages to assess their popularity, sometimes at the cost of sleep, and affecting their academic performance.
“While women always like to look good, now the pressure is much more on girls, who are following poor role models and setting impossible standards,” points out Dr Mehta.
This also leads to less physical activity, contributing further to obesity-related problems.
Poor body image—genuine or perceived—and the inability to get the ‘perfect’ figure are leading to higher incidence of depression, bulimia or anorexia and other disorders.
A 2018 study found that 30 million out of 69 million teens and pre-teens in urban India own a mobile phone.
These days, children as young as 9 and 11-years-old have their own devices and access to social media.
A Research Gate study from 2018 shows that adolescents themselves view social media as a cause for mood and anxiety disorders, cyberbullying and addiction.
Late adolescence is also the time of decisive examinations and career choices, which have to be made while also being swept away by emotional storms.
In addition to performing academically, they may also be involved in several extra-curricular activities that require them to pack many things into a day. This eats into sleep time and increases anxiety.
“Where is the time for the girls to just sit and day dream or do some unstructured activity?” asks Dr Mehta.
Girls in this age group are often not aware of the need for vulvar hygiene, yet the lack of it can lead to pelvic infections and even uterine cancer.
Sanitary napkins should be changed every two to three hours, whether stained or not, and menstrual cups too must be washed and reused every few hours.
“It is the old blood that causes the infection, and must not be allowed to remain in the body for long,” explains Dr Mehta. She also adds that many times, girls do not even know what a normal cycle is—4-5 days of bleeding every 24-34 days.
Heavy bleeding could be caused by thrombocytopenia (low blood platelet count) and lead to anaemia. “Many think that bad blood is going out of the body, so heavy bleeding is ok,” cautions Dr Mehta.
While in some cases it may be okay, it is important to check for and eliminate the chances of conditions that are causing such bleeding. Girls also suffer severe, crippling pain during periods, but taking pain killers is not a bad thing, she adds.
This could be because of endometriosis, a condition which is the presence of uterine tissue in abnormal area like ovary, where it forms endometriotic ovarian cyst. All girls with severe pain, called dysmenorrhea, during periods should do an early ultrasound pelvis.
When a girl attains menarche (first occurrence of menstruation), it may be better to take her to the doctor once for a thorough examination.
Girls who cross the age of 18 need to be given sex education.
“There is still a lot of stigma attached to premarital sex. But, it is a fact of life and it is better to empower them by telling them about contraception, rather than let them contract sexually transmitted diseases if they have multiple partners, or become pregnant so early,” points out Dr Mehta.
For underage girls, pregnancy can be even more complicated as it will have to be reported for possible child abuse under the Protection of Children from Sexual Offences (POSCO) Act.
Therefore, discussing sex-related matters maybe better than to let them find out from other sources in a manner that could do them more harm than good.
Communication is the key for parents to help their late adolescent children as they face severe stress situations related to body image and pressures.
Reminding them that nobody is perfect and expressing unconditional love becomes even more important for girls in their late adolescence.
It is important to spend time together as a family and talk to each other to boost confidence and positive self-image.