Swedish researchers from Skane University Hospital in Malmo conducted a study of almost 400 women over the course of just under 30 years.  They found that of the women who started menopause before the age of 47, 56 percent developed osteoporosis compared to just 30 percent in the women who started menopause later in life.  Women suffering from osteoporosis are at greater risk for bone fractures, bone pain, and loss of height due to bone loss.  Their findings also showed that women who had undergone early menopause had a greater risk of fragility fracture and death with a rate 17 percent higher than the women with later menopause.  The rate of fractures in women with early menopause was 44% compared to 31% in those women who entered menopause later.

The cause of early menopause is not yet clear, though there seems to be a link between it and premature ovarian failure, hysterectomies, chemotherapy, and possibly even stress.  Premature ovarian failure has been associated with Fragile X syndrome, so there may be a genetic link. Unfortunately, preventing and reversing early menopause is not yet possible, but there are ways to decrease your risk of osteoporosis.  The bone masses of most women peaks in their 20s.  You can increase yours by getting plenty of calcium, vitamin D and exercise.  A balanced diet and thirty minutes of weight training or other moderate exercise every day can make big difference when it comes to your bone health.

The association found between early menopause, osteoporosis, and death is causing some to call for more studies to determine a more definite correlation. The higher mortality rate in women with early menopause does need further study in order to address the confounding variables, such lifestyle, medications and smoking.  In the meantime, we should take the results as a warning to take care of our bodies, particularly our bones, as early as possible.

— Yvonne S. Thornton, M. D., M. P. H.

Childhood obesity is on the rise and it’s having effects in some unexpected areas.  Studies are now suggesting that girls who are overweight start menstruation at much younger ages.  The average age of onset of menstruation (menarche) in the late 20^th century was between 12.6 to 12.8 years.  Recently, that age has decreased to 12.43 years.   It has been argued that girls need to reach a critical weight (47.8 Kg) to initiate pubertal changes; it is more likely that what is needed is a shift of body composition, with an increase in the percentage of body fat. The percentage of body fat in children (16%) needs to rise to 23.5% to initiate puberty.  A 2011 study found that each 1 kg/m² increase in childhood body-mass index (BMI) can be expected to result in a 6.5% higher absolute risk of early menarche (before age 12 years).

Normally, once a young woman reaches a particular body mass index, that tells her body she is of childbearing weight.  This starts the menstruation cycle.  If a young girl, say of about eight or nine, is overweight, she will reach this body mass index much sooner, triggering her body to go into early puberty.  While early childhood obesity is itself a problem, early puberty can also lead to a shortened growth span.  Most girls stop growing a few years after starting menstruation.  If they start this too soon, they will also stop growing much earlier than normal.  If childhood obesity continues to increase, the rise in early maturation is likely to follow.  In 1965, about 5% of kids were considered obese in the US.  Obesity in children has increased three-fold over the past 30 years.  In 1980 obesity in children, ages 6-11, was a mere 6.5% but by 2008 it increased to 19.6%.

Today, about 25 million children are either overweight or obese.  Researchers are finding that increases in the number of girls hitting puberty early seems to be in keeping with these obesity statistics.  The First Lady is even promoting a change in our habits that affect childhood obesity.

Although convenient, fattening foods have flooded the markets; there are still plenty of healthy foods out there.  Parents cannot expect their kids to make smart choices about their diets, especially at such young ages.  It’s up to them to teach their children how to eat, so they can grow up to make good choices for themselves and their own families.  There’s something to be said for those traditional sit-down dinners, because they truly benefit the health of our children in more ways than one.

— Yvonne S. Thornton, M. D., M. P. H.

Sources:

http://children.webmd.com/features/obesity

http://www.helium.com/items/1249193-delayed-puberty

With childhood obesity approaching an epidemic, early puberty is becoming more common. There appears to be a critical weight for girls, above which the body starts its journey to womanhood with thelarche (breast buds), pubarche (pubic and axillary hair) and finally, menarche (onset of menses).   So, in general, the heavier a young girl is, the earlier the onset of her secondary sexual characteristics.

While we don’t know all the possible consequences of early puberty, we know that puberty is a time of emotional turmoil. For a younger child, that’s going to be more difficult.

We also know that youngsters have a great need to feel like they fit in and the combination of obesity and early puberty can punch a hole in a young girl’s self-esteem.

So, watch the eating habits of your whole family, and help your children make good choices –  just as you make healthier choices for yourself. As I’ve said before, when it comes to battling the bulge, I’ve been there, so I know it’s a struggle. But maintaining a healthy weight is essential, for everyone.

- Yvonne S. Thornton, MD, MPH

So how do you, a layperson, judge the qualifications of your doctor? If they drive fancy cars, wear designer clothes, and charge the highest fees in the community, you can be sure they’re successful. But does that mean they’re qualified? You can ask your girlfriends or your sister or mother to recommend someone. You can determine whether you have rapport with a physician. But that won’t tell you about qualifications, either.

If you want to know whether the kind, caring person you select has the minimum qualifications, there’s one way to determine that. Go here to see whether your doctor is board-certified.

Board certification isn’t mandatory. Once a doctor gets a medical degree and a state license to practice medicine and surgery, he or she can practice any specialty. No law requires a doctor to complete a four-year residency in a specialty, such as ob-gyn, in order to be called a specialist. Nothing prevents a doctor from giving him or herself the title of obstetrician or fertility expert or perinatal specialist or really, almost anything.

But only board certification assures you that the doctor has earned that title.

A board certified doctor has gone a giant step further than a physician who hasn’t passed her boards. After completing a residency program, passing a written test in the specialty, and practicing for a year or two, she’s gathered up all her cases and submitted them to an august body known as the American Board of Obstetrics and Gynecology. Before these distinguished university professors and chairs of departments, she’s been extensively questioned about real and hypothetical situations and asked about diagnoses, patient management and treatment.

As an oral examiner for the American Board of Ob-Gyn since 1997, I’ve certified hundreds of new ob-gyn candidates who have proven their capabilities under difficult circumstances. And there were some who did not pass because they didn’t meet those high standards.

So I speak from experience when I say that board certification is the minimum you should expect from your doctor.

- Yvonne S. Thornton, MD, MPH

So, the big question becomes, how long after you stop taking the pill can you expect to become pregnant? No two women are alike but, generally speaking, pregnancy is possible the next time you ovulate. You may ovulate within two weeks after finishing up your last package of birth control pills. So, theoretically, you could become pregnant almost immediately. However, as we all know, there are many variables. Some couples try for years to become parents without success.

It almost seems an unfair trick of the heavens that it’s sometimes the women who don’t want to become pregnant who easily do.

That means, if you’re dead set against pregnancy, and you stop the pill, you need to begin another form of contraception immediately. I actually recommend that my patients begin using an alternate contraceptive before getting off the pill so they get into the habit of using it.

Otherwise, you may have to get into the habit of changing diapers.

- Yvonne Thornton, MD, MPH

That depends.

Some women have regular periods every two months. Others have regular periods every 21 days. So, if your periods aren’t on a 28-day schedule, it may not be a problem at all, as long as it’s regular for you. And your cycle’s schedule may change over time. In your 20s, you may menstruate every 30 days, then every 33 days in your 30s. In  your 40s, the intervals could change again. There’s no one-size-fits-all cycle.

If you’re used to getting your period every 28 days and it’s now 45 days without a sign of menstruation, the first thing you should do is to see your gynecologist.  A blood test (not urine testing) for pregnancy would probably be ordered.

But what if you haven’t been sexually active? Ask yourself, what else in your life has changed? Have you been on a starvation diet? Undergone some very stressful event? If so, mention these changes when you discuss your menstrual cycle with your doctor.  The menstrual irregularity may be the first sign of thyroid dysfunction, or other metabolic or endocrine disorders.

The “take home” message here is that you should always be sure to keep an accurate menstrual calendar every month so you can tell your doctor when your period started, when it ended, when you had intercourse, and when you have spotting.

Speaking of spotting between periods, sometimes it’s a sign of a problem but often it’s not. Certain women will spot right in the middle of their cycles, when they ovulate. This sort of spotting can be perfectly normal. There’s even a German name for it: mittelschmerz,  But, if it continues, even in the middle of your cycle or if you’re spotting at odd intervals, like three days after your period ends, it’s time to make a gynecologist’s appointment.

- Yvonne Thornton, MD, MPH