Resources for Themes from the Stories 
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Advanced Bone Age
From Dayton Children’s Hospital
Early Puberty: Developing too Soon
Most of the time, reaching a milestone early is a cause for celebrating with your child. Early puberty, however, is not a typical milestone. Fortunately, this condition, which affects 6.7 percent of whites, 27.7 percent of blacks and an undetermined number of Hispanics, is treatable. A recent US study found that girls are reaching puberty increasingly early.  What’s going on?

Finding the cause of this increase has been the focus of recent research. Links to the food we eat, the environment and exposure to plastics have all been mentioned in the media as possible causes for children, particularly girls, "developing early.” The link that has gained the greatest acceptance among experts, however, is the link between obesity and precocious puberty in girls. There does not appear to be this same link in boys. About five percent of boys with precocious puberty inherit the disorder.

 "What initiates the start of puberty is still unknown,” says Moira Pfeifer, MD, a pediatric endocrinologist at Dayton Children’s. "There are many theories, but nothing is 100 percent accepted as the factor that initiates puberty. What is known is that puberty is starting earlier in girls and not in boys. There appears to be a link between an elevated BMI and precocious puberty in girls.” The early release of hormones may trigger breast development in girls and enlarged testicles in boys, among other symptoms (see box). The age at which this occurs is key.

When to be concerned

"If we see breast development in a girl 6 to 8 years old, we would evaluate the child for precocious puberty. Any breast development in girls before age 6 is concerning. In boys, the first sign of puberty is enlarged testes. If this occurs before age 9 years, the patient must immediately be evaluated by a physician. This is because precocious puberty is due to a brain tumor 50 percent of the time in boys. A brain tumor is the cause of precocious puberty in a girl 10 percent of the time,” Dr. Pfeifer explains.

If early puberty is suspected

If doctors suspect your child is starting puberty early, your child may be referred to a pediatric endocrinologist for further testing. According to Dr. Pfeifer, testing consists of blood work to check hormone levels and an x-ray of the hand to determine bone age. "Advanced bone age is concerning because the child is losing height potential,” she says. An MRI may be done to evaluate the cause of precocious puberty.

If testing confirms puberty has started early, the child will be treated with hormone injections. Every 28 days, the child will get an injection of leuprolide, which is a synthetic hormone that initiates and drives pubertal progression in children.

"It sounds counterintuitive—if a child’s body is already releasing hormones, why give him or her more?  Because the body releases hormones in cycles, giving a large dose or bolus of this hormone causes the body’s hormone receptors to ‘down regulate.’ This means that the body recognizes this bolus as ‘too much’ and stops responding to pubertal hormones,” Dr. Pfeifer explains.

You may wonder why it is important to treat precocious puberty. "In addition to the social stigma and emotional upheaval from hormones, early puberty will cause the child’s growth plates to fuse, and the child will stop growing," Dr. Pfeifer says. The result is that the child will be a tall fifth-grader, but an extremely short adult, which carries its own set of emotional difficulties.

One mother, whose 7-year-old was treated for precocious puberty at Dayton Children’s, has been pleased by their family’s experience in the endocrinology department.
"Everyone caring for my daughter has been so nice. The nurse who gives the monthly injections has really connected with her. The staff have helped me talk to my daughter about this condition, and we have always been open and honest with her.”

If you suspect your child is starting puberty early, first talk to your child’s doctor. He or she may make a referral to Dayton Children’s pediatric endocrinologists for testing and, if necessary, further treatment.

Early puberty: Not caused by fast food

You’ve probably heard friends theorize that all the hormones in fast food are causing kids to start puberty earlier than before. While that hasn’t been proven, your friends are right about one thing: Children are going through puberty sooner than ever before. It’s the "why” of early puberty that is much more complex.

Possible causes from the experts:
Obesity. Excessive body fat increases the levels of estrogen that play a role in breast development.
Environmental factors such as chemicals known as estrogen disruptors. These are naturally occurring compounds or manmade chemicals that interfere with the production or activity of hormones. Chemicals can be found in plastics, cosmetics, detergents, toys and more. You’ve probably heard the most about bisphenol A and phthalates. Excessive ingestion of soy products has been linked to early puberty.
Unless a child has an underlying medical problem such as a tumor or genetic disorder, the exact cause of precocious remains unknown. The pediatric endocrinologist will screen for tumors or other disorders because precocious puberty is caused by a brain tumor 50 percent of the time in boys and 10 percent of the time in girls. Fortunately, even when the cause is unknown, precocious puberty can be successfully treated by pediatric endocrinologists—doctors who specialize in growth and hormonal disorders in children.
Precocious puberty: Know the symptoms

In girls, any of the following before 7 or 8 years of age could indicate early puberty:
Breast development
Pubic or underarm hair
Rapid height growth
Starting her period
"Mature” body odor

In boys, watch for the following before 9 years of age:
Enlarged testicles or penis
Pubic, underarm or facial hair
Rapid height growth
Voice deepening
"Mature” body odor

Talk to your child’s doctor if you notice any of these signs. He or she may refer your child to a pediatric endocrinologist for further testing and treatment.

A Cautionary Tale of Hormones
This story really resonated with me. I had a friend many years ago who went from doctor to doctor, ER to ER with symptoms that could not be diagnosed. One night she was lying down on the couch and she told her daughter she might not live. That night she died and the autopsy showed she had pulmonary emboli (clots). That’s all I know…so after Elizabeth’s experience…I found the following website that might be informative to us all. Patient stories and information help make this a robust site. As well I’ve included url’s for the D-Dimer Blood Test.



WARNING LETTER: NOA # 21-676, 21 ~873, 22~045 YAZ(f (drospirenone and ethinyl estradiol) Tablets MACMIS 10# 16473

The following site – National Center for Complementary and Alternative Medicine
 has excellent pieces for practitioners and the public. In the most recent segment, I especially enjoyed reading

"How to find a complementary health practitioner”

Read the section on how to talk to your doctor at

Mindfulness Based Stress Reduction-On the same site, I especially enjoyed the articles on Mindfulness Based Stress Reduction


National Certification Commission for Acupuncture and Oriental Medicine


A concern I had was there was a section I could click on entitled Chinese Medicine Proven Helpful to Manage Menopausal Symptoms but when I clicked on it the article was from a newspaper with no references related to studies to show that studies have been conducted to "prove” the statement. My caution to you is if something is said to be "proven” ask where the proof is. Remember that the FDA does not require supplements to undergo the same testing as "medicines”…so buyer beware.


The second article I read was entitled Effect on Fertility Treatments (2013).This was an actual study and was quite interesting…however small numbers, but interesting nonetheless

A Tale of Two Cancers
The following email was sent to me from Amy. I thought this might be the best place to share the information with you.


Email sent by Amy to friends and family…sharing with all of you here…


Thyroid cancer

On Wednesday, Dr. Oz had a show on the fastest growing cancer in women, thyroid cancer. It was a very interesting program and he mentioned that the increase could possibly be related to the use of dental x-rays and mammograms. He demonstrated that on the apron the dentist puts on you for your dental x-rays there is a little flap that can be lifted up and wrapped around your neck. Many dentists don't bother to use it. Also, there is something called a "thyroid guard" for use during mammograms. By coincidence, I had my yearly mammogram yesterday. I felt a little

silly, but I asked about the guard and sure enough, the technician had one in a drawer. I asked why it wasn't routinely used. Answer: "I don't know.

You have to ask for it." Well, if I hadn't seen the show, how would I have known to ask? We need to pass this on to our daughters, nieces, mothers and all our female friends and husbands tell your wives !! I just did, now you send it on to your list. Someone was nice enough to forward this to me. I hope you pass this on to your friends and family. THANKS FOR SHARING THIS, AMY!

Amy also shared with me the following website which she felt was very helpful during her experience with thyroid cancer.

Aging into Wellness - Dr. Gladys McGarey

Menarche: A Story of Aching and Understanding


Having tools available for young women can be of great benefit in helping they feel more confident in understanding their bodies as they experience menarche and their menstrual cycle.

Menstrual Cycle Charting


The Menstrual Cycle: Stigma or Life Map? 
The Society for Menstrual Cycle Research was founded in 1979 by women who understood the importance of the menstrual cycle in women’s lives and health needs involving the menstrual cycle. This dedicated group of women (and a few men) conduct research, influence policy, provide women’s healthcare, and mentor students in the field. I have been a member of this Society for several years and have so enjoyed observing women from across the world come together for the cause of supporting other women in such a way.

The Road Less Traveled 

Hannah’s webinar teaching about Fertility Awareness is excellent (see "Webinars" in the Educational Corner…below is a guideline from the government related to guidelines for fertility. As well, I’ve included a url for menstrual cycle charting which is so important in fertility awareness.

     Guidelines for fertility -

     Charting -

 Read about Rachel’s dedication to the environment and helping women on this wonderful website … perhaps you’d like to have them cycle to your community~

ALSO...go to the following URL and read about Menstrual Products: Safe or Profitable:     WHAT DO YOU THINK? Tell us in the Forum.