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Dr. Jones: "Help! My daughter is 10 and she's developing breasts. Is this too soon? I'm not ready for this." This is Dr. Kirtly Jones from obstetrics and gynecology at University of Utah Health Care and this is puberty on The Scope.

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Jones: Many years ago, a dear friend of mine called me with a worried question. Her 10-year-old, flat-chested daughter had developed a small, tender bump under one nipple. "Is it cancer?" she asked. I replied, "Oh, no. It's something much more frightening. It's puberty." But what is puberty? How old are girls when it usually happens? And is it occurring earlier in the US?

Well, puberty is when the sleeping gonads, ovaries, and testicles of boys and girls wake up to begin the coordinated development of sexual tissues. In girls, it begins with breast development called thelarche, followed closely by pubic hair called pubarche. And about two years after the beginning of breast development in the normal pubertal process, the first menstrual period starts, menarche. This waking up of the sleeping gonads is preceded by a year or two by the maturing of the adrenal glands called adrenarche. All of our lovely developing arches, I'm waiting for an arche to name the start of the development of the mature brain.

Anyway, all of these arches, menarche is the easiest to reliably record and remember. Most women, or their mothers, don't know or recognize the first beginning of breast buds. But the first period is more memorable and there are many reasons why a culture may want to record the age of menarche in its girls. Not the least of which is their potential fertility and marriageability.

The average age of menarche in the early 1800s was about 17, as reported in Norwegian records. There was a steady and significant decline in the age of menarche over the past 200 years in European records. Although one researcher in the US noted about 1900 that girls with "greater culture and education" had earlier menarche by about a year, it was probably better nutrition that contributed to the earlier menarche. "Cultured white girls" had earlier menarche than Irish immigrant girls or African-American girls. And that's probably not the culture that made a difference, but the nutrition.

Contributing to earlier menarche is early childhood nutrition and pre-pubertal nutrition. So, is the age of menarche still falling? And the answer is yes, all over the world, but not so quickly. The National Health and Nutrition Examination Survey, NHANES, found that the average age of menarche in the US dropped about one year from girls born in 1920 to women born in 1980. African-American girls had the biggest drop from 13.6 years to 12.2 years. Non-Hispanic white girls had a decline from 13.3 years to 12.5 years. And Hispanic girls were about in the middle. In Japan, Japanese girls had their change of menarche drop from 13.8 in girls born in the '30s to 12.2 for girls born in the '80s.

But, you know, 13, 12 is not such a big deal, but to think of it a different way, the percent of US girls who've had their first period by age 10 was zero for girls born in the '20s and is 2% to 3% for girls born in 1980.

So why is this happening? Is it good nutrition, our fruits, veggies, and protein? Or is it bad nutrition? Well, body weight is a contributing factor to the age of menarche and we know that kids are taller now than they were 80 years ago. The most recent changes in the past 30 years have not been so much taller kids, but fatter kids. The likelihood of reaching menarche in girls now is most likely associated and most highly associated with pre-pubertal adiposity, or fatness. Although, some people even question this.

So sweet drinks in cans and boxes are associated with earlier periods. A few separate studies have debated whether it's the sodas, caffeinated, sugared, or artificially sweetened, and whether they're associated with early menarche. And there are some debates as to whether it's the caffeine, the sugar, or the artificial sweeteners, but one big study suggests that sweet drinks in cans do make puberty earlier. We do know that kids that consume artificially sweetened sodas are more likely to be overweight. But is it the overweight kids are more likely to drink artificially sweet drinks?

Or is it the bisphenol A that lines the soda cans? Well, BPA is a plastic with some estrogen-like activity that's been a concern for all of us. One study, though, looked at BPA levels in the urine of kids and recorded that the menarche, when controlling for race and fatness, didn't seem to be different based on their BPA levels. But there is still a concern about the artificial chemicals in the environment in the lotions and potions we put on our kids that may have some effect on their puberty.

So how does this all matter? Well, first, as the age of menarche goes down, the number of kids who have menarche before 10 goes up. Developing breasts at seven and periods at nine is hard for girls that we still consider as little kids. We also know that earlier exposure to estrogens is a small factor in the risk of breast cancer. When could early puberty be a medical problem? Well, if your daughter develops breasts before the age of seven, you should talk to her pediatrician.

Now, is there anything we can do about it? If pre-pubertal adiposity, fatness, is the number one risk factor for earlier breast development and periods, we should take care with what our kids eat and drink and keep them active. We should have a say about what food is available at their schools, such as sodas and juices and high-calorie snacks in the machines. We should try to decrease screen time and increase outdoor time. And, most importantly, because we cannot control everything, we need to be ready to have the talk and support our girls as girls as they make this transition. And thanks for joining us on The Scope.

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Dr. Jones: If you're having a hysterectomy for problems with your uterus, should you have your ovaries removed the same time? This is Dr. Kirtly Jones from obstetrics and gynecology at the University of Utah Healthcare, and this is The Scope.

Announcer: Covering all aspects of women's health this is the seven domains of women's health with Dr. Kirtley Jones on The Scope.

Dr. Jones: A recent study from Sweden published in the British Journal of Surgery found that women who have their ovaries removed were at higher risk of colon cancer. A more careful look at the numbers found that this was a study looking back through the Swedish Patient Registry, about 200,000 women who had their ovaries removed for one reason or another compared to thousands, hundreds of thousands of women who did not. They found that removing the ovaries increased the chance of developing colon cancer in the future by 30%.

Now, Scope listeners are smart about numbers and they should be asking themselves right now 30% of what? Although 30% increase is a scary figure, the real rate of colon cancer in women who did not have their ovaries removed, was 1.3/100. And in women who had their ovaries removed it was 1.6/100 and that was a 30% increase, but it's not so scary when you look at the real numbers.

Now this was a study looking back at health histories. And maybe women who had their ovaries removed had other health risks for colon cancer, but there is another strong set of scientific evidence that estrogen protects against colon cancer. In general, women get colon cancer later in life than men. In the women's health initiative, a prospective randomized placebo controlled trial - the gold standard of medical evidence - found that taking estrogen slightly decreased the risk of colon cancer compared to women who were taking placebo, about 30%.

Finally, in a lab, adding estrogens to colon cancer cells partly inhibits their growth. There's plausible evidence in the laboratory. There's a prospective randomized trial and there's some big data that says taking out your ovaries puts you at increased risk of colon cancer. However, women don't think of colon cancer as being a woman's problem, even though about 1 in 24 women, about 4% of women will get colon cancer in their lifetime compared to 1 in 21 men. So it isn't that uncommon.

Women think about ovarian cancer as being a woman's problem. The lifetime risk of ovarian cancer is 1 in 75, significantly less common than colon cancer in women. Of course taking the ovaries out just decreases the risk of colon cancer but taking up the ovaries mostly but not completely decreases the risk of ovarian cancer. The famous Nurses Health Study followed thousands of women for many years and looked at their health outcomes if there were other conditions that are more likely in women who have their ovaries removed. Coronary heart disease is more common in women who've had their ovaries removed and osteoporosis bone thinning is more common in women who have had their ovaries removed. Lung cancer, believe it or not, is more common in women who had their ovaries removed. Breast cancer is less common, of course, in women who've had their ovaries removed.

So your surgeon is in your tummy to perform a hysterectomy because you have too much bleeding, and you're under anesthesia and you're about 50 years old. Should you have your ovaries removed? Removing the ovaries adds very little to overall risk of the surgery and your ovaries look normal.

This is a conversation you should have had with your surgeon long before you were in the operating room. What are your risks of ovarian cancer? Do you have ovarian cancer in your immediate family? Do you carry a BRCA mutation that increases your risk of breast and ovarian cancer? Did your best friend die of ovarian cancer and it's your number one fear and you can't stop thinking about it? Then the answer is probably yes. Talk to your surgeon about removing your ovaries.

However, in one study, about 98% of women who had their ovaries removed at the time of the hysterectomy were not at increased risk of ovarian cancer. In the end, weighing the risks and benefits, it's a highly personal decision. Although a Mayo Clinic paper and the Nurses Health Study that looked at all causes of death found out that women who had their ovaries removed in the past for non-cancerous reasons died just a little younger than women who didn't.

This decision is one for you to make with your doctor, but you should come to your appointment prepared. You can just google, "Should I have my ovaries removed" and there lots of choices, but I would suggest the website at the University of Wisconsin as an excellent interactive tool. Google, "Should I have my ovaries removed University of Wisconsin" and it'll get you there. But it's also on our website.

Full disclosure, I am the OB/GYN editor for Healthwise, the non-profit patient education company who created this patient decision document. Get the facts, not just the fears and make the right decision for you, and thanks for joining us on The Scope.

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