COMMENTARY

Puberty and the Women's Health Clinician: What's New?

Andrew M. Kaunitz, MD

Disclosures

September 07, 2010

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Hello. I'm Andrew Kaunitz, Professor and Associate Surgeon in the OB/GYN Department, University of Florida College of Medicine in Jacksonville. Today I'd like to discuss: Puberty and the Women's Health Clinician -- What's New?

In today's video blog, I'm highlighting findings and recommendations from a recent article and a government advisory, both of which focus on puberty in girls. First, the age of puberty in girls continues to decline. A recently published, federally funded study[1] used standardized breast evaluation to determine pubertal status in an ethnically diverse population of 7- and 8-year-old girls in 3 regions of the United States.

The investigators found that the proportion of girls who had attained breast stage II varied by age, ethnicity, and BMI [body mass index]. At age 7, 10% of white, 23% of black, and 15% of Hispanic girls had attained breast stage II or greater. These proportions were almost doubled when the investigators assessed 8-year-old girls. The authors concluded that the proportion of girls in those studies who had breast development at ages 7 and 8 years, particularly among white girls, was greater than that observed in studies of girls born 1 to 3 decades earlier.

Early puberty in girls is associated with lower self-esteem, higher rates of eating disorders, depression and suicide attempts, as well as an earlier onset of sexual intercourse and a higher risk for breast cancer later in life. Although the role of environmental exposure remains uncertain, what is certain is that higher BMI contributes to early puberty in this world of television and electronics that today's kids inhabit. A constructive role we can play is to encourage healthy eating and adequate exercise, not only in our patients' children but also for girls in adolescence who we care for directly.

In related news, the FDA [US Food and Drug Administration] issued an advisory[2] in July that inadvertent exposure by skin contact to the menopausal estrogen spray Evamist® [Ther-Rx Corporation, Bridgeton, Missouri] resulted in premature breast development in puberty in children ages 3 through 5. Used by menopausal women to treat hot flashes, Evamist® is sprayed on the skin of the arm. The FDA advises that women using Evamist® should avoid letting children have skin contact with areas where Evamist® has been applied, and they should wash the child's skin with soap and water if exposure occurs.

Because I believe that transdermal estrogen is less likely to increase thrombosis risk than oral estrogen, the majority of the prescriptions for estrogen I write for menopausal women are indeed transdermal. This FDA advisory highlights a previously unrecognized concern with spray-on estrogen, a concern that is not likely to apply to use of estrogen patches. In my practice, I'll stick to patches.

Thank you.

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