Women’s Health Conditions
What is the definition of obesity?
Obesity is defined as a body mass index (BMI) of over 30. Overweight is defined as a BMI of over 25. BMI is defined as weight in kilograms divided by height in meters squared (BMI=kg/m2). The "correct weight for height" is expressed through this measurement.
Isn't "baby-fat" ok when a girl is young?
Studies have shown that obese children often grow up to be obese adults. In fact, in the population of women with gestational diabetes (abnormal blood sugar during pregnancy) babies are often overly large and these large babies grow to be obese adults with greater risk of insulin resistance and diabetes themselves. The concern about obesity actually begins even before birth.
What are the health risks of obesity in this age group?
When childhood obesity continues into adulthood, it is a major risk factor for heart attacks, stroke, cancer, and diabetes. But even in childhood, being overweight can contribute to problems with the joints, sleep apnea, asthma and especially type 2 diabetes, which is now seen much more commonly in childhood than in the past. Insulin resistance is worsened by obesity and contributes to the risk of diabetes, hypertension (high blood pressure), and polycystic ovary syndrome (see below). Children may also face serious psychological issues and problems with social interaction due to obesity.
Other endocrine disorders can be seen in young girls. In childhood, an underactive thyroid often becomes apparent with failure to grow normally. It can also cause fatigue, poor concentration and difficulty with learning, constipation, muscle pains or weakness, and intolerance to the cold. In girls, thyroid disease can cause failure to menstruate, early onset of menses, or irregular menses.
Congenital hypothyroidism is usually caused by improper development or actual absence of the gland. This is a very serious condition, which can lead to mental retardation. Fortunately, all babies in the US have a test for thyroid disease when they are born and parents are notified immediately if there is a problem. Prompt treatment with thyroid pills will allow perfectly normal growth and development.
Overactivity of the thyroid can cause weight loss, irritability and poor school performance, change in sleep habits, shakiness, muscle weakness, menstrual problems and palpitations.
A goiter or enlargement of the thyroid may or may not be present when the thyroid does not work correctly.
Since thyroid disease is often hereditary, children in families with a high frequency of thyroid disease should be checked with a simple blood test as should all children with any of the symptoms listed above.
Also, keep in mind that thyroid malfunction is 5-10 times more likely in females than males.
Adrenal hyperplasia refers to a series of conditions, which are genetic and lead to improper production of adrenal hormones. Usually, this is apparent at birth sometimes with abnormal development of the genital tissues. In some cases, the symptoms do not become apparent until adolescence. Endocrinologists are able to test for this condition and medical therapy is quite successful.
Cushing's disease may occur in childhood and adolescence but is extremely rare, as are tumors of the adrenal glands.
Addison's disease (adrenal insufficiency) is also rare in childhood and adolescence but is more common in people with type 1 diabetes and other autoimmune disease. If your doctor suspects this condition, there are easy blood tests to determine its presence and treatment is very successful.
Pituitary problems are rare in childhood and adolescence. Pituitary tumors and tumors called craniopharyngiomas, which grow near the pituitary gland, can affect growth, development, menstruation, and cause secondary failure of the thyroid and adrenal glands.
There is a wide range of normal height in this country, particularly since we are a diverse community with people from all over the world. Since the major influence on height is genetic, it's unfortunate that youngsters compare themselves with friends who may have different growth potential. If a girl had been growing normally for her own pattern of growth and that growth slows, it is proper to search for a cause. This may include thyroid disease, pituitary problems, growth hormone deficiency, problems with the absorption of food from a variety of causes, or even a sign of a young onset of an eating disorder. Turner's syndrome and its variants may also be present with short stature, and it is important to find this disease since growth hormone therapy early in life can improve the final adult height. (See below) An endocrinologist specializing in growth problems can perform the appropriate tests and prescribe treatment if a deficiency is found.
What is Turner's syndrome?
Turner's syndrome is the most common condition, which causes a failure of development of normal ovaries, often in conjunction with other abnormalities of the skeletal system, kidneys and sometimes heart and aorta. It is caused by specific mutations or changes in the genetic material (DNA), which allows normal development of these structures. Girls with Turner's syndrome are not able to produce estrogen nor can they ovulate (produce eggs for procreation). Growth is often limited. It is important to identify girls with this condition as early in life as possible in order to make sure there are no associated health issues, as well as to assess the possible need for growth hormone treatment to optimize height potential. At the time of expected puberty, estrogen and progesterone must be added to provide menses and bone health. If a woman with Turner's syndrome is interested in fertility, the option of ovum donation exists.
Polycystic Ovarian Syndrome
What is PCOS?
Polycystic ovarian syndrome is a condition, which results in abnormal function of the ovaries with irregular, infrequent ovulation, and menses frequently with the production of excess androgen (testosterone) from the ovaries. This may result in acne, excess facial or body hair, and/or loss of scalp hair. Women with PCOS may have some difficulty in becoming pregnant, but medical therapy is often quite successful.
Why is PCOS so important and why are we reading more and more about it?
PCOS is associated strongly with a condition called insulin resistance. As a result, women with this condition are at greater risk than the average person for diabetes, hypertension, lipid disorders, heart attack and stroke. When a diagnosis of PCOS is made, teenagers must not only be treated with appropriate medication (which may include estrogen, progesterone, anti-androgens, and insulin sensitizers), but should be strongly counseled regarding healthy living to avoid obesity and sedentary behavior. Regular medical check-ups and blood sugar, blood pressure, cholesterol and triglycerides testing should be encouraged.
Diabetes in young and teenage girls
There are two types of diabetes, type 1 and type 2. Type 1 diabetes is a genetically-based autoimmune disorder that leads to complete insulin deficiency, is not preventable and treatable only with insulin (see diabetes section in website). The complications of both type 1 and type 2 diabetes are serious but often preventable: blindness, kidney failure, amputation, heart attack and stroke. Practicing good blood sugar control, frequent testing of blood sugar along with healthy eating and good physical activity can reduce the risk of complications of diabetes even in type 1 diabetes.
Type 2 diabetes is also genetically-based and is caused by the combination of insulin resistance and relative deficiency of the pancreatic cells, which make insulin. This disease is strongly affected by diet, weight, and physical activity. The "power of prevention" in this disorder is so important that it can literally change the course of a person's life.
Osteoporosis & the Menstrual System
What does the menstrual system have to do with bones?
The menstrual cycle is a finely tuned system with its "clock signal," which regulates timing in a part of the brain called the hypothalamus. This organ, in turn, sends a signal to the pituitary gland, which makes other signals (hormones) that allow the ovaries to release eggs ("ovulate"). The hormones necessary to allow the uterus to have regular periods are then made. Bone development depends on having enough estrogen from the ovaries, among other things.
What does nutrition have to do with hormones?
Without good nutrition, the hypothalamus doesn't work properly and the functions referred to above can't occur. This leads to lack of periods (amenorrhea) as well as the direct effects of a lack of nutrients.
Pregnancy and Infertility
Conception may be easy or more difficult for different women. As women marry later and defer pregnancy for professional or social reasons, it may be more difficult to conceive. If couples have unprotected intercourse for more than a year without conception, evaluation of both "male and female factors" should be undertaken. If a woman is ovulating regularly, there are a number of issues, which can be addressed by her gynecologist or reproductive endocrinologist.
Failure to ovulate may be caused by PCOS, hypothalamic amenorrhea, ovarian failure (menopause), thyroid, adrenal or pituitary disease. Testing can determine the cause and treatment is often available.
It should be emphasized that avoiding excessive dieting and weight loss and over-exercising will improve hypothalamic amenorrhea and improve chances for conception.
Women are usually the most conscientious about their own health during pregnancy, knowing how important it is for the developing child. Now is the time to "lock in" all those healthy habits and remember that even after delivery, babies need healthy moms all their lives.
This common condition refers to an inability to "handle" food properly as a result of the hormones of pregnancy working against the normal effect of insulin, and allowing the sugar in the blood to rise to dangerous levels. It occurs more commonly in women with a family history of diabetes as well as women from certain ethnic groups and is worsened by obesity. Often it can be treated by careful diet alone; but, in many cases, treatment with insulin injections will be necessary to protect the baby from the bad effects of the mom's high blood sugar. These include high birth weights and the need for Cesarian sections as well as low blood sugar in the baby at birth (hypoglycemia), which can cause seizures. Expectant mothers may be asked to check their own blood sugars after meals with a finger-prick to make sure that therapy is working correctly.
Gestational diabetes is also a strong predictor of type 2 diabetes later in life. This gives a woman a "heads-up" to engage in healthy eating, regular exercise and keeping her weight in the normal range, since all of these things have been shown to actually prevent or delay the onset of diabetes and all of its complications.
Type 1 diabetes and pregnancy
Women with type 1 diabetes must be certain that their blood sugars are very "tightly" controlled even prior to conception; since the result of early fetal exposure to high blood sugars is birth defects. These are a result of the mother's high blood sugar during very early pregnancy (even before mom knows she is pregnant) and can be prevented by good blood sugar control. Women with type 1 diabetes must perform frequent glucose monitoring to make certain that their insulin doses are constantly adjusted, to maintain normal or near normal blood sugars throughout the whole pregnancy to avoid overweight and developmentally immature babies with serious metabolic risks.
Thyroid disease and pregnancy
Since thyroid disorders may affect as many as 6% of women in the reproductive age group, it is not surprising that they may influence the course of pregnancy. Having either an underactive or overactive thyroid may reduce the chances of conception and cause complications of pregnancy once achieved.
Untreated hyperthyroidism can cause preterm labor, preeclampsia, heart failure, fetal death, small for gestational age and "thyroid storm."
Hypothyroidism has been associated with an increased risk of miscarriage, placental abruption, low IQ, impaired psychomotor development and preterm delivery.
AACE believes that all women who are pregnant or about to become pregnant should be tested for thyroid problems. Other authorities feel that such testing is only necessary for women with a higher risk than the general population to develop these conditions. If you have any doubt, you should discuss this important issue with your doctor.
This refers to a condition in which the tissues that normally respond to the hormone insulin to activate many chemical processes in cells do not respond properly. The tissues involved are the liver, fat cells (adipose tissue) and muscles. If the pancreas, which makes insulin can make extra insulin to compensate for the insulin resistance, the blood sugar level remains normal but insulin resistance itself is linked to an excess risk of not only diabetes, but also high blood pressure, certain lipid abnormalities and problems with the function of blood vessels, which can lead to heart attack and stroke. If the pancreas fails to compensate, blood sugar levels rise and type 2 diabetes and the risk of its complications results.
Insulin resistance is typically a disorder of middle age, but because of the increase in obesity and lack of exercise, it is now seen in younger and younger women. There is a genetic tendency to have insulin resistance; and, it is extremely common in women with PCOS, non-Caucasian women, and women with a family history of diabetes, high blood pressure, heart attack, and stroke. National statistics indicate that by age 50, 35% of American women have insulin resistance and by age 60, 50% have it.
Menopause refers to the normal failure of ovaries to produce estrogen. This can occur normally any time after the age of 35, but usually in the mid to late forties and as late as age 55. Many women "sail through" menopause with few symptoms, but hot flashes of variable severity may require treatment with estrogen. Some women (those who have had breast cancer) should not take estrogen or substances that behave like estrogen in the body (certain herbs or "natural hormones" can have the same effect as prescription estrogen on the breast). For other women, estrogen can dramatically improve the quality of their lives. Current guidelines suggest that estrogen should be given in the lowest dose and for the shortest time possible to control symptoms.
If menopause occurs after the age of thirty-five, it is said to be normal. Some women experience failure of the ovaries to produce estrogen at a much younger age. This is called premature ovarian failure. In some people, this is linked with other hormonal, autoimmune or genetic disorders and in some it may be hereditary. Simple blood tests can distinguish premature ovarian failure from other causes of periods stopping at a young age. (see above).
Many women experience a time when periods still occur, but hot flashes may have started and periods may become different or more irregular. This is called the "perimenopause" and simply reflects the fact that the ovaries often lose their function gradually.
It is also important to understand that some symptoms are related directly to loss of estrogen, including hot flashes, poor sleep as a result of night sweats, vaginal dryness, difficult intercourse and dryness and irritation of the urinary outflow tract (urethra). These symptoms can be expected to be improved with estrogen. Other symptoms, such as fatigue, dry skin, poor memory, moodiness or depression, decreased libido, hair loss, etc, occur as part of aging in some women, are not caused by lack of estrogen and will not be cured by replacement.
Since most women spend a third of their lives in menopause, it is important to understand the changes that occur in the body and what we can do to stay fit and healthy.
What is osteoporosis?
Osteoporosis means less bone mass and more fragile bones that are more likely to break.
Why is proper nutrition needed to form strong bones?
Bones are living tissue made of a "matrix" or core, which is made of protein that is mineralized with calcium to harden it. In order to form strong bones, we need the right nourishment to make the protein and obtain the calcium and vitamin D necessary to mineralize the bones.