Rude Awakening 
I'm dying. I’m dying. I’m dying.
I kept repeating the words as I stared at my 10-year-old reflection in a bathroom mirror at Bonanza Steakhouse, a cheap buffet-style restaurant in my home state of North Dakota. It was 1990, and outside the door I could hear my sister’s volleyball teammates chattering. I tried to picture my parents smiling tolerantly at the middle-schoolers as they ate their iceberg lettuce salads with ranch dressing. How was I going to break their complacent reverie to tell them that their youngest daughter was deathly ill?
I stepped out of the bathroom, walked over to my mom, and placed a hand on her shoulder. “Mom, I have something to tell you.” I paused, letting the world slow down for one last moment. “I’m hemorrhaging.”
She didn’t burst into tears, faint, or tear at her hair. She snorted. I was aghast. How could my mother respond so casually to the news of my mortality? When she stopped laughing, she turned to me and said, without preamble: “It’s your period.”
In retrospect, perhaps I should have known. After all, I have older sisters, and my mom was a sex education instructor, so videos about changing bodies were as common in our house as cartoons are in others. My mom carried plastic, ahem, parts in the trunk, to the perpetual embarrassment of my brother and me. I knew what menstruation was, but I also knew I was way too young to have it. This was something older girls dealt with. Not fifth-graders. Not me.
In the United States, menstruation generally arrives when a girl is 12-and-a-half years old; that hasn’t changed significantly in recent decades. What has changed is the onset of early, or “precocious,” puberty, which triggers breast development and pubic hair as early as seven (for boys, the cutoff is nine). Until the late 1990s, researchers thought puberty usually started around age 11. By 1997, the average age bumped down to 9.96 years; today, it may start as early as six-and-a-half years old. Although environmental chemicals, hormone levels in water supplies, and mere evolution have been cited as possible culprits, researchers still don’t know why the shift is happening.
If a six-year-old girl starts developing breasts, her pediatrician likely will send her to an endocrinologist. These specialists first look for simple answers such as a parent using steroid creams; then they explore the child’s genetic background. Doctors can, and will, slow or halt puberty when necessary and will help kids and parents adjust to something they didn’t think they’d need to fret about for years.
Precocious puberty accelerates these worries. It can also signal long-term health problems like polycystic ovary syndrome (PCOS), which affects up to 10 percent of women, can lead to infertility, and has been linked to heart disease and diabetes. “We worry that these children are at an age that they aren’t ready to deal with it,” says Megan Kelsey, M.D., an assistant professor of pediatric endocrinology at Children’s Hospital Colorado. “If children have excess estrogen before they reach their full height, they can end up short or face other psychological effects caused by early development.” That can be bad news for a parent—or a soon-to-be young woman.
Kelsey tries to ensure that children are developing, just not too quickly. In many cases, a girl with precocious puberty will get her first period at a normal age. Others will need hormone intervention—a drug regimen similar to those used to halt puberty for transgendered children—to stall the development process. Either way, parents of a child with precocious puberty are faced with a dilemma: Let nature happen, or chemically alter their child’s transition to adulthood.
My pediatric medical file has no record of my first period; apparently, it was considered a medical non-issue. There’s no “official” mention of my menstrual cycle until my high school years, when I once asked to skip gym class because of cramps. I adopted my doctor’s indifference—never tracking my cycle, living guilt-free on a contraceptive pill—until I turned 30 and my husband and I started talking about having kids.
After six years of marriage, we’d moved to Colorado, bought a house in Denver with too many bedrooms, and settled into careers. We were ready, we thought, to have someone join our family. We set about getting pregnant, expecting it to be easy—because we’d spent so much money on avoiding pregnancy, we figured it must be pretty simple to get knocked up on purpose.
We were naive. I went off the pill—and my period disappeared for six months. I chalked it up to nearly a decade of being on birth control, but when I finally told my obstetrician’s office about it, they couldn’t stop asking questions: When did I first get my period? Ten. Has it ever been regular? No. Have I gained weight suddenly? Yes, it’s the strangest thing; it’s all in my midsection, but I run nearly every day. Do I have hair growing in unwanted areas? No. Do I have adult acne? Doesn’t everyone have breakouts? Has anyone ever talked to me about PCOS? No…why?
PCOS is usually discovered by an obstetrician when a woman complains of irregular periods or infertility. Researchers suspect it’s inherited but haven’t yet found a direct genetic correlation; however, women with PCOS are likely to have a sister, cousin, or daughter who has it, too. Doctors know it’s a problem with a woman’s hormones—they just don’t know exactly what’s wrong. “We don’t think all women with PCOS are the same,” Kelsey says. “We think a lot of women got lumped into the same group and there actually are at least two different disorders.”
That confusion is inherent in the name, which describes ovaries riddled with cysts. An ultrasound of the ovaries—and the appearance of multiple cysts—was once used to diagnose a patient with PCOS. Now that’s just a piece of the puzzle, because women without PCOS can have the same issue. (There’s no definitive test that detects the condition.) PCOS patients also may have abnormal levels of hormones, specifically androgens (the male ones). This doesn’t mean they look or act more masculine; every female has these hormones. Rather, the balance between their estrogen and androgen is skewed, resulting in weird cycles, hair growth, weight issues, and insulin resistance. (These latter two may actually cause PCOS rather than be caused by it.)
Taken alone, these symptoms may seem more pesky than deadly, but over time, PCOS patients may have trouble ovulating and getting pregnant, or they can develop diabetes or heart disease. For women with PCOS, tracking periods shouldn’t be something they only sort of think about; these women need to track every cycle—beginning with their first one.
When I finally visited the Colorado Center for Reproductive Medicine, a world-renowned fertility practice, I arrived with pages of a color-coded spreadsheet that tracked a year of my cycles. It was so type A the doctor asked me if I was an engineer. But after 12 months of religiously charting my temperature, I still didn’t understand what was—or, more accurately in this case, what wasn’t—happening to my body. My doctor explained that my insides were like the Cookie Monster hooked on sugar: My insulin levels were jacked. I had an elevated level of male hormones, and my female hormones were high, too. In my case, though, I had trouble finishing the process and dropping an egg, which helped explain my lackadaisical monthly cycle. They showed me lab reports and rattled off acronyms before sending me away with a treatment plan that included a daily metformin pill. Normally used for diabetics, its role was to rein in my hormones by controlling my blood sugar. This meant that just about anything containing sugar—pastries, pizza, beer, yogurt—made my stomach so upset I couldn’t stand up. I learned to subsist on greens and meat, an unintentional Paleo diet. Slowly, my period became semiregular, and after six months of treatment, I got pregnant.
At our 16-week ultrasound, our doctor giddily asked us if we wanted to know our baby’s gender. Yes, we did. Did we have a prediction or a preference? No, we didn’t. At least that’s what I thought until she swirled the wand around my belly and delivered the news: a boy. I went so still that my doctor turned to me and asked if I was OK. I nodded quickly and bit into my lower lip to keep from crying—because I was relieved.
As much as I would have welcomed a baby girl and could vividly picture teaching her to read, to lead, to be, I couldn’t shake the image of that hypothetical girl becoming a young woman. My genetic code probably ensures that my daughter’s puberty—and, later, her ability to be a mom—wouldn’t be easy. She, like me, would have to carry menstrual pads in a backpack while her friends played four square. She’d wonder why her body just didn’t feel right. She’d have to take pills to turn a natural process into a heavily regulated and unnatural one.
And with good medical care, she’d manage it. Of course she would. And I would be there for her. But he—that peanut of a person finally growing inside me—would never have to worry about PCOS. I could cross this off my parental worry list, which was growing as fast as my belly. And just when I started to relax, I had another thought: I know more than most people about raising a girl through puberty but next to nothing about raising a boy. And so, I followed the same instincts I had when I was 10—and I called my mom.
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