Knowing signs of polycystic ovary syndrome in teens
My teenage patient seemed well-adjusted to high school and voiced no real physical or emotional complaints, but I was still bothered by some of the things I observed during her visit.
The young lady ate well and exercised, and was, in fact, in the office that day for her pre-participation sports exam. Despite her commitment to physical fitness, the girl was overweight, and plotted at the undesirable upper end of the body mass index chart. She also had extra hair in unusual places under her chin and along the central line of her lower abdomen.
When describing her menstrual cycle, the girl wondered why her periods were so irregular and infrequent. Additional history taking revealed that the high school student also had a number of relatives with health problems caused by their adult-onset diabetes.
The girl displayed enough features of polycystic ovary syndrome that I felt a referral to a gynecologist would be helpful for definitive diagnosis and treatment. The specialist examined her, and after running a few blood tests, determined that the teen did have PCOS and started her on appropriate therapy.
The National Institutes of Health report that 5 percent to 10 percent of women of childbearing age are affected by PCOS, an endocrine condition thought to be influenced by genetic as well as environmental factors.
Though there's still some disagreement over the definition of PCOS, many specialists make the diagnosis when two of the following three criteria are met: chronic lack of ovulation leading to irregular menstruation; high blood levels of androgens (commonly known as male hormones) that are not caused by other medical conditions such as adrenal gland abnormalities; and the presence of cysts on one or both ovaries as visualized on a pelvic ultrasound.
According to NIH experts, several physical features are characteristic of PCOS. More than 70 percent of women with PCOS display hirsutism with excess hair appearing in a male-type pattern on the face, chest and abdomen. Many PCOS patients also have oily skin with acne that can be severe and nonresponsive to treatment or which appears in adulthood instead of adolescence.
Patches of thick dark brown or black skin are common along with areas of hair loss or thinning hair, and weight gain or obesity.
Early diagnosis and treatment during the teen years can make a difference, according to diabetes researcher Darren J. Salmi and his colleagues. Writing in the journal Experimental Biology and Medicine, the team finds that early cosmetic intervention can help restore an adolescent's self-esteem deflated by struggles with weight and ongoing dermatologic problems.
Preventive care measures can also help ensure a healthier adulthood, as teens with PCOS are known to be at higher risk of developing serious medical conditions such as Type 2 diabetes, heart disease, hypertension, infertility and gynecological cancers.
The diabetic research team notes that “weight control is possibly the best method to prevent PCOS complications” and promotes healthy eating habits and regular exercise as the key components of treatment.
Another PCOS therapy often used is metformin, an oral insulin-sensitizing medication used in diabetes care. Metformin improves glucose metabolism and can help regulate periods and decrease some of the physical signs and symptoms of excess androgen production.
Oral contraceptives also have a role in PCOS treatment, due to their obvious effect on menstrual cycles and their added benefit in treating acne and hirsutism. As with many other medical conditions, the use of these and other PCOS therapies need to be tailored to the individual patient.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.