Spotting PCOS in your teenager
MANY people categorise polycystic ovary syndrome (PCOS) as a reproductive problem faced by only adult women. But obstetrician-gynaecologist Dr Robyn Khemlani said that the condition, which is the most common reproductive endocrine disease among women of childbearing age, also affects approximately 10 per cent of adolescents.
“Five to 10 per cent of teens and young women have this diagnosis. The most common symptoms are irregular periods, weight gain, acne, and excess facial and body hair. The severity of the symptoms, as with adults, varies from girl to girl,” Dr Khemlani told All Woman.
She said that teens diagnosed with the condition — which is characterised by high levels of androgen (male hormones) from the ovary and in some instances insulin resistance — commonly experience depression and a significant blow to their self-esteem because of the impact of the symptoms on their lives.
“The signs and symptoms of PCOS usually appear at the onset of puberty when there’s a normal increase in insulin levels as part of human development,” Dr Khemlani said.
She notes that the name “poly”, meaning many, and “cystic”, meaning cysts, refers to the fact that those with PCOS may have enlarged ovaries that contain many very small cysts. These small cysts, also called follicles, develop in the ovary, but the eggs are only rarely released. The outer wall of the ovary thickens, giving the ovary a polycystic appearance. She said that these cysts are not cancerous and as such do not need to be surgically removed.
“While in most cases a change in the ovaries is seen, it is not uncommon for girls with PCOS to have normal-appearing ovaries but still have an imbalance in their hormone levels. Generally, associated symptoms of PCOS begin during the teenage years around the start of menstruation and can be mild or severe,” Dr Khemlani pointed out.
She said that most times a PCOS diagnosis in an adolescent is often missed because irregular menstrual cycles from fluctuating hormones are typical in adolescent girls and other symptoms are simply missed.
Some of the most common telltale signs include:
•Irregular periods — periods that come every few months, not at all, or too frequently;
•Hirsutism — extra hair on the face or other body parts;
•Acne;
•Weight gain and/or trouble losing weight, and in some cases, obesity;
•Patches of dark skin on the back of the neck and other areas called acanthosis nigricans;
•Infertility or impaired fertility due to irregular periods or lack of ovulation;
•Hair thinning (on the top of the head);
•Skin tags under the armpits or neck area;
•High total cholesterol and/or low HDL (good cholesterol);
•High blood pressure;
•Pre-diabetes or in some cases, diabetes.
To reach a diagnosis, Dr Khemlani said that this generally involves asking general health questions, questions about the menstrual cycle, in addition to a panel of other tests.
“The Ob-Gyn will complete a physical examination and order blood tests to check hormone levels, blood sugar, and lipids (including cholesterol). A pelvic ultrasound will also be performed so that the doctor can get pictures of the reproductive organs (ovaries and uterus) and bladder to assist in diagnosis. In girls with PCOS, the ovaries may be slightly larger than normal and may have multiple tiny cysts on them,” Dr Khemlani outlined.
She said that a diagnosis of PCOS is made if two of the following are confirmed to be present:
•Irregular menstrual cycles (also known as oligo/anovulation)
•Signs of excess testosterone, which include acne or excess body hair, or by bloodwork (also known as hyperandrogenism)
•Polycystic-appearing ovaries on ultrasound.
Once the condition is diagnosed, Dr Khemlani said that a full hormonal work-up should be performed to determine if there is a condition other than PCOS that could explain the symptoms. However, the doctor will move to commence treatment so that the condition can be effectively managed.
“There’s no cure for PCOS, but don’t be alarmed, it is treatable. Diagnosing PCOS is an important first step because getting treatment reduces the chances of developing other serious problems in the future. For example, some complications that could occur as a result of PCOS include infertility, excessive hair growth, acne, obesity, diabetes, heart disease, high blood pressure, abnormal bleeding from the uterus, and cancer,” Dr Khemlani advised.
