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Recognizing the Signs of Polycystic Ovarian Syndrome

  • November 1, 2007
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Parents of adolescents expect most of the physical changes that the teen years bring. Growth spurts, bigger feet, body odor and acne are all part of puberty.

Even though initial menstrual periods for young female teens are often irregular, parents need to be watchful if their daughters begin showing signs of a hormonal imbalance that can indicate the presence of Polycystic Ovarian Syndrome (PCOS), a disorder that develops in 5 to 10 percent of women today, according to the National Institutes of Health.

Diane F. Merritt, MD, a Washington University adolescent gynecologist at Barnes-Jewish Hospital, recommends that parents discuss menstrual irregularities with their primary care physician, who may recommend consultation with a gynecologist.

"If a teen is bleeding too much, too long or too often, the pediatricians will usually send them in for help," said Dr. Merritt. "But patients with PCOS often have infrequent, erratic, or absent menses, and may slip below the pediatrician''s radar screen. If coupled with other worrisome factors like obesity, acne and excess body hair, we can provide early evaluation and intervention."

Many adults with PCOS reflect back on their adolescent years wishing the condition had been recognized earlier. Such women often present with infertility concerns since the lack of regular ovulation interferes with their ability to become pregnant.

A normal ovary creates fluctuating levels of estrogen, progesterone and testosterone. In PCOS, the testosterone production is elevated and may result in a significant weight gain, worsening of acne, dark hair over the upper lip, cheeks, chin, and body, and menstrual cycle irregularities. Other visible symptoms may include stretch marks, thinning of hair on the scalp, and patches of darker skin on the neck, beneath the breasts or inner thighs.

If blood testing is done, the teen may also have high levels of insulin production, a warning sign of a high risk for diabetes. High levels of insulin and lipids often accompany the elevated levels of testosterone. These are signs of future problems associated with PCOS, which Dr. Merritt states is part of the bigger picture of insulin resistance, or the "metabolic syndrome" that is linked to diabetes.

Prevention and treatment
While the exact cause of PCOS is a hot topic for research and study in endocrinology, experts believe there is a genetic component since a family history has been a strong indicator of the disorder. If a woman is diagnosed with PCOS, there is an increased chance her daughters and granddaughters may develop it as well.

Dr. Merritt recommends early recognition and intervention to decrease the risk of long-term complications. When symptoms are suspected based on the teen''s medical history and examination, Dr. Merritt performs a series of blood tests to determine whether the teen has PCOS or,some other diagnosis.

While specific medications are used to regulate menstrual cycles and correct insulin resistance, Dr. Merritt also advises a proactive approach – she encourages patients to reevaluate their lifestyle to include healthy food choices, smaller portions and increased physical activity.

"Many teens are sedentary, watching hours of television, playing video or computer games, instant messaging or talking on the phone," said Dr. Merritt. "I strongly encourage participation in individual or team sports, helping with household chores and limiting consumption of fast food or junk foods."

Dr. Merritt says teens who work hard to change their eating habits and become more physically active profit by feeling and looking healthier. "This is great for self-esteem, which is a real issue for many young women with PCOS," she said. "If we can encourage healthier lifestyles in the teen years, future generations will reap the benefits."

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