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Polycystic Ovary Syndrome in Adolescents

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May 18, 2022
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Dr Kanika ChopraMBBS, MS Obstetrics and Gynecology
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How is it different from normal PCOS?

Polycystic ovary syndrome (PCOS) is not a disease but a combination of multiple diseases forming a syndrome. Adolescent PCOS is a difficult diagnosis to reach and start treatment thereafter. Nearly 6-18% of adolescent females are diagnosed with PCOS, with this proportion being just the tip of an iceberg. The major reason behind this syndrome being undetected is the symptoms in PCOS being similar to physiological changes during puberty that happen ranging from 10-19 years of age.

Polycystic ovary syndrome is diagnosed as per Rotterdam’s criteria as presence of one of the following, oligo or anovulation, clinical or biochemical signs of hyperandrogenism and polycystic ovarian morphology on ultrasonography. This criterion primarily is suitable for adults and cannot be applied in adolescents.

PUBERTY AND PCOS

During pubertal changes, the changes occur in the hypothalamic-pituitary-ovarian axis which in turn helps in these changes to happen. The most important being start of menstruation. In the initial year, there happen to be alteration in menstrual cycles varying from their regularity to frequency.But, if the variations in cyclicity and duration of cycle length persist for more than 1-year post-menarche i.e., starting of menstrual cycle then it is a matter of concern.

pcos

FACTORS OF CONCERN

  • If abnormal menstrual cycles are present with regularity of less than 20 days or more than 90 days even in first post-menarchal years requires evaluation and these girls are labelled as “AT RISK” for Polycystic ovary syndrome. These then require reassessment and re-evaluation after 3 years.
  • Presence of more than 10 lesions of comedonal acne on face or inflammatory acne warranting treatment is another marker of hyperandrogenism i.e., excess testosterone levels.
  • Presence of excessive facial hair requiring frequent depilation, and hair growth in chest, upper back and abdomen are features of hyperandrogenism. These require clinical evaluation by a gynaecologist and thereafter biochemical confirmation.
  • One other feature is acanthosis nigricans i.e., hyperpigmentation of skin of neck, under-arms and inner thigh and is due to insulin resistance or in simple terms a preliminary stage of developing diabetes.

DIAGNOSIS

These features if present in an adolescent characterize that you might be suffering from PCOS. But irony is majority times adolescents are subjected to ultrasonography and are diagnosed as PCOS.This is an absolutely wrong practice and just assuming that you are suffering from PCOS and getting an ultrasound done is not warranted. During early pubertal years, there is high possibility of polycystic appearance of ovaries and thus wrong diagnosis. This feature is seen in less than 8 years post-menarche and is not a feature of PCOS and reproductive dysfunction thereafter. If you or your friend or family member is having such symptoms, its better that you visit a gynecologist and avoid self-diagnosis.

DON’T MIS-DIAGNOSE PCOS….

A complete evaluation of a girl is must which includes history taking and examination followed by biochemical evaluation that your gynecologist may think are necessary to reach the diagnosis. Mind it, all this is essential as PCOS is the diagnosis of exclusion. Over and mis-diagnosis both should be avoided as much as possible.

Diagnosing PCOS in adolescence is important to prevent this syndrome reaching adulthood as it holds with it multiple reproductive and health related issues. Most important sequelae being infertility i.e., inability to conceive and you may then require support of drugs or artificial reproductive technology. Other chronic health problems one can suffer from include obesity, type 2 diabetes mellitus, cardiovascular diseases etc.

REASONS FOR DEVELOPMENT OF PCOS:

There are many reasons of development of PCOS. The pathogenesis is rare and complex with multifactorial origin, but the most important is abnormality in lifestyle of an individual.

  • Poor eating habits.
  • Sedentary lifestyle
  • Dependence on machines around us make one susceptible to metabolic syndromes including PCOS

A thorough change in lifestyle is required. And this is reason for PCOS having no permanent cure. As the vicious cycle of poor life style leads to PCOS which in turn leads to poor life style. So, the most important treatment is life style modification in the form of planned dietary habits and exercise.Even 5 % weight loss can help you to begin with. Along with this, as per your clinical manifestation of the syndrome you can be prescribed medications.

Often the adolescent girls diagnosed with PCOS are found to suffer from anxiety and depression.These can be due to the presence of physical symptoms of PCOS as highlighted above which are obesity, excessive facial hair and acne and also acanthosis nigricans. This also forms a vicious cycle and further aggravates the problems. There may be presence of eating disorders that may have precipitated this diagnosis. So, such adolescents require special care and treatment with psychiatrist and psychologist and most importantly peer and family support.

So, to conclude, prevention is better than cure is a very common proverb and holds true even in the cases of PCOS. Also remember, prevention starts at family level and aim should be to promote healthy life style for all. Avoid self-diagnosis and treatment, however minor you find your symptoms.

And once diagnosed, go in for proper treatment and address it properly.

Dr Kanika Chopra

Dr. Kanika Chopra (MBBS, MS Obstetrics and Gynecology) is working as an Assistant Professor in Lady Hardinge Medical College, New DELHI. She has also worked as an Associate consultant in Sir Ganga Ram Hospital, New Delhi in the minimally invasive surgery unit. A dynamic and diligent doctor, she was awarded the BEST POST-GRADUATE AWARD in her residency period and has received many prizes for her work. An avid writer and researcher, she has authored over 30 articles in both National and International Journals, and wellness magazines.


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