Treating PCOS in Adolescent Girls

If your adolescent daughter has menstrual issues such as infrequent, prolonged or the absence of periods, you should make an appointment with her primary doctor.

There are many possible causes for menstrual problems, including a hormonal condition called polycystic ovarian syndrome (PCOS). Other symptoms of PCOS include acne and/or excess hair on the face or body (hirsutism) that can present without abnormal periods.  PCOS may be associated with obesity that increases the established risk for diabetes, fatty liver and dyslipidemias. The condition is called PCOS because it was first described in women who had  numerous ovarian cysts. However, the hormonal disorder can occur in absence of ovarian cyst and ovaries might just be larger than normal.

While the cause of PCOS is unclear, there is increase production of male hormones, mainly testosterone, by the ovaries. The production of testosterone might be because of high insulin levels, or hyperinsulinemia, observed in these adolescents.  To diagnose PCOS, your family doctor will examine your daughter, take blood tests to determine hormone levels and may schedule an ultrasound to see if there are any abnormalities in the ovaries or lining of the uterus. It’s also helpful to keep track of your daughter's periods to see how frequently they occur and how long they last. An early diagnosis and prompt treatment may help reduce her long-term health risks, such as diabetes, high cholesterol and heart disease.

Treatment of PCOS

Treating PCOS usually focuses on restoring a regular menstrual cycle and addressing other concerns, such as excess hair or acne.  In many cases, a doctor will recommend birth control pills that contain synthetic female hormones such as estrogen and progesterone. Birth control pills can reduce the production of androgen, induce regular periods, and reduce the risk of endometrial cancer.  Other options include Metformin, an insulin sensitizer, that has been used “off level” to decrease high insulin levels and lower testosterone levels and metabolic risk factors.

In addition, there are several things you can do to help your daughter manage her condition and develop a long-term healthy lifestyle:

• Maintain or reduce weight. Obesity can affect the body’s metabolism in many ways, including increasing the level of insulin resistance. It’s a particular concern in girls who are at high risk for developing diabetes. Losing weight in a healthy manner can help reduce the levels of both insulin and androgen, and can even restore ovulation, which are all important health benefits for girls with PCOS.

• Discuss changes in diet. Many adolescent girls try to eat low-fat, high-carbohydrate foods to avoid weight gain. However, this can increase insulin levels — a problem for girls with PCOS. Therefore, your doctor may recommend a diet that includes high-fiber foods with complex carbohydrates such as whole-grain breads, cereals and pasta, brown rice and beans. Foods high in sugar should be avoided.

• Get more exercise. If your daughter has PCOS, participating in a regular fitness program can help lower insulin resistance and keep her weight under control.  It also strengthens her body and can improve her overall outlook on life.

Dr. Carillo-Iregui is a pediatric endocrinologist at Miami Children’s Hospital.