Adolescent PCOS.

Many patients are able to date their symptoms to puberty. Several studies support that for many patients there are hormonal imbalances at this time. Normally, the progression through puberty is characterized by irregular menstrual cycles, most of which are not associated with ovulation. During the 1st year after menarche (time of 1st menses) only 15 % of the cycles are ovulatory, by the 3rd year 40 %, and by the 6th year 70 % are ovulatory. There are several independent risk factors for PCOS seen in the prepubertal girl; above average birth weight and early rapid weight gain after birth, premature menarche/pubarche, anovulation, and obesity with Acanthosis Nigricans. Oligomenorrhea (irregular menstrual cycles) is common in the post-pubertal child, but if combined with acne and hirsutism PCOS may be present and the child should be evaluated. The menstrual cycle is a good indicator of the patients overall health. If the child has a BMI greater than the 95^th percentile for age a health and dietary evaluation needs to be done.

A study of hyperandrogenic girls between the ages of 11 and 18 years when compared to age matched normally cycling girls were found to have increased secretion of Luteinizing Hormone, increased LH/FSH ratio, increased insulin, and decreased insulin-like growth factor binding protein-1. Thus, there appears to be hormonal differences in these young patients with PCOS.

A study by Apter and Vihko in 1990 examined long-term 200 girls between the ages of 7 and 17 in 1974. In 1992, patients that had not yet conceived had elevated testosterone levels. There was an inverse relationship between the testosterone levels as a teen and the likelihood to become pregnant.

In a study by Reichart and Southam, patients were followed between 1941 and 1964. If they had irregular cycles for more than 2 years, 2/3 still had abnormal menstruation as they got older. Dhalgren, in 1992, followed women that had PCOS and a wedge resection between 1956 and 1965. Many still had irregular cycles after the age of 40. Post-menopausal patients had elevated testosterone, LH, FSH, and estrone. They had more hysterectomies, entered menopause later, increased central obesity, insulin levels, diabetes, and hypertension.

The diagnosis of PCOS is the adolescent is difficult and not all agree. Some investigators suggest having 4 out of the following 5 signs and symptoms; clinical hyperandrogenism, biochemical hyperandrogenism, increased insulin levels, oligo/amenorrhea, and PCO appearance on pelvic ultrasound. Thus, it appears that patients with PCOS experience distinct hormonal abnormalities that, with other symptoms, persist throughout the reproductive years and beyond.

The therapy in the adolescent is similar to the adult. A 5% to 10% weight loss has been shown to dramatically improve the symptoms. Metformin and diet have been shown to restore menses and decrease androgens. Please see our web page on weight management.