If the variations in cyclicity and duration of cycle length persist for more than 1-year post-menarche, then it is a matter of concern.
Polycystic ovarian syndrome (PCOS) is not a disease but a combination of multiple diseases forming a syndrome. Adolescent PCOS is a difficult diagnosis and treatment thereafter. Nearly 6-18% of adolescent females are diagnosed with PCOS. PCOS is diagnosed as per Rotterdam’s criteria by presence of one of the following features; 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.
During pubertal changes, the changes occur in the hypothalamic-pituitary-ovarian axis which in turn helps puberty related changes to occur. The most important being the start of menstruation also known as menarche. In the initial years following menarche, 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, then it is a matter of concern. But if abnormal menstrual cycles are present with regularity of less than 20 days or more than 90 days even in first post-menarchal years, it requires evaluation and these girls are labelled as “AT RISK” for PCOS. These then require reassessment and re-evaluation after 3 years.
Similarly, 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 (male hormone) 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 and biochemical confirmation.
These two features if present in adolescents characterize PCOS. But the irony is that, the majority of the time adolescents are subjected to ultrasonography and are diagnosed as PCOS. This is an absolutely wrong practice and there is a high possibility of polycystic appearance of ovaries up till at least 8 years post-menarche. It is advisable to visit a gynaecologist and avoid self-diagnosis by getting unnecessary ultrasounds done.
One other clinical feature is acanthosis nigricans i.e., hyperpigmentation of skin of neck, under-arms and inner thighs and is due to insulin resistance or in simple terms a preliminary stage of developing diabetes.
Even 5 % weight loss can help one to begin with decreasing the problems associated with PCOS.
Diagnosing PCOS in adolescence is important to prevent multiple reproductive and health related issues in future. Most bothersome sequelae being infertility i.e., inability to conceive and may require support of drugs or artificial reproductive technology to conceive. Other chronic health problems one can suffer in later life includes obesity, type 2 diabetes mellitus, cardiovascular diseases etc.
Let us explore the reason for the 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 and sedentary lifestyle, increasing dependency on machines around us make one susceptible to metabolic syndromes including PCOS. This is the reason for why PCOS has no permanent cure.
So, the most important treatment is lifestyle modification in the form of planned dietary habits and regular exercise. Even 5 % weight loss can help one to begin with decreasing the problems associated with PCOS. Along with this, as per the clinical condition one can be prescribed medications for a period of 3-6 months in the starting.
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, acne and also acanthosis nigricans. This 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 treatment with a psychiatrist and psychologist,most importantly peer and family support.
Prevention is better than cure is a very common proverb and holds true even in the cases of PCOS. Prevention starts with the initiation of change in the lifestyle of the family. Self-diagnosis and treatment should be prohibited even if it is a minor problem.
“Dr. Kanika Chopra is associated with Lady Hardinge Medical College. She is keen in learning, writing and has contributed numerous research publications in both National and International journals.”
