Polycystic Ovary Syndrome


Cecily never really worried that her periods weren't regular because,
like many girls, she assumed her monthly cycle would take time to
settle down. But then Cecily's periods stopped for several months, so
she went to see her doctor.

The doctor noticed that Cecily's acne had worsened and that she had
gained a lot of weight since her last appointment. She said she wanted
to check Cecily for a condition called polycystic ovary sydrome (PCOS).

What Is Polycystic Ovary Syndrome?



Polycystic (pronounced: pol-ee-sis-tik) ovary
syndrome is a common health problem that can affect teenage girls and
women. Although no one really knows what causes PCOS, it seems to be
related to an imbalance in a girl's hormones.

Both girls and guys produce sex hormones, but in different amounts. In girls, the ovaries produce the hormones estrogen and progesterone, and also androgens. These hormones regulate a girl's menstrual cycle and ovulationovulation, when the egg is released. Even though androgens are sometimes referred to as "male hormones," every female produces them.

In girls with PCOS, the ovaries produce higher than normal amounts of
androgens, and this can interfere with egg development and release.
Sometimes instead of the eggs maturing, cysts, which are little sacs
filled with liquid, develop. Instead of an egg being released during
ovulation, like during a normal menstrual cycle, the cysts build up in
the ovaries and may become enlarged. Because girls with PCOS are not
ovulating or releasing an egg each month, it's common for them to have
irregular or missed periods.

Although PCOS (which used to be called Stein-Leventhal syndrome) was
first recognized in the 1930s, doctors can't say for sure what causes
it. Research has suggested that PCOS may be related to increased insulin
production in the body. Women with PCOS may produce too much insulin,
which signals their ovaries to release extra male hormones. PCOS seems
to run in families, too, so if someone in your family has it, you might
be more likely to develop it.

If PCOS is not treated properly, it can put a girl at risk for lots
of problems. Girls with PCOS are more likely to have infertility,
excessive hair growth, acne, obesity, diabetes, heart disease, high
blood pressure, abnormal bleeding from the uterus, and cancer.

The good news is that, although there's no cure for PCOS, it can be
treated. The most important step is diagnosing the condition, because
getting treatment for PCOS reduces a girl's chances of having serious
side effects.

What Are the Signs and Symptoms?



A key sign of PCOS is irregular or missed periods because the effects
of the condition on the ovaries can make a girl stop ovulating.
However, because it can take up to 2 years after her first period for a
girl's menstrual cycle to become regular, it can be hard to recognize
missed periods as a sign of PCOS in teen girls. Imbalanced hormone
levels can cause changes in a girl's entire body, not just her ovaries.

So doctors also look for these other signs that might indicate PCOS:

• very heavy periods or irregular periods
  
• weight gain, obesity, or difficulty maintaining a normal weight,
  especially when the extra weight is concentrated around the waist
  
• a condition called hirsutism (pronounced: her-suh-tiz-um),
  where a girl grows extra hair on her face, chest, abdomen, nipple area,
  or back (a little of this is normal for most girls, though)
  
• thinning hair on the head (doctors call this alopecia)
  
• acne and clogged pores
  
• darkened, thickened skin around the neck, armpits, or breasts (this is called acanthosis nigricans)
  
• high blood pressure, high cholesterol, or diabetes mellitus (high levels of sugar in your blood)
  

Girls who show certain signs of puberty early — such as girls who
develop underarm or pubic hair before the age of 8 — may be at greater
risk of having PCOS later on.How Is Polycystic Ovary Syndrome Diagnosed?



If you've taken your concerns about your body to your doctor, you're on the right track. Your doctor may refer you to a gynecologistgynecologist or an endocrinologistendocrinologist for a diagnosis.

The gynecologist or endocrinologist will ask you about any concerns
and symptoms you have, your past health, your family's health, any
medications you're taking, any allergies you may have, and other issues.
He or she will also ask you lots of questions specifically about your
period and its regularity. This is called the medical history.

In addition to your medical history, your doctor will do a physical examination,
which includes checking your weight, and checking especially for
physical signs such as acne, hair growth, and darkened skin. The doctor
may perform a gynecologic examination to rule out other possible causes of your symptoms, but this is not always necessary for diagnosis.

A doctor may also perform blood tests to diagnose PCOS or other
conditions, such as thyroid or other ovarian or gland problems. Blood
tests allow doctors to measure androgen, insulin, and other hormone
levels. The results of these tests can help doctors to determine the
type of treatment a girl will receive.

Your doctor also might order an ultrasound to look at your ovaries
and to determine if you have cysts or other abnormalities of the
ovaries. Because cysts are not always visible, this test is not always
used.

Early diagnosis and treatment for PCOS are important because the
condition can put girls at risk for long-term problems. Getting treated
for PCOS is also a good idea if you want to have a baby someday — PCOS
often causes infertility if it's not treated. But when PCOS is treated
properly, many women with the condition have healthy babies.

Also, many girls with PCOS can get pregnant. If you are sexually
active, you need to use condoms every time you have sex in order to
avoid getting pregnant or getting a sexually transmitted disease (STD).
This is important whether or not you have PCOS.How Is It Treated?



Although there's no cure for PCOS, there are several ways that the condition can be treated and managed.

If a girl is overweight or obese, a doctor will recommend that she
lose weight. Weight loss can be very effective in lessening many of the
health conditions associated with PCOS, such as high blood pressure and
diabetes. Sometimes weight loss alone can restore hormone levels to
normal, causing many of the symptoms to disappear or become less severe.

Your doctor or a registered dietitian can look at your food intake
and your exercise and activity to tailor a weight-loss program for you.
Exercise is a great way to help combat the weight gain that often
accompanies PCOS as well as a way to reduce bloating, another symptom
girls with PCOS sometimes experience.

Sometimes doctors prescribe medications to treat PCOS. A doctor might
first have a girl try birth control pills or another hormone pill
called progesterone to help control hormone levels in her body and
regulate her menstrual cycle. Birth control pills may help control acne
and excessive hair growth in some girls, but they don't work for
everyone.

Other medications used to treat PCOS include antiandrogens,
which counter the effects of excess androgens on a girl's body.
Antiandrogens can help clear up skin and hair growth problems in girls
with PCOS.

Another medication, metformin, which is used to treat diabetes, can
lower insulin levels. In some girls with PCOS, it can help control
ovulation and androgen levels. This can make a girl's menstrual cycles
more regular. Some girls and women treated with metformin have also
experienced weight loss and lowering of high blood pressure.Coping With Polycystic Ovary Syndrome



Having PCOS can be hard on a girl's self-esteem because some of the
symptoms, such as skin and hair problems and weight gain, can be
noticeable. Fortunately, there are things you can do to reduce the
physical symptoms — and take care of the emotional side of living with
PCOS.

Although the medications used to treat PCOS will slow down or stop
excessive hair growth for many girls, different types of products are
available to help a girl get rid of hair where she doesn't want it.
Depilatory creams can gently remove facial hair on the upper lip or
chin. Be sure to follow the instructions carefully so you don't develop a
rash or allergic reaction.

Tweezing and waxing are other things you can do (at home or at a
salon) to manage hair growth. A girl can also visit a dermatologist (a
doctor who specializes in skin problems) or qualified hair removal
specialist for electrolysis and laser surgery treatments. These
procedures offer longer term removal of unwanted hair, but they are more
expensive.

If you have severe acne as a symptom of PCOS, it may improve if part
of your treatment includes birth control pills or antiandrogens. If it
doesn't, your doctor may refer you to a dermatologist for further acne
treatment. A dermatologist may also be able to recommend medications to
help reduce skin darkening or discoloration, and to prevent hair growth.

Some girls with PCOS may become depressed, in which case it may help
to talk to a therapist or other mental health professional. Talking with
other teens and women with PCOS is a great way to share information
about treatment and get support. Your doctor may be able to recommend a
local support group.

If you can't find a local group, the Polycystic Ovarian Syndrome
Association offers a "Big Cyster" program for teen girls as well as
online message boards. If you join, you'll be hooked up with other women
or teen girls with PCOS to whom you can turn for advice, support, or
just a listening ear.