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Polycystic ovary syndrome in adolescence

Mr Amit Shah, Mr Anil Gudi and Prof Roy homburg

One of the most important psychological factors in the life of teenage girls is their self image, i.e. how they look. If they have polycystic ovary syndrome (PCOS), they may well have excess body and facial hair (hirsutism) and persistent acne, which may severely damage their self confidence, not to mention irregular or absent periods, an additional source of worry. These are made very much worse if they are overweight, which, even on its own, is not well received by their peers.

The treatment of obesity is especially important in adolescents with PCOS. Loss of weight can reduce symptoms of acne and hirsutism and regularise menstruation. It is also important in the prevention of long-term effects of PCOS in adulthood such as infertility and, at a later stage in life, diabetes, high blood pressure, heart attacks and blood vessel diseases.

This emphasizes the importance of making the diagnosis in adolescence, allowing early intervention of treatment. The first line of treatment in the overweight teenager must always be loss of weight which can be achieved by good dietary and exercise advice. These changes in life style may often be enough to reduce or even eliminate symptoms. An early diagnosis also allows the planning of follow-up visits for regular examinations, adjusting treatment if necessary and maintaining motivation.

Assuming that advice for weight control is being followed, pills to ensure regular periods are standard treatment for girls diagnosed with PCOS. Not only do they ensure monthly periods but they also reduce the amount of the male hormone, testosterone, which is being produced, the main source of the imbalance of hormones and the consequent symptoms. Although standard oral contraceptive pills will eventually do the job, some pills are particularly effective for PCOS as they have specific actions to counteract the effects of an excess of male hormones. There is no problem to start them at the age of 15-16 years and continue on a regular basis until a pregnancy is desired.

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