Changing hormones ... or polycystic ovary syndrome?

by Rima Himelstein, M.D.

Irregular or heavy menstrual periods ... excess facial and body hair ... acne ... weight gain ... When are these signs of hormonal changes that are part of the territory for teenage girls? And when does one or more of these signal a common female hormone problem: polycystic ovary syndrome (PCOS)?

It can be hard for girls and their parents to know based on these signs alone. I think back on several of my teenage patients with PCOS, and they all presented differently:

  • One with a heavy period that had been going on for two months without stopping …
  • One with no period for six months …
  • One with excess facial and body hair and regular monthly periods ...
  • One with severe acne and rare periods ...
  • One with a very high blood sugar, excess facial and body hair, obesity, and no period for several years ...

What is PCOS? PCOS is the most common female hormone problem, occurring in 5-10 percent of teenage girls and women, including girls as young as 8 or 9. It is even more common than thyroid problems. It often begins soon after a girl begins having periods but it can also develop later. It is a hormone imbalance, which can cause a wide range of symptoms due to excess testosterone, the “male” hormone that is normally present in small amounts in females, too.

“Poly” refers to many and “cystic” refers to the finding that the ovaries may have many small cysts (fluid-filled sacs). These cysts are not cancerous and do not require surgery. Some young women with PCOS have these cysts while others may not. The severity of the signs and symptoms of PCOS varyfrom girl to girl.  

What are the signs and symptoms of PCOS?

  • Irregular menstrual periods—too many, too long, or too infrequent—the most common symptom of PCOS.
  • Excess hair (hirsutism) on the face, chest, back, arms, and legs—PCOS is the most common cause of excess hair growth.
  • Acne—which can be severe—on the face and sometimes on the back.
  • Obesity—weight gain and/or difficulty losing weight.
  • Patches of dark skin on the back of the neck, under the arms, and in the groin area—may be associated with obesity and insulin resistance.

It’s complicated! Not every girl with these symptoms has PCOS and not every girl with PCOS has these symptoms. Irregular menstrual periods may be normal for girls during the first few years after puberty and some girls may pass through a phase when their testosterones level is elevated and then becomes normal.

What are possible problems from PCOS? Not ovulating regularly can increase the risk for cancer of the uterus (endometrial cancer). Obesity may be associated with insulin resistance and diabetes as well as high cholesterol, high blood pressure and heart disease. 

How is PCOS treated? Hormones are used to treat the symptoms and prevent complications. The birth control pill (“the pill”) corrects the hormone imbalance and lowers testosterone. The pill regulates the menstrual periods and lowers the risk for endometrial cancer.

Excess hair may need bleaching, waxing, hair-removal creams, etc.; and sometimes another prescription medicine. The pill helps prevent the hair from returning. Acne treatments include topical creams, and sometimes oral antibiotics. The pill also helps treat acne.

When girls with PCOS are overweight, weight loss and exercise are very important. Studies have shown that losing even 5 percent of excess body weight can eliminate some of the symptoms of PCOS. Some girls who have insulin resistance are treated with medications to lower their insulin levels and help decrease their risk for diabetes.

What about future fertility? Women with PCOS have a normal uterus and healthy eggs. Some women with PCOS have trouble getting pregnant because they may not ovulate regularly while other women have no trouble at all. Medication may help ovulation, if needed.

If you think that your daughter may have PCOS what should you do? Your daughter’s doctor is the first stop. The doctor will ask questions about her menstrual periods, weight changes, and other signs and symptoms. The doctor will order a blood test to measure her hormone levels, especially testosterone, and to exclude other potential diagnoses. Other blood tests may include blood sugar, cholesterol level, insulin level, and glucose tolerance. Sometimes an ultrasound is done to evaluate the ovaries. 

Your doctor may suggest you take your daughter to an adolescent medicine specialist, to a gynecologist, or to an endocrinologist.

Does your teenage daughter have signs or symptoms of PCOS? If so, don’t panic, but do check it out.

Rima Himelstein, M.D., is a Crozer-Keystone Health System pediatrician and adolescent medicine specialist.