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Polycystic ovary syndrome (PCOS) is a health issue that can affect women and teens of the reproductive age. This condition occurs when teens have extra testosterone (a male hormone) in their body. Due to the increased amount of testosterone, the physical symptoms of PCOS start to show. PCOS affects the menstrual cycle, hair growth, skin, weight, and the ability to have children.
PCOS is thought to be caused by a mixture of genetic factors and weight gain. Many teens who have PCOS are overweight, and more than half have family members with either PCOS or type 2 diabetes.
For overweight teens, decreased physical activity causes weight gain, which increases the amount of insulin in the body. As a result, the increased level of insulin causes more testosterone to be released from the ovaries. The extra testosterone causes the physical symptoms of PCOS, like hair growth.
In women who are not overweight, it is thought that the ovaries make too much testosterone.
In all women with PCOS, the ovaries don’t work very well. In a healthy female, once a month the ovaries make a follicle (where an egg grows). As the follicle grows, it makes hormones and then it releases an egg. This is commonly referred to as “ovulation.”
However, the ovary in a woman who has PCOS makes many small follicles instead of one big one. The follicle looks like a cyst on ultrasound and gives us the name “polycystic ovaries.” Although the follicles are harmless, hormone levels become out of balance and ovulation doesn’t happen every month the way it is supposed to due to the increased amount of follicles. As a result, periods become irregular or stop altogether.
Genetics do play a role in causing PCOS, but the condition is also caused by weight gain and other unknown factors.
Yes – about 5-10% of all women have PCOS.
More information about polycystic ovary syndrome (PCOS) is available from the following resources:
Some of the symptoms of PCOS are very noticeable, and others your teen may keep hidden because she may be embarrassed discussing these issues with parents and caregivers.
The following signs and symptoms are commonly associated with PCOS:
There is no single test for diagnosing PCOS. Your teen may be diagnosed with PCOS based on her symptoms alone, or with blood testing and/or a pelvic ultrasound.
The overall diagnosis of this condition is based on three main factors:
In order to diagnose PCOS, other causes of irregular periods must be ruled out. Thyroid hormone, prolactin (a hormone needed for making breast milk) and adrenal gland hormone problems produce similar symptoms. Sometimes, these tests are ordered, too.
Most doctors don’t routinely order an ultrasound of the ovaries because the diagnosis can be made by physical exam and laboratory findings alone.
Children’s Colorado has the only multidisciplinary adolescent PCOS Clinic in the region. Doctors from different areas of medicine all work together in one clinic to provide your child with the most accurate and efficient care. The specialties involved in the clinic include endocrinologists (doctors who manage weight gain and diabetes risk), gynecologists (doctors who manage irregular periods and other women’s issues), dermatologists (doctors who can help with acne and unwanted hair growth), psychologists, and lifestyle experts (to help with nutrition and exercise).
Blood test results generally take 1-2 weeks. The only discomfort is from a quick needle-stick to draw the blood.
At Children’s Hospital Colorado, our pediatric gynecologists provide patients with different treatment options for PCOS, including healthy lifestyle changes that teens and parents can manage on their own. However, when lifestyle changes aren’t enough, medication may also be prescribed.
In girls who are overweight, or who are not overweight but are not exercising, the most important treatment is making lifestyle changes in diet and exercise. A 5-7% reduction of total body weight can control periods in many teens with PCOS. Patients and their families using this treatment method have access to lifestyle specialists in our multidisciplinary clinic to help implement these changes.
Metformin: for girls who are overweight and have high insulin levels
This medication can lower insulin levels and help the body use insulin more effectively. In 6-12 months, Metformin can help control periods, clear up acne and reduce hair growth. The most common side effect is nausea (upset stomach) but, generally, the drug is well tolerated. Metformin improves the health of the ovaries, and makes it easier to get pregnant. All young women who are sexually active should use birth control while taking Metformin.
Birth control pills: for girls who have irregular periods, severe hair growth, acne, or those who are sexually active
These pills work by decreasing the amount of free testosterone in the body. Regular periods may start within the first month. It is normal to have some irregular bleeding at first, but this will improve with time. It usually takes 3 months for acne to clear up and 6 months for decreases in hair growth.
Provera: a progesterone-only pill that is taken for 10 days to cause a period; best for teens who have not had a period in more than 3-6 months
Spironolactone: works by blocking the action of testosterone
This medication is used to minimize hair growth and acne in 6-12 months. Taking birth control while on spironolactone is suggested due to the risks of birth defects while taking this medication.
Rogaine: an over-the-counter product that blocks the hair follicle from “seeing” testosterone
It’s used for balding and the loss of hair at the front of the scalp. It takes 3-9 months to work and can be purchased at drug stores or grocery stores.
Laser hair removal: for girls with light skin tone and dark hair growth
There is a dermatologist in our multi-disciplinary clinic to discuss laser hair removal, if desired.
Vaniqa: a prescription cream that can decrease hair growth
Hair growth is minimized only while using the cream. It does not change hair growth over time.
Long-acting, progestin-only methods
Both the progesterone-IUD (Mirena) and the under-the-skin implant (Nexplanon) provide a steady, low-dose of progestin. Progestin keeps the lining of the uterus healthy and reduces menstrual bleeding. The IUD works for 5 years and the implant works for 3 years. Either method can be removed at any time.
The pediatric experts in the Department of Gynecology place a strong emphasis on communicating with adolescents and their families in caring and sensitive ways. We recognize that the teenage years are a difficult time in a young woman’s life, and struggling with irregular periods and obesity as a result of PCOS can be very difficult.
Although PCOS is a common condition, the diagnosis and management of adolescents with PCOS is very different from adults. It requires a unique expertise and medical training in pediatric healthcare. The efforts of health professionals from several different departments, including gynecology, endocrinology, dermatology, psychology, lifestyle medicine and nutrition are needed to effectively manage this condition.
The multidisciplinary PCOS Clinic at Children’s Colorado provides you and your daughter with direct access to the all of these medical specialists at one location, in order to ensure your teen is receiving not only the best care possible, but that treatment is tailored specifically to her individual needs.