Acne, increased hair growth , oily skin which are the findings of hyperandrogenism in adolescents are common problems, irregular menstruation within the next 2 years after the first menarche is an expected situation. But all these may be the symptoms of a diseases called Polycystic ovary syndrome. Thus, it is important to make differentiation between the normal findings and pathologic findings. But it is also important not to be late for diagnosis. There are 3 main scopes in the approach for the patient having hyperandrogenism: 1. Excluding the tumors and congenital adrenal hyperplasia (congenital adrenal gland disease) , 2. Treating hyperandrogenis as soon as possible after diagnosis(because there is no treatment which suppresses hairs, medications only prevent growth of new hairs), 3. Being able to diagnose polycystic ovary syndrome and starting to intervene metabolic problems such as insulin resistance and obesity as soon as possible. Hirsutism should be evaluated according to the ethnic composition of the society, people living in Mediterranean countries are more hairy than in the Nordic race.
Diagnosis of PCOS is made according to the Rotterdam criteria in which 2 of the 3 findings shown below are present and that other reasons causing hyperandrogenism are excluded.
Polycystic ovary appearance in USG (this may be seen in females without PCOS and it may not be related to the disease)
Menstruation periods with longer than 35 days of intervals
Hyperandrogenism findings (acne, hirsutism, male type hair loss) or high values of male sex hormones.
But these 3 criteria may be normal findings of adolescents. All findings should not be suspected. Hair growth may not initiate immediately, it may take time to realize and make diagnosis. In adolescents, performing transvaginal USG is generally not possible, ovaries can’t be evaluated sufficiently by Abdominal USG. In this case, rectal USG may be performed.
PCOS and type 2 diabetes are more common in family members of PCOS patients. Most important problems are the metabolic problems and related diseases which may appear in long term. In patients with PCOS, diabetes, high blood pressure, heart disease, and thus metabolic syndrome are more common. Losing weight and maintaining weight, low-glycemic nutrition, sports are very important. However, technological advances and changing life circumstances make it difficult. Adolescents spend a daily average of 8 hours in front of television and the internet which reduce the time devoted to sports and lead fast food type nutrition. PCOS patients' daily calorie needs are lower from their friends at the same height and weight.
Another problem is the patients' menstrual irregularities. Precautions should be taken in order to reduce the risk of endometrial hyperplasia (thickening of cervical membrane) and cervical cancer in further ages of the patients having menstruation with longer intervals than 35 days. Losing weight and fixing insulin resistance may help menstruation be regular. Weak patients having PSOS may menstruate with progestins, Combined Oral contraceptives are preferred in case of hirsutism.
Best was to avoid hyperandrogenism findings is losing weight. Losing weight reduces insulin resistance and avoids progression of hirsutism. But there is no medication which enable loss of hairs. After preventing hirsutism by losing weight and using combined oral contraceptives, epilation can be applied. When medication treatment is required, most accurate thing to do is using the birth control pills which has the least side effects and is the most effective treatment. Starting epilation 6 months after medication treatment lead achieving the best result. If the treatments which are started with this aim is not continued for 2 years without interval, they are helpless.
Patients may experience problems in getting pregnant if they ovulate irregularly and sometimes if they never ovulate, but most of them get pregnant spontaneously. Change in life style helps them have regular menstruation and get pregnant.
As a result PCOS is not a disease which recovers only with treatment, it can be just taken under control and one should learn how to live with it. It may be more difficult for adolescents than the adults to accept it and have change in their life styles . Also, negative physical appearance created by hirsutism and obesity may cause psychosocial problems.