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Polycystic Ovary Syndrome (PCOS) During Adolescent Years

In our society today, it is routine when a child is born to start testing for certain diseases that can affect development. Doctors have set a routine schedule for growth and development to evaluate and encourage parents to have children immunized against the disease. Prevention is a buzz word that is used repeatedly in clinics and hospitals, however, when used for Polycystic Ovary Syndrome (PCOS), testing and evaluation are not performed until adulthood when uncontrolled conditions and complications have begun. PCOS testing and evaluation during adolescence should be used to prevent the devastating complications of PCOS.

Do women know what they have that can be treated, and if left untreated can lead to terrible illnesses? There are many women who experience daily complications associated with untreated PCOS. For many women's test it did not work. Because in reality, PCOS women do not know that there is anything that can be done for their symptoms, and continue to suffer. According to the American Society of Clinical Endocrinology (AACE):

PCOS is the most common metabolic disorder for reproductive age women in the United States, commonly known as reproductive disorders but is also associated with life-threatening medical illnesses. In the U.S., six million women of reproductive age are affected by the syndrome. (& # 147; Fact Sheet & # 148;)

PCOS was discovered before computers were invented and (2005) is still being evaluated for PCOS in adolescence, when symptoms begin to develop. Symptoms associated with PCOS were first reported by Irving Stein and Michael Leventhal in 1935 (9). Women with menstrual problems who have large ovaries because of multiple cysts (classic symptoms) are diagnosed with Stein-Leventhal syndrome. As more and more of these symptoms research becomes just a subset of a broader syndrome called PCOS. Many people in the medical profession can easily call it PCO, as symptoms will vary in individuals.

Statistics show that no one has all the same symptoms, but doctors should be able to make educated guesses and send women to the test much earlier than they did in adulthood (11). At that time, some women were treated with complications due to lack of treatment, and some women were fertile, overweight, and depressed. In Living with PCOS, Angela Boss states:

Although the age at onset for PCOS symptoms varies, most women with PCOS can think back to their teen years and remember a time when they began to feel & # 147; and wondered if there was something wrong with them. (1)

The signs and symptoms of PCOS include irregular menstruation, menstruation, menstruation, central obesity, excessive hair growth in male distribution patterns, acne, ovarian cysts, and infertility (2). Abnormal test results such as increased male hormones, lower female hormones, fasting insulin abnormalities and decreased sex hormone levels (8).

Another abnormal test, in PCOS that should be evaluated as part of routine examinations for adolescents, is the cholesterol test. There is a new test used in the process of assessing cholesterol (4). VAP (Vertical Auto Profile) helps to evaluate cholesterol and appears to have several cholesterol-lowering factors in women with PCOS (12). As more studies are conducted to confirm this information, this may prove to be the final test for PCOS patients (4). Most parents become very concerned when drugs are involved and want some kind of evidence that something is wrong with the medicine before starting treatment. Without a VAP test many parents cannot take the doctor's word, just based on symptoms, their child has PCOS and needs to take medication for treatment. This drug will be used to treat PCOS and Insulin Resistance (IR).

IR increased insulin production, is one of the worse syndromes, but can be associated with PCOS (10). Acanthosis Nigricans (hyperpigmentation of skin moisturizers, brown spots) may be present on the neck, axillae, areas below the breast and exposed areas (elbows, fingers) of insulin resistance (2). However, this is also one of the indicators used by doctors to diagnose PCOS. Studies have been conducted to determine whether IR causes PCOS or whether PCOS causes IR. The debate is the same as the first question of chicken or egg. & # 147; Untreated insulin resistance can cause glucose intolerance or type 2 diabetes mellitus & # 148; (2). Treatment should be started as soon as possible to prevent complications. In order for treatment to begin the condition must be diagnosed.

Diagnosis of PCOS is a difficult thing to get from many Doctors. The reason, as mentioned earlier, is because symptoms vary from person to person and many physicians still follow the classic symptoms and do not know how to treat this syndrome. The Mayoslinic states, & # 147; PCOS management focuses on the main concerns of every woman, such as infertility, hirsutism, acne or obesity & # 148 ;, this is how most doctors today treat this syndrome. My daughter, Alizza, had this first hand when she couldn't lose weight no matter what she ate or how hard she was doing. While in one of the doctor's offices, the doctor told Alizza all she needed to do was exercise more, eat less and see someone for her depression. Alizza is very depressed and lacks self-esteem due to overweight. He felt that the doctor's proposal was not his answer and began to investigate. He was fortunate enough to find a doctor who knew about PCOS and how to treat it. When my daughter was experiencing most women with PCOS she was suffering and thinking that the symptoms were in her head or that it was just how they were made and they had to live with the symptoms.

As more studies have been done, there is a wealth of information available to the medical community and women. AACE in conjunction with the Association of Polytechnic Ovarian Syndrome (PCOSA) seeks to educate doctors and women of all ages in awareness campaigns (2). Most websites on the internet have conference schedules, and public forums to educate people about PCOS. The Associate Press has taken PCOS and reported: Doctors often fail to connect different symptoms. There are also stories of how PCOS affects women like & # 147; Hidden Fertility Fertility can cause Diabetes & # 148; (7). In order to educate AACE medical providers, we provide the following Statement of Ranking:

Experts can no longer consider this woman a dubious complaint, or especially suffer from infertility, but also have metabolic disorders that may be associated with type 2 and cardiovascular mellitus diabetes. (2)

Doctors and women's education are needed to make the initial diagnosis a reality. Before a person can be treated for an illness, they need to know that there is a treatment available for them. With education begun by AACE, there are better opportunities to treat PCOS during the teen years.

Doctor Foley, a pediatrician who specializes in adolescent gynecological problems, stated in our interview, & # 147; Adolescents with abnormal periods should be evaluated for PCOS. & # 148; When asked why this assessment is important, Doctor Foley has several reasons. Early treatment of PCOS will prevent complications later in life. There is an increase in the number of adults with diabetes in younger and younger children. Weight gain puts them at risk for diabetes, and heart disease. It also has a profound effect on the image of the self, which is very important in the child's development. We also know that PCOS affects the neurotransmitters of the brain and can cause depression.

The last reason to treat PCOS in adolescence is a unique philosophy. Until our interview, I didn't think about the implications. According to Doctor Foley teenagers who have PCOS have higher testosterone levels. This high level of testosterone causes women to feel more masculine. Most symptoms do not have an irregular period or period. Combined with high levels of testosterone, it can make a girl feel like she's not very feminine. & # 147; Insulin resistance (IR) almost always goes along with PCOS, and girls with IR will experience problems with weight gain, and difficulty losing weight & # 148; (10). Put this all together and Doctor Foley thinks this can lead girls to lean towards the alternative and homosexual lifestyle:

Girls came and made statements like, & # 147; I don't & # 147;, and & # 147; I don't look like any other woman, and & # 147; I don't know. 146; You don't feel like a girl '. Part of this is because hormone levels are not in the normal range. This is caused by PCOS and IR. After treating PCOS, the girls reiterated that they feel more like a normal girl now, as they now have their testosterone levels and levels within normal range.

Studies have confirmed the prevalence of PCOS in adolescence. In Dr. Hashemipour's doctoral study, he concluded that PCOS is a common endocrine disorder in adolescents. Adolescents with mothers, or younger women with PCOS and PCOS symptoms should be evaluated for this syndrome to prevent potential complications (6).

PCOS treatment varies from doctor to doctor. The newer philosophy is to focus on the root causes of PCOS. & # 147; Many of these new therapies are designed to lower insulin levels and, therefore, reduce testosterone production & # 148; (3). Doctor Foley agrees with this newer approach but feels he needs to be emphasized on the nutritional side of treatment. Treatment with drugs aimed at lowering insulin levels and changing eating habits has shown to eliminate most PCOS and IR symptoms.

The role of hereditary factors in the development of PCOS, related metabolic abnormalities and the use of insulin-sensitive agents in the treatment of PCOS are being studied at the University of Chicago by Dr. David Ehrmann and his team. Metformin is an insulin resistant drug. It has been approved by the FDA for diabetes, but has not been approved by the FDA for use in PCOS treatment. These studies will help determine if metformin helps in reducing insulin production in PCOS patients. Doctor Glueck's study found:

During adolescence and childhood, before the advent of Metformin therapy, PCOS treatment was directed (with only modest success) to the clinical features presented. Metformin, a safe and effective oral drug, is widely available, improves the effectiveness of insulin at the peripheral cell level, reduces hyperinsulinemia, and reduces hyperandrogengenemia, thereby correcting biochemical domino effects by correcting it at source.

Dr. Foley is currently using metformin in the treatment of PCOS, and has seen dramatic results in her patients and her husband, Dr. Steven Foley, a Board Certified Psychologist. Dr. Foley and her husband treat patients with a combination of metformin and nutritional therapy. After the diagnosis of PCOS, the patient is scheduled to see a nutritionist for an hour's appointment. During my daughter's evaluation, a nutritionist explained that a diet that limits carbohydrates to 30-50 grams a day, and increases protein intake to 80-100 grams a day, helps lower insulin levels. As stated by Doctor Foley, & # 147; These are lifestyle changes that will stay with you for the rest of your life. & # 148; If the diagnosis of PCOS is made in the teenage years these lifestyle changes can start earlier and help reduce the risk of long-term complications early. It will also be easier for young women to adapt to this new lifestyle than when they are older and in the way they are.

Most women report one or more symptoms to their doctor, but unless the doctor is trained to recognize the symptoms and associate them with each other, many women will suffer until their symptoms worsen, or they experience more symptoms. & # 147; Irregular or heavy periods may indicate a teenage state, or PCOS may become obvious later when a woman experiences difficulty & # 148; (8).

There is currently no screening done until a woman sees a doctor to treat her symptoms. If early diagnosis and treatment of PCOS can help reduce the risk of long-term complications in six million women, then why not screenings during adolescence? PCOS testing and evaluation during adolescence should be used to prevent the devastating complications of PCOS.

Work Cited

1. Boss, Angela, Evelina Weidman Sterling, and Richard Legro. & # 147; Adolescent girls. & # 148; Live with PCOS. Omaha: Addicus, 2001.

2. Cobin, Rhonda, et al. & # 147; American Association of Clinical Endocrinology Positions on the Metabolic and Cardiovascular Effects of Polycystic Ovary Syndrome. & # 148; American Clinical Endocrinology Society. Oct. 2004. 10 Apr 2005 (http://www.aace.com/pub/pcos2004/index.php)

3. Ehrmann, David, et al. & # 147; Treatment Options. & # 148; University of Chicago Polytechnic Ovarian Syndrome Center. n.d. Apr. 10 2005

http://centerforpcos.bsd.uchicago.edu/Treatment_options/treatment_options.html.

4. Foley, Deborah. Pediatric Psychiatrist LLC. Personal Interviews. March 15, 2005. 719-633-8773.

5. Glueck, C.J. & # 147; Metformin: A Selective Treatment of Polycystic Ovary Syndrome. & # 148; Online Health Alliance. Scientific Updates Sept. 5 2000. Apr. 7. 2005

6. Hashemipour, Mahin, et al. & # 147; Political Ovarian Syndrome Awareness in 14-18-year-old Girls in Isfahan, Iran. & # 148; Hormone Research: 2004, Vol. 62 Issue 6, p278, 5p. Article. EBSCOhost. Front Range Comm College, Westminster Lib. Feb. 10 2005 http://rpa.westminster.lib.co.us/rpa/webauth.exe.

7. & # 147; Hidden fertility disorders can cause diabetes. & # 148; The Associated Press. 11 Oct 2004. 11 Feb. 2005 http://msnbc.msn.com/en/6227116.

8. Hunter, Melissa and James Sterrett. & # 147; Political Ovarian Syndrome: It's Not Infertility. & # 148; American Academy of Family Physicians 62 (2000): 1079-88. Mar. 22. 2005 http://www.aafp.org/afp/20000901/1079.html

9. Marrinan, Greg. & # 147; Political Ovarian Disease (Stein-Leventhal Syndrome). & # 148; Emedicine. August 30, 2002. Feb. 22 2005 http://www.emedicine.com/radio/topic565.htm

10. Choose, Marcelle. & # 147; Resistance to Insulin in Women. & # 148; Women for Women online. n.d. 9 Apr 2005 (http://www.womentowomen.com/LIBinsulinresistance.asp)

11. & # 147; Political Ovarian Syndrome. & # 148; Mayo Foundation for Medical Education and Research. Nov. 14 2003. February 2, 2005 http://www.mayoclinic.com/invoke.cfm?id=DS00423

12. & # 147; VAP Testing: An Emerging Care Standard in Cholesterol Risk Assessment. & # 148; Forum Medco. 8 (2001): 36. 29 Apr. 2005

http://www.atherotech.com/information/default.asp?section=aa&location=1



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