TORONTO -- Physicians who are hasty to do a lab work-up on teenage girls with irregular periods may find themselves chasing a false diagnosis of polycystic ovary syndrome.
"The biggest thing we're asked to face as pediatric gynecologists is teenagers with dysfunctional uterine bleeding. But it's absolutely normal to have abnormal periods. We should not panic, and we should not overtreat," Dr. Jay Spence said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.
Ovarian hyperandrogenism is a normal transient stage in teens that usually resolves within a few years of the start of menarche, said Dr. Spence, who is professor of ob.gyn. at the University of Ottawa.
Polycystic ovary syndrome (PC OS) is a diagnosis that should be made very reticently early on, he said.
Physicians who see teenagers with irregular periods should be aware that the first 2 years of menstrual periods are characterized by wide swings in the length of menstrual cycles. Studies have shown a range of around 18-83 days between periods in the first year of menarche, compared with a range of 19-42 days by the seventh year of menarche.
From 2 to 4 years after the first period the intervals should begin to normalize, and the periods should become more predictable and less heavy, he said in an interview.
Dr. Spence strongly advises against drawing blood early in the investigation because early postmenarchal endocrine patterns look misleadingly like PCOS; they include elevated testosterone, androstenedione, dehydroepiandrosterone, and luteinizing hormone, as well as decreased sex hormone-binding globulin.
"Most of the time I would advise people not to do the blood work. There is a tendency to overinvestigate when you should just be a little more patient and give it time," he said.
"Occasionally, I'll see a kid in her early gynecologic years with irregular periods and nothing else except this kind of PCOS-like lab work," agreed Dr. Kristi Mulchahey, a pediatric and adolescent gynecologist in Atlanta. "In that kind of situation I treat the irregular periods with the oral contraceptive pill and tell the parents that the child might have an androgen problem, but she is so young, that it's too early to tell... and we [will] need to reassess when she's older," she said in an interview.
Anovulatory cycles are largely responsible for these symptoms: These cycles decrease from about 80% of cycles in the first menstrual year to about 20% in the fifth year.
Still, the incidence of PCOS is very, much population based. Although the syndrome occurs in about 2%-6% of the general population, it can be present in as many as 53% of teens who have persistent anovulation with no physiologic cause.
In a separate presentation at the meeting, Dr. Mulchahey said that there are definite cases of PCOS that are clearly evident, even in early adolescence. It is necessary to look out for those patients who have really marked hirsutism and obesity because they are the ones in whom the ovarian hyperandrogenism may not be transient, she said.
But seven in these patients, there is no way of telling which girls will have persistent problems, Dr. Spence said.
"It's those patients with the more obvious signs that you will be more suspicious of. But you can't make the diagnosis on any one test," he said.
Even ultrasound, once used to visualize the classic PCOS ovarian cysts, is no longer helpful. "A lot of adolescent ovaries are full of cysts, similar to what we see in PCOS. And now we know that even a lot of normal women shave ovaries that look like PCOS," Dr. Spence said.
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hmmm...i wish that mine was just something mild that would go away. That is waht I've been wishing ever since i found out about PCOS. I've been waiting for my periods to become regular..but things only went downhill.....>
Re: Don't Be Too Quick to [Dismiss] Teens With PCOS
Quote:
"Most of the time I would advise people not to do the blood work. There is a tendency to overinvestigate when you should just be a little more patient and give it time," he said.
Over-investigation of PCOS symptoms is the problem? I don’t think so!
And wouldn’t a teen with excessive androgen levels have a more difficult time with acne and perhaps weight and other possible issues that make puberty even for painful and awkward than it already is? What about the social and psychological impact of living with these symptoms, even if it is a temporary situation?
I was always told that my irregular periods were just something that I had because I was young and that my cycle had not had enough time to establish itself. I was told that when I was in my late 20’s and I expect that they would have continued to tell me that until they could blame peri-menopause, if I had not found information about PCOS and insisted that someone investigate the situation properly!
Teens are not as able to stand up for themselves when a person of authority, like a doctor tells them something. Even as an adult, I had a difficult time dealing with doctors who wanted to tell me that my symptoms were nothing to worry about. I think that this article may be sending a dangerous message to teens, parents and doctors.
I am new to the Soulcysters website and think it's just great. Listening to alot of peoples stories I consider myself to be very lucky. My doctor (female) new right away that I had PCOS. I was diagnosed only 2 days ago, I have to go for an ultrasound soon.
I had a questions though. Does anyone else get cramps and pain constantly? I havn't had my period in about 8 months and yet it always feels as though I am just about too. (Cramps, headaches, etc.)
Welcome to the Cysterhood, Leah! Y'know, alot of times I have really bad cramps "out of season," usually in the afternoon. I've always thought it was cause I tend to eat fast, but it really does feel like menstrual cramps. You've made me wonder......I should find out more about this.
__________________ Cherish forever what makes you unique, cuz you're really a yawn if it goes! --Bette Midler
Dx October 2000
Ortho-Evra (bc patches)
Trying for 120 lb. (HA!)
1 FAT brat cat sweetie pie fur baby (8 yrs., orange tabby)
When I was younger people used to tell me I had the body of a dancer. Well, I don't anymore. I have the body of a goddess.
Yeah, dont worry cause I used to have the same until after I had been on Med. for a while
This article seems to go against what I know, i was diagnosed exactly the way this sais not to yet I do have PCOS and since being treated am a lot better!
Getting back to the article....I think it cuts both ways. It's not good to mistake irregularity for PCOS, or PCOS for irregularity. I was 12 1/2 when I started menstruating, I skipped four months, then two, then....nothing. No blood, no spotting. For TEN WHOLE MONTHS!!!!!!!!!
When I finally got diagnosed, I was told that all that fluid sitting in my uterus put me at risk for endometrial cancer, and the risk would have been higher if I had waited a few years. That scared me, I tell you. My mom had thought it was just irregularity, but apparently it wasn't.
Checking all possible causes of irregularity, not just ascribing it to adolescence, isn't a bad thing. I know I would have been alot worse off if I had waited for the irregularity to stop for longer than I did.
__________________ Cherish forever what makes you unique, cuz you're really a yawn if it goes! --Bette Midler
Dx October 2000
Ortho-Evra (bc patches)
Trying for 120 lb. (HA!)
1 FAT brat cat sweetie pie fur baby (8 yrs., orange tabby)
When I was younger people used to tell me I had the body of a dancer. Well, I don't anymore. I have the body of a goddess.
Don't Be Too Quick to Diagnose Teens With PCOS 
