Teen Got Period Once and Not Again
The Checkup
When a Teenager's Irregular Periods Are Crusade for Concern
Ane mutual crusade is polycystic ovary syndrome, or PCOS, which is hard to diagnose in adolescents.
I've written recently about teenagers having too-heavy periods and too-painful periods, and at present I want to talk about too-irregular periods. These bug can overlap, but allow'southward focus on what information technology can hateful when an boyish doesn't menstruate regularly — and on the question of how irregular is too irregular.
Dr. Andrea Bonny, an associate professor of pediatrics at The Ohio Land University and chief of adolescent medicine at Nationwide Children'southward Infirmary, said that in the past, many doctors had thought that in the outset two years subsequently flow begins, "actually, annihilation goes," as far as frequency.
Now, she said, the thinking is that some irregularity is OK, but to become more xc days without a period for 2 consecutive periods is concerning — and should go worked up medically. After someone has been menstruating for two years, she said, intervals shorter than 21 days or longer than 45 days are considered abnormal, particularly if they recur. And many adolescents with irregular cycles — like those with heavy periods, and like those with very painful periods — may be offered hormone treatments, either oral contraceptives or other hormone-based contraceptives.
The diagnosis hanging like a shadow over these conversations is polycystic ovary syndrome, or PCOS, the most common endocrine problem in reproductive age women, which has been the subject of recent work developing diagnosis and management guidelines in women. But information technology is a hard — and sometimes controversial — diagnosis in adolescents, because the polycystic ovarian changes that requite the syndrome its name, unremarkably identified on ultrasound, can overlap with what ovaries unremarkably look like in adolescents.
So in adolescents, making this diagnosis is not about doing ultrasounds, but about paying attention to menstrual cycles and too to other symptoms. The underlying crusade is a high level of androgens, or what nosotros usually think of every bit male sex hormones. Hyperandrogenism — more testosterone in the blood than is usual for adolescent girls — can also hateful bad acne and hirsutism, body hair growing heavily and in patterns more associated with male puberty than with female puberty (for example, hair on the upper lip and chin, on the breast and abdomen, or on the back and artillery). Girls with these symptoms should as well be tested for other sources of androgens and for other hormonal issues like thyroid problems.
Raising awareness around PCOS is important because many developed women feel, looking back, that this diagnosis was not considered soon enough equally a possible cause of fertility issues and other health issues they experienced; it is associated with metabolic alterations that can put women at take a chance for obesity, diabetes and centre disease. With adolescents, the priority should be treating the symptoms and helping girls understand the importance of the choices they can make effectually diet and practise, which should be the existent first line treatment.
[ Read more: Information from the National PCOS Clan ]
"You don't have to label to treat," said Dr. Sharon Oberfield, a professor of pediatrics at Columbia Academy and chief of pediatric endocrinology, who was one of the authors of a contempo update on the diagnosis and treatment of PCOS in adolescents. The formal diagnosis in adolescents, she said, which should not be made until at least 2 years afterwards menarche, has to be based on high androgen levels and irregular menstrual periods. And many adolescents with irregular periods will not get on to develop PCOS.
Dr. Oberfield worries that making the diagnosis besides early may requite some younger girls the sense that the later problems are inevitable, and therefore bring up issues of anxiety and low and body paradigm problems, not to mention concerns about fertility. "We similar to employ the words, 'at gamble,'" she said. "The key event of looking at these girls is sometimes with early screening you tin do early on intervention." Some of the adolescents with these symptoms will go on to develop polycystic ovaries, but the priority when they are young should be to make sure there are no other underlying medical trouble causing the excess androgens, and to help them understand what'south going on in their bodies.
Dr. Bonny said she explains to patients that men make a lot of testosterone, gesturing with her mitt upwards near her head, and that most "women make a teeny tiny bit, only some make a fleck more." She explains that usually it's the ovary producing it, and that the extra hormone tends to shut downwardly their periods, and cause the acne and the hair growth.
Dr. Susan Coupey, an practiced in adolescent medicine and gynecology at the Children's Hospital at Montefiore in the Bronx, said that she explains, "there are ii kinds of cells in the ovaries, the ones that make the eggs and the ones that make the hormones." As well much testosterone in some girls, she said, "causes them oftentimes to have acne and have unwanted hair; it tin can also change their lipid metabolism."
The hormone imbalance and its associated troubling symptoms are often treated with oral contraceptives, which stimulate the regular shedding of the endometrium — that is, the menstrual period. And that's as well important because information technology lowers the risk of endometrial cancer down the line.
In girls who tin can't have hormonal contraceptives because of medical contraindications, or whose families don't want them to, Provera, some other course of female hormone that helps regulate period, is sometimes used to induce what is called a "withdrawal bleed" if they go for more three months without a period. Dr. Bonny said she tries to make sure that either a period or a withdrawal bleed happens at least iv times a year.
Dr. Coupey said that with young girls and their families, though she explains that older women use these pills for nativity control, for them, "I say, 'You've got a hormone imbalance, taking this pill will put your ovaries to sleep.'"
For overweight patients, losing weight tin help with the symptoms — simply the hormonal issues tin make this even harder than usual; the androgens and the insulin resistance tend to spur the body to gain weight, not lose it. Adolescents who have testify of insulin resistance may be started on a medication called metformin, an oral treatment that helps control insulin resistance and blood carbohydrate levels and sometimes makes weight management a piffling easier too for kids with this problem.
Dr. Coupey said she suggests those prone to weight gain make a single alter — commonly cut out sugary drinks — and then possibly move on to a depression-saccharide nutrition. And many of them eventually have both metformin and birth command pills. "Many of them exercise quite well," she said.
If the metabolic bug are not addressed — with lifestyle changes, with medication, with shut follow-up — these adolescents with persistent symptoms are at risk for Type two diabetes and cardiovascular issues as they grow, in addition to the reproductive and fertility bug that may arise, every bit well as mental health issues.
"You don't have to diagnose PCOS in a young girl to tell her she's at risk for it and still treat her," Dr. Bonny said. "It'southward the symptoms that are so troubling to these young women — follow her, make sure you provide some treatment for acne, hirsutism, abnormal periods."
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Source: https://www.nytimes.com/2020/02/24/well/family/teenagers-irregular-menstrual-periods-PCOS.html
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