has suggested that girls with premature puberty who develop pubic hair early (say before the age of 8) have many of the signs and symptoms of PCOS. Throughout puberty these girls produces excess testosterone and have irregular periods. So, premature puberty could be an early sign of PCOS.
Some adolescent girls experience many of the same symptoms as adults – especially irregular or absent periods, unwanted hair, weight gain and acne. In rare cases these symptoms can occur very rapidly. A young girl may gain 30 or so pounds in a few months, even though her diet has not changed, or she might notice more and more dark hair on her chin and upper lip.
IF YOU SUSPECT YOUR DAUGHTER MAY HAVE PCOS
Adolescence is a tough time for a girl regardless of whether she has PCOS or not. But for girls with PCOS, it can be even tougher. They can often feel isolated and confused. At an age when appearance seems to be everything, girls with PCOS lose a great deal of self-confidence when their symptoms start appearing. This is made worse because many girls feel they haven’t got anyone to talk or feel too embarrassed to seek help.
If you suspect your daughter might have PCOS, either because her symptoms are physically obvious or because you know her cycle is irregular, it’s very important that you find a doctor who knows about PCOS and can diagnose it.
Puberty may seem chaotic but it does follow an orderly process, and if events fall out of line questions should be asked. If there’s early hair growth, or no period 12 months after breast and pubic hair development, or excessive acne or abnormal hair growth, do make sure you seek help and advice. You should also consult your daughter’s doctor if six months after they start her periods are very frequent, excessive or far apart.
Do be aware that, even today with increased awareness of PCOS, some doctors pass off early signs as ‘typical’ teenage symptoms – hair growth, acne, mood swings are common to many teenagers, after all. If you’re concerned, seek a second or a third opinion – when a health-care provider takes the time to explain what PCOS is and offers treatment options, a young woman may feel relieved that at last there’s an explanation and treatment for her problems. And an early start with control measures can make a real difference to health, self-image and quality of life.
Many girls with PCOS tell us that talking with a counsellor about their concerns can be very helpful, as can joining a support group for girls who have PCOS. (See our recommended websites for great online links.)
Generally the tests for PCOS in teens are the same as those for women, as are the treatment options offered, such as the contraceptive pill and metformin. The lifestyle and self-help advice given in Part 2 of this book can be broadly applied to teens as well.
PCOS AND FERTILITY
Many women with PCOS are diagnosed in their twenties and thirties, but some aren’t diagnosed until they are in their forties. This is because it’s during this time a woman is most likely to want to conceive, and many women with PCOS aren’t diagnosed until they have trouble getting pregnant. (This is a concern, as PCOS is far more than a fertility issue and has long-term health effects.)
You’ll find plenty of information about boosting fertility in Part 2.
PCOS AND PREGNANCY
Despite fertility problems, 70 per cent of women with PCOS do conceive naturally. It might be logical to assume that PCOS is ‘cured’ or goes away when you get pregnant – after all, you’ve ovulated – but unfortunately this isn’t the case. ‘Although some women with PCOS find that their post pregnancy cycles get more regular, there isn’t any evidence to suggest that pregnancy cures PCOS,’ says PCOS expert Adam Balen. ‘What we do know, though, is that research does seem to indicate that a PCOS pregnancy is at greater risk.’ While it may seem scary to read about the risks, knowing about them means you can deal with them in a proactive and positive way.
Research6 suggests that women with PCOS are more likely to miscarry, possibly due to excess weight, which is itself associated with an increased risk of miscarriage. It could also be due to the higher LH concentrations in PCOS, which could damage egg quality.
PCOS may also increase the risk of gestational diabetes7 (diabetes that occurs during pregnancy) due to weight issues and/or insulin resistance, and this ups the risk of hypertension and the need for a Caesarean section during labour.
Pregnant women with PCOS who are insulin resistant are also at an increased risk of hypertension or high blood pressure.8 Pregnancy-induced hypertension carries with it the risk of growth retardation in the baby and damage to the nervous system and kidneys in the mother.
We know this all sounds alarming, but do remember that every pregnancy carries risks, whether you have PCOS or not. And if your doctor is aware, and works with you to monitor your pregnancy closely, you should pick up any early warning signs.
PERIMENOPAUSE AND THE MENOPAUSE
In the same way as a car can’t go from 60 mph to standstill without slowing down, your ovaries also need time to slow down before they stop completely at the onset of the menopause. Perimenopause is the period of gradual physical and biochemical change that leads to the menopause, when your ovaries’ production of oestrogen slows down, causing irregular periods. Generally changes such as shorter or longer periods, heavier or lighter bleeding and varying lengths of time between periods may be an indication of perimenopause, which usually lasts around two to five years, before the menopause itself – your last period. The average age for the onset of perimenopause is 47, though this varies.
Typical symptoms of perimenopause include fatigue, mood swings, hot flushes, vaginal dryness, loss of libido, memory loss, night sweats and irregular periods.
The average age of the menopause for women in Western nations is 51, though some may experience it as early as their thirties or as late as their sixties due to hereditary influences or even illness. You’re classified as post-menopausal when you haven’t had a period for 12 months.
PCOS AND THE PERIMENOPAUSE
Perimenopause can often go unnoticed in women with PCOS, as they are used to having irregular periods. Some women with PCOS say that, instead of their cycles becoming more irregular, they actually become more regular. A possible explanation for this is that the hormonal swings and high oestrogen and androgen levels associated with PCOS may lessen as a woman nears the menopause, when oestrogen and androgen levels naturally lower.
Many women with PCOS assume that because they’ve always had irregular periods they won’t go through the menopause. This isn’t the case. Whether you have PCOS or not, the menopause causes a significant decrease in oestrogen and this can increase the risk of heart disease, osteoporosis and cancer, so you do need to manage it.
Many of the symptoms of the menopause are related to this drop in oestrogen, and you can still expect these changes if you’ve got PCOS.
According to research, the high levels of androgen in PCOS may fall during the menopause, sometimes to normal levels, although they usually remain higher than for women who don’t have PCOS. But many androgen-related problems, such as increased hair growth (hirsutism) and acne, continue (although they rarely get worse).
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