Treatment of polycystic ovary syndrome in adolescents
TO THE EDITOR: The article (1) on polycystic ovary syndrome (PCOS) by Dr. Richardson in the August 15, 2003, issue of American Family Physician was an excellent review of the diagnosis, treatment, and currently recognized long-term sequelae of the disease. The author acknowledged that young women may have symptoms of PCOS and that these symptoms can begin as early as puberty. The article (1) effectively discussed treatment strategies for adult women; however, it did not address options for affected adolescents. It should be noted that there is a small yet growing body of knowledge regarding the efficacy and tolerability of treatment for adolescents with PCOS. Given the long-term adverse effects of this condition, it makes sense to begin counseling and treatment as soon as possible.
All patients, including adolescents, should be counseled regarding diet, exercise, and maintaining an appropriate weight. The use of oral contraceptive pills is one treatment option that has been used in the adolescent population for irregular menses and should be considered for treatment of PCOS in this age group. Recent studies investigating metformin therapy in adolescents with PCOS or PCOS symptoms have shown that metformin improves glucose tolerance, (2) normalizes menses, (3,4,5) results in resumption of ovulation, (3,4) improves insulin sensitivity, reduces elevated androgen levels, (2,4) improves lipid profiles, (5) and decreases hirsutism. (5) Additionally, metformin is generally well tolerated. (2,3,5) Further research with larger, randomized controlled trials will expand our scope of the treatment possibilities for adolescents with PCOS.
(1.) Richardson MR. Current perspectives in polycystic ovary syndrome. Am Fam Physician 2003;68:697-704.
(2.) Arslanian SA, Lewy V, Danadian K, Saad R. Metformin therapy in obese adolescents with polycystic ovary syndrome and impaired glucose tolerance: amelioration of exaggerated adrenal response to adrenocorticotropin with reduction of insulinemia/insulin resistance. J Clin Endocrinol Metab 2002;87:1555-9.
(3.) Ibanez L, Valls C, Ferrer A, Marcos MV, Rodriguez-Hierro F, de Zegher F. Sensitization to insulin induces ovulation in nonobese adolescents with anovulatory hyperandrogenism. J Clin Endocrinol Metab 2001;86:3595-8.
(4.) Glueck CJ, Wang P, Fontaine R, Tracy T, Sieve-Smith L. Metformin to restore normal menses in oligoamenorrheic teenage girls with polycystic ovary syndrome (PCOS). J Adolesc Health 2001;29:160-9.
(5.) Ibanez L, Valls C, Potau N, Marcos MV, de Zegher F. Sensitization to insulin in adolescent girls to normalize hirsutism, hyperandrogenism, oligomenorrhea, dyslipidemia, and hyperinsulinism after precocious pubarche. J Clin Endocrinol Metab 2000;85:3526-30.
KIRSTEN STOESSER, M.D.
University of Utah
Department of Family and Preventive Medicine
50 N. Medical Dr.
Salt Lake City, UT 84132
COPYRIGHT 2004 American Academy of Family Physicians
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