At least 1 in 10 females of reproductive age meet criteria for the diagnosis of polycystic ovarian syndrome (PCOS), and many of them first develop symptoms in adolescence. The implications of this disease extend beyond the obvious physical signs of increased body hair, acne and irregular menstrual cycles to include long-term risks of cardiometabolic disease and infertility.
Sensitive, multidisciplinary care at the PCOS Clinic
Traditional treatment venues — the primary care physician office or gynecology practice — might not offer the full range of current treatments or be sensitive to the particular concerns of adolescent patients. To fully meet these patients’ special needs, The Children’s Hospital of Philadelphia created the Polycystic Ovarian Syndrome Clinic, which brings together pediatric clinicians from the divisions of Endocrinology, Dermatology, and Nutrition and a reproductive endocrinologist to provide comprehensive care.
“We’re approaching diagnosis and treatment from the pediatric perspective,” says Rachana Shah, MD, medical director of the PCOS Clinic. “We acknowledge the physiologic and psychologic changes during the adolescent period and adjust our treatment and counseling accordingly.”
During monthly clinics, girls and their parents or guardians are assigned to exam rooms, and the clinicians rotate among the patients. “Our specialists come to them,” says Shah. “A major draw is that the families can see all the specialists they need at one time. We develop the patient’s treatment plan collaboratively, so medications and therapies are complementary.”
A focus on nutrition is important since two-thirds of patients are overweight. “The emphasis is on a healthy diet — favoring vegetables, fruits, whole grains, and lean meats, decreasing sugar and junk foods — and practicing portion control as well as regular physical exercise,” Shah says. It is now well recognized that even in the absence of obesity, women with PCOS are at increased risk of metabolic complications that can lead to cardiac disease. Thus, another important aspect of clinical care includes regular screening for metabolic complications and age-appropriate treatment and preventive strategies.
Particularly in the image-conscious timeframe of adolescence, the hirsutism (excessive hair growth on face and body) brought on by excess androgen is a major concern for girls with PCOS. While modulating hormones through oral contraceptives, spironolactone, and metformin can reduce hair growth, they do not remove hair already on the face, chest, abdomen and back. CHOP Dermatology plans to provide laser hair removal during clinic visits to help the girls feel better about their appearance. This will give patients an alternative to having hair removed in a nonmedical, cosmetic setting where the operators may have less training and expertise.
“Girls with PCOS can suffer from low self-esteem as well as anxiety and depression due to the frustrating physical symptoms, excess weight, and long-term concerns for fertility and health,” Shah says. “It’s been shown that women and teens with PCOS have increased psychosocial issues. In our clinic, we screen patients for depression and anxiety and help them access Behavioral Health when needed.”
Research on adolescents with PCOS is limited, and Shah is initiating a pilot study to characterize the extent of hormonal changes, inflammatory upregulation, and metabolic dysregulation seen in the early stages of the disease. “This will give us important data to drive future research and to develop treatments that abrogate the risk factors, rather than just addressing the obvious symptoms,” Shah says.