Polycystic Ovarian Syndrome in Adolescent

Polycystic Ovarian Syndrome in Adolescents: Management of PCOS in Adolescents

The recent increase in the incidence of Polycystic Ovarian Syndrome (PCOS) in adolescents is becoming a major concern in America. PCOS is recognized as the most common endocrine disorder in adolescent women and it has both metabolic and reproductive consequences. It may manifest itself as early as the first decade in the individual's life. First described by Stein and Leventhal in 1935, PCOS occurs when small cysts surround the ovary due to hormonal imbalances. It is characterized by excessive androgenizations, which are high levels of male hormones, irregular menstrual cycles, and obesity. The disorder affects almost 5 to 10% of adolescent populations and is becoming a great concern because it is the most frequent cause of fertility in women. Due to the high prevalence of PCOS in adolescents, there has been increased research aimed at identifying the main cause of the disease. Nidhi and his team of researchers (2013) set out to find out how one specific hormone, the anti-mullerian hormone, contributes to the etiology of PCOS, and its recent emergence as a screening and diagnostic tool. This text takes a look at AMH in detail and investigates how holistic yoga programs can be used to control this hormone and other endocrine parameters.

The problem

Although PCOS is most common among adolescents, there is still a great debate about its pathogenesis and definition. The symptoms often vary with height, weight, race, age and medication and they pose great challenge when it comes to diagnosis. Furthermore, the normal characteristics of common puberty often overlap with the signs and symptoms - and diagnosis becomes rather complicated. In addition to menstrual irregularities and androgen excesses, other common features include excessive growth of hair on the arms and face, acne, alopecia, and skin problems.

According to Nidhi and his colleagues (2013), recent studies have pointed towards the excessive production of one particular hormone: the anti-mullerian hormone (AMH), which has been identified as one of the major causes of PCOS. AMH facilitates the accumulation of small follicles in the ovary and it may cause failed ovulation. Therefore, it is important to identify lifestyle changes such as methods of exercise, which will help in the reduction of AMH levels in adolescents.

Significance of the problem

Since the symptoms of PCOS can be distressing for adolescent and their families, it is imperative to find a solution that reduces the level of discomfort. Nidhi and his colleagues (2013) state that a stressful lifestyle can contribute largely to this distress, particularly because the chronic stimulation of sympathetic activity can cause a malfunction in the hypothalamus-pituitary-ovarian axis (HPO) in adolescents with PCOS. This highlights the need for strategies to reduce the level of stress, which will correct the HPO axis and reduce the sympathetic activities. Since yoga has been widely accepted as a holistic medicine of both the body and the mind, it may offer relief to adolescents with PCOS and help them reduce the level of discomfort and stress in their lives.

Participants

The participants in the study were adolescent girls aged between 15 and 18 years. The participants had to possess two thirds of the features of the Rotterdam criteria for PCOS which included: a lack of menstruation for more than 45 days, polycystic ovaries, and clinical hyperandrogenism. Those who had used oral contraceptives in the past 6 weeks, had previous experienced with yoga, smoked, had thyroid abnormalities, and were unwilling to participate were excluded from the study.

Methodology

After obtaining signed consent forms from parents, the adolescents first had to attend a lecture. Girls with hirsutism and oligomenorrhea were subjected to blood tests and ultrasound scans. Using a computer generated table of random numbers, the participants that possessed two thirds of the features of the Rotterdam criteria were grouped into two. After details of diet patterns, body measurements, endocrine parameters, stress history and patterns of diet were recorded, two halls were availed for control group and yoga practice (Nidhi et al., 2013). Both groups practiced one hour daily for a total of 90 sessions. Routines alternated between breathing exercises, physical practices, lectures and relaxation, and the instructors, who were present during all the sessions, recorded the attendance.

Analysis

Data was analyzed using SPSS version 17.0. Normal distribution was confirmed using the Kolmogorov-Smirnov test and the data that was not normally distributed was compared using the Mann- Whitney U test. In the instances where the scores were different, before and after values for each variable were subtracted accordingly.

Findings

According to Nidhi and his colleagues (2013), the findings revealed that yoga is better than normal physical exercise in reducing the distress caused by PCOS in adolescents. 12 weeks of normal exercise were not as effective as 12 weeks of yoga exercise. Yoga was much better in decreasing AMH and testosterone, and it was more effective in increasing the frequency of the menstrual cycle.

Management and risk reduction

DiVasta (2013) gives certain recommendations that may contribute towards the reduction of the risks associated with PCOS and ways of managing the disorder. She posits that initial management will be more effective if it emphasizes on androgen excesses and irregular menstrual cycles. In agreement with Nidhi and his colleagues' statement that a stressful lifestyle can increase the risks, she also states that lifestyle modification is the best strategy to manage the disorder. Another effective method is the use of oral contraceptives (DiVasta, 2013). They should be considered by sexually active adolescents as they correct androgen excess by reducing androgen production, lowering the levels of testosterone, and limiting iso-enzymes of 5-alpha reductase. For adolescents who may be obese, DiVasta (2013) states that reducing the risks of PCOS will require weight reduction because it will improve insulin resistance. If lifestyle medications do not manage the risks effectively, the next best option is the use of medication such as lipid lowering and anti-hypertensive medication.