VAIL, COLO. — Weight loss can go a long way toward improving the effects of hyperandrogenism in the adolescent with polycystic ovary syndrome, Dr. Patricia S. Simmons said at a meeting sponsored by the American Academy of Pediatrics.
“In the obese patient, this can be all she needs,” said Dr. Simmons, a past president of the North American Society for Pediatric and Adolescent Gynecology. “If their weight normalizes, usually their insulin levels and secondary hyperandrogenism will too.”
Polycystic ovary syndrome (PCOS) can be associated with a different pathophysiology in different individuals, said Dr. Simmons, a professor of pediatrics at the Mayo Clinic, Rochester, Minn. About 2%–3% of the general female population has PCOS, and it is present in about 53% of adolescents with chronic anovulation and amenorrhea.
One of the condition's hallmarks, hyperinsulinemia, is present in about 20% of adolescents with PCOS. Those individuals are more often obese, but that is not always the case. And in those individuals, the hyperinsulinemia helps drive the hyperandrogenism, which is why weight loss and improving insulin sensitivity can help, Dr. Simmons said.
Though in overweight individuals, weight loss alone may be treatment enough, others may also require drug therapy. The first-line drug for adolescents is an estrogen/progestin oral contraceptive, she said. The progestin inhibits luteinizing hormone, which leads to decreased androgen production by the ovaries, and the inhibition of adrenal androgen production. The estrogen elevates serum hormone-binding globulin, which further inhibits the effects of androgen.
Over the long term, this therapy protects the endometrium from the dysplasia and cancer associated with PCOS.
The oral contraceptive that many experts recommend is the one with ethinyl estradiol and drospirenone, because that progestin is actually an anti-androgen structurally similar to spironolactone, which itself is used as a treatment for PCOS in conjunction with an oral contraceptive, Dr. Simmons said. Though common, this is not supported by data.
Oral contraceptive therapy also improves acne, makes menstruation more regular, and stops the progression of hirsutism.
“It's an easy thing to prescribe with great confidence,” Dr. Simmons added.
The diagnosis of PCOS in the adolescent can be difficult, especially since one would like to identify it early and begin addressing some of the long-term health impacts.
Oral contraceptives, however, do not influence insulin levels, hence the necessity for weight loss in overweight PCOS patients.
The use of oral glycemic agents in children and adolescents has not been rigorously studied and is recommended for use only in selective cases, she said, adding “We don't use them unless we have clearly defined need.”
Dr. Simmons has no conflicts of interest to report.